0012-261 (SFD)It&. LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
1�t Signature of Contractor '6yfy �
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct ' the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of. the Labor Code,.for the
performance of the work for which this permit is issued. '
() I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
,. M,i.Tmi OLF'.1wo,
(This section need not be completed if the permit valuation is for $100.00 or less):
(.) I certify that in the performance of the work for which this permit is issued',
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall, forthwith comply with those provisions. ,+
Date: e7 Applicant -
/Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up -to $100,000, in
addition to `the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application.is hereby made to the Director of Building and Safety
for a permit subject, to the conditions -and restrictions set forth ,on. his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or.pursuant to
any permit issued as a result of this-applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 ,days from date of issuance of such
permit, or cessation of work for 180"days will subject permit to cancellation.
I certify that I have read -this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the.;above-mentioned property for inspection purposes.'
NSignature (Owner/Agent) .r �' T l.•� r':r .:<` Date./e
BUILDING PERMIT PERMIT"
DATE ` VALUATION LOT .2-61 TRACT
JOB SITE
APN
ADDRESS
454*5 LAS COMMAS.
W4 -W41-0-19
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CFI:NTT,1,l Y efZ(YVM.L C:OM&1ZJ};lM&S
CENTURY RY CROWVLL
MUUMUU
1533 30. "f)"pl",l, ;.'L 42 W
1535 80, -D"'W,.M.i', S. 1102,,00
SAN CA 99A•G8
&MB:i:+R%ifAk?l?WO
CtA.
92 408
(90vy, 4fiI1-4`:t w
,(MLO
2120
USE OF PERMIT ,
SM't71E PAMMY I:MULNG3•
Bi.WltiWALLMCS[ DRIVIMAY.BuN'ROACK1,6% PLAN (ifWK F99
RKOUCT1014 FOP. ISSU ANCt OF SAW PLAW °[` PE.
TRACT G.OiMi'Y'AUC IM fl
P[?RC i1PATIO FA.00 SI''
GARAGFICAP;aOlZ'I' (0) .soi`Y3.xU
EMMRCOST OF C0149MVIC3110 A
A130,44W.10
PA,IYAWT V", W"M6:ky
G 0I433'ltt!C`1ION FI�.P. 101-000141S-t,I00 �t�43.l10
,ELAN CHECK YWI 141-000439-318
- �
7.f
MECKANICAL M 1014110"21 _000
i
ELM=WAI, f+ER 101-000-420000 �af3u.�i
CJ
FM�
T'I.i1gIiIT�T 3 i T� : 101.000m419u040 %17835
S'fl'tl;??i o MOTION FEU 4 RMID 101-000-2,41-000 o%
:'M'
(�
GRAPTNG;#.FFR 101.0Litl'-423A000
DZrllifE PLI R'.IA PACI1' PRS?
SUB 710TAL Cf33�1ti`�ii t�t.Tt..°'fO AND ALAN Cf-MCk,'.
$2,996.46
LE3B PRE -PAID F=
$0.00
RECEIPT
I
DATE+Y
I.UA
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MEC_ HANICAL APPROVALS_
Set Backs
Forms & Footings
_ _
i7
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�j
Exhaust Fans
F.A.U.
_
Z7
_ _
O.K. to Wrap - Z —O(
Framing G
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall -Int. Lath
Ye
��
Final
-.
Final —
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Waste Lines � �'
Gas Test
Electric Final
Heater Final
Plumbing Final
_
Water Piping `
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:.
/'
Ix111�
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final ,
Utility Notice (Perm)
INSULATION CERTIFICATE
45-965 LAS COLINAS
Number —and
Riverside
29563
LA QUINTA
City
IC -1
County Tract No Lot Number
Description of Installation
1 ROOF
Material
Thickness (inches)
2 CEILING
Brand Name
Termal Resistance (R -Value)
Batt or Blanket Type BATT Brand Name CERTAINTEED
Thickness (inches) 12 Thermal Resistance (R -Value) R38
Loose Fill Type BLOWN IN Brand CERTAINTEED
Contractor's min installed weight square ft 0.615 14 3/4 inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) R38
3 EXTERIOR WALL
Frame Type
A. Cavity Insulation
Material BATT
Thickness (inches) 31/2
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 FLOOR OVER GARAGE AREA
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL
Material
Thickness (inches)
Brand Name CERTAINTEED
Thermal Resistance (R -Value) R13
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Complianc where applicable.
2, 3A 14OZ 8/6/01 PARAGON INSULATION
Item #s S-11anature, qate Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date
Item #s Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
1)