0012-256 (SFD)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
Signature of Contractor .-°� j P4,>''�J
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.
(S,).) 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.
(101�3$l+l BACILe15, . l�'�d'C'..-�4RGa-D2
(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 s. 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: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,'darhages as provided for in Section 3.706
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 aresult 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
/Signature
above-mentioned property for inspect ion purposes.
/Signature (Owner/Agent) lr�'''`` �` Date` +�
BUILDING PERMIT PERMITk
DATE VALUATION LOT 1612-2'A TRACT
$111.'3 f AW 15 29563
JOB SITE APN
ADDRESS
45-%50 LAS C('1.10A.S CAM -Wil -019
OWNER I CONTRACTOR / DESIGNER / ENGINEER
3535 301 ` o OT7MM r`1.`rE ##200
SAN 1~3 RNARDIHO C:A. 92408 SW fcER.t�'.�`t;1 DWO CA 92408
(909)381.60m Cwk .2121
I USE OF PERMIT
'f -L? R'A.iA LY.,DV�'��`k U40
3"FiD. PLAfil::fit, R LOVS .PERMIT i3C"SS NOT I1Nt,1 130E
t4L+ CK,WA,t� POOUDRlii'It;WAYAPP!a .)ACd 7t1o.PLMI CtTF:PK Rin
ItEDUCT1036 FOR lSSUANC::K OF S.AMIZ PLAN TVVE
TR&CK' OOMTRUCTION, ?,003m -90
PORCHIPATIO 4&W 3F
CiT3AC1�slG`ARPf$`1" (ak 8,173.20
106'r OF MMSTRUCTION
,
PERMIT FIRE WAI IlkCONSTRUCTION
PEV,
I IN -MOA, J 0-0-90
PLAN CHECK FEE,'
101-000439-316
MEC HANICALi/U.
1.01n000421.000
M,EC i`WIV AL 'FEE
101-IOt 420-000
11 i 2.1
[' 7
PLUMBING FU
101.000*4I9.000
V-1635
/i
J'1'f8l3Na MOrOg M RFSID
101-000-241-000
�.
GRADYNCI FIT
MOO
DEVELOPER. IMPACT Ful.
�1,3�tf70v
a
SUB -Wr fyL CON '1=1:1COl+e"AW1a P) A19 (`7EMI9Cp,..�J�
RECEIPT DATE! j BY 4 DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'L—C
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
O.K. to Wrap
Framing
�'�
3-��� ��-
y (�—�
y 2
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation
c��Zp_�1L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final.
-L % ��
Final
POOLS -SPAS
BLOCKWA
L APPROVALS
Steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
' L� (�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Zjp
Pool Cover
Sewer Connection
2 �yQ
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
`
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
45-950 LAS COLINAS
Riverside
29563
LA QUINTA
City
15
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 TVDe
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 8/6/01 PARAGON INSULATION
Item #s gnature, to Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
41