0012-255 (SFD)LICENSED CONTRACTOR DECLARATION
y,' 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
14188., 13 �_ } 1 on- 11V
Date '?���!� Signature of Contractor �x°% • °!�� 7�!��� f
V 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.
GOLDEN EAGLE ffil.
(This sectionneed 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 shalrliforthwith comply with those provisions..
Date: I'CJs C&t-•77Applicant^-'�+'"1.--}
/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 com pe nsation, '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 Jorth 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.
V.Signature (Owner/Agent) '/ ".t /� -? _ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
Ap ���t YP yy rry'(���.�A
^Ni -92.5'.1. `1OLI Ct. S
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C; TC1T,RY ('`RC9dFbEIL C(:91V.a1Af.1)?jT IM
C'�"! i'LlRY t'ROWEIL
(110bi UNT.Mes
15:5 = 'D MIM.1?T, ME 420D
1535 so, -V mrxa, n. 4200
SART BUMAR ["iS TO CA 92AOB
SACT `F3EFtN.A,k'�..�U NO
Cy t.
02408
(90 381-6007
CPJA
,7120
USE OF PERMIT
Sl't • 11_1Jl.13•.3AC1R :I,u<O %I i -PERJAIT UM NOT .INCLUDE
B.UOCKW:4-nt.J,Pf 'iJDRIVE:W,AY AP��P.,,OA.CH.75.%, PLAN C119CY FR
REDUCTION #OR ISSUANICK OF PAMY, PIAN TYPE
M.,WT CONSTRUCTION X902100 s
I:ORC`.HIPATIO 4&00 SK
04RA CARPORT (SP)
CONSTRUCTION FEE 01.000.418 0000 SM.'"
,
PLAN CHZCK FEE $146.(13
MWFUNNIC^,t`ALFEE" 101.000.421-000 853.0
C,
171I'I �
P8El11Yi13C�tcFT� 10 16000-419-000 $14539
'
1 fi. �►
S"'.RO7NO MOTION PIPE ,. R i+'*10 101-000-241-0-00 $1 ma
R3
r �
ORADWO FRE
SU B-1 A1, C..'0VrMa UCTj1, ��� AM '��.,. N HO=
" 1ESa $'119_PA,1D FFIM
$0.00
Te 1'1;, ' 1 is'96 DUF- OW
RECEIPT
DATEBY
/�'. �o
D/AT�6/�I ALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs _ Underground Ducts
Forms & Footings Sy Ducts
Slab Grade / 9 � Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K to Wrap F.A.U.
Fireplace P.L. / Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wali Firewall /�
Exterior lath
Drywall - Int. Lath / -il/1',4//
Final 1/per D�j—o/ 1 6gn
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top
Shower Pans
Sewer Lateral
Sewer Conne
Gas Piping
Gas Test
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
OX for Finish Plaste
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
INSULATION CERTIFICATE IC -1
45-925 LAS COLINAS LA QUINTA
Number and Street City
Riverside 29563 11
County Tract No Lot Number
Description of Installation
ROOF
Material
Thickness (inches)
Brand Name
Termal Resistance (R -Value)
2 CEILING
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 Compliance, where applicable.
2, 3A &- 8/6/01 PARAGON INSULATION
Item is Sibnature, 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
I,