9801-142 (AR)LICENSED CONTRACTOR DECLARATION
I here;y affirm under penalty of perjury that I am licensed under provisions c
Chapter 9 (commencing with Section 7000) of Division 3 of the Business an
Professionals Code, and my License is in full force and effect.
License # Lic. Class, / Exp. Date
D t 1 �+ r�Signature of Contra" ctor
OWN ER -BU ILDEFt DECLARATION
I
I hereby affirm under penalty of perjury that I am exempt from the Contractor'
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sol
compensation, will do the work, and the structure is not intended or offered fc
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting _with license
contractors to construct the,,project (Sec. 7044, Business & Professional
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 declaration;
( ) I have and will maintain a certificate of consent to self -insure for worker:
compensation, as provided for by Section 3700 of the Labor Code, for th
performance of the work for which this permit is issued.
(\)- I have and will maintain workers' compensation insurance, as required b
Section 3700 of the Labor Code, for the performance of the work for which thi
permit is issued. My workers' compensation insurance carrier & policy no. are
rampr POIICv No.
S'I'AM; 11JIND
1421-'t7
(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 issuec
I shall not employ any person in any manner so as to become subject to th
workers' compensation laws of California,'and agree that if I should becom
subject to the workers' compensattih provisions of Section•,3700 of the Labc
Code, I shall forthwithcomply with those provisions. - �"
,f Date: , < .. , Applicant/ r / . - *-✓
Warning: Failure to secure Wo Rers' Compensation coverage is unlawful an,
shall subject an employer to criminal penalties and civil fines up to $100,000, ii
addition to the cost of compensation damages as provided for in Section 370,
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safet
for a permit subject to the conditions and restrictions set forth on hi
application.
1. Each person upon whose behalf this application is made & each person e
whose request and for whose benefit work is performed under or pursuant t,
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& hold harmless the City of La Quinta, its officers, agents and employee:
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date ofissuance of sud
permit, or cessation of work for 180 days will subject permit to cancellatior
I certify that I have read this application and state that theaboveinformation i
correct. I agree to comply with all City;'and State' laws -relating to the buildin
construction, and hereby authorize represent fives of t�h.l,�...C.,j>;y to enter upoi
the above-mentioned propy for inspection.,urposes
I l �
,,Signature (Owner/Agen ) - •-''""�"•� D t , �_
.f
BUILDING PERMIT PERMIT#
49111_ r4t
CONTROL#
d
DATE 1129)41.1 VALUATION LOT TRACT 6774
JOB SITE ADDRESS ith .1L1 . lLh Ia.Qit#{ 1l`tt .�
APN
1;49-67 1 -ft I'S
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IIC0 Cf`Ink! SIt, I U(7rIo5!
46-2135 JEFFERSON
2330 N. SAN AWMNIQ
Ria.
s
LAQUINI'A CA 92253
PALN1.1SR1N(IS
C'A 02262
r
USE OF PERMIT�%t
s
AF) )K
. 73 .r: + t7IVVtiK;16pP! ��t+ C1AItNGt; St't1Cti •t'« UViNG MEA PAID
t�rill� 1100001� 3iS.fl+i ig �%� E T�
S
iy 0
s
�
'0 'CRUCTION
PERMIT FEV—SUMMARY
PLAN+Cflf.:F`K it 101.000-43)-3i8 5
77�NS"TR.Itf 7T10NrTst? ltli.(1(x1-.i1H-(NN3 �5;stn
ritiii"llr\IYtC�1L i 1:7i 101 -OW -421-000 3:'1.511
r
UE.0 1tlCAU Fiat- I01-000.420.ON
N'ntONG 1v1{31'ION RIX. RES10 101-000-74t-000 51.30
1
i
i
V
t
y
NCJft-»'i'(.�.r.'r1 L CC.fNS' R 1.IG"I ON AND PLAN C I I J -.(X
fLESS
rrLL M
["RE -PAID
TO 'Al, P1,.itfi1IT F 1rES 014 NOW
ECEIPT
DATE
BY/
I DATE FINALED
JINSPECTOR
r INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ Exhaust Fans
O.K to Wrap., ..
F.A.U.
Framing ,2-�Z
Compressor
Insulation 2 _ ,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL A PROVALS
POOLS - SPAS
steel
Set Backs
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
Heater Final
Water Piping
Plumbing Final `
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K, for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
-
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 1/29/98
No. 16582 Jurisdiction
Owner Name Bill Hall
N0.46235 Street Jefferson St
City La Quinta zip 92253
Tract #
Lot #
Type of Development Residential Addition
Comments
conversion
APN # 649-071-015
La Quinta
Permit #
Log #
Study Area
Square Footage 375
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 375 or $ 0.00
the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By n/a
_T0ephone 32378791
Name on the check
By Dr. Doris Wilson
0.
Superintendent
.5k
Fee collected /exempted by Pauline Pearson
`., <
Exempt
Check No. n/a
Signature
Ph A, K 12 '-',o AU 'A A10-
-r-
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the dale on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
bllect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Residence Address- 46-235 Jefferson La Quinta, Ca
CERTIFICATION This is to certify that attic insulation has been installed in conformance with
the coverage chart recommendations on the opposite side of this card using 1 ; bags to
cover 420 sct ft to obtain an Rvalue of 38
Contractor's authorbed signature
Date -
Ins all br
74-741L JoN1 DRIVE
PALM DESERT, CA 92260
(6M) 346-2339
-r !JatJLA RON SPECIALIST)
Builder
.. -R-PRO PLUS
•
(Formerly Cordex)
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elkwood, Virginia • Ft. Wayne, Indiana
Norfolk, Nebraska • Phoenix, Arizona • Pbrtland; Oregon
ATOMIZED PNEUMATIC APPUCATION COVERAGE CHART
3.5
39.6F25.3
Net Coverage
Gross Coverage
R -Value at
5.5
No Adjustment for Trusses
Based on 2 x 6'
751F Mean
Minimum
Thickns
es
Trusses on 16'
Maximum
Minimum
Temperature
Net
Weight Per
Centers
Coverage
Square Foot
Tq Qbtain
Installed
Square
Minimum
The Weight Per
Suare
Bags
an Insulation
Insulation
Feet
Bags
Sq. Ft. of
Feet
Required
Resistance
Should Not
Per
Required
Installed
Per
Per 1,000
(R) of
Be Less Than
Bag
Per t,000
Insulation Should
Bag
Square Feet
(inches)
Square Feet
Not Be Less
Than: (lbs)
R-50
13.5
20.5
48.8
1.464
21.3
46.9
R-42
11.4
24.4
41.0
1.230
25.6
39.1
R-40
10.8
25.6
39.0
1.172
26.9
37.2
R-38
10.3
27.0
37.1
1.113
28.4
35.2
R-32
8.6
32.0
34.1
.937
34.1
29.4
R-30
8.1
34.2
29.3
.878
36.5
27.4
R-24
6.5
42.7
23.4
.703
46.4
21.6
R-22
5.9
46.6
21.5
.644
51.0
19.5
R-19
5.1
53.9
18.5
.556
59.6
16.8
R-13
3.5
78.8
12.7
.381
87.0
11.5
R-11
3.0
93.2
10.7
.322
102.8
9.7.
Sidewalls (pressure Filled -density 2.6 PPCF)
R-13 (2 x4)
3.5
39.6F25.3
.758
R-20 (2 x 6)
5.5
25.2
39.7
1.192
Note: This coverage chart compensates for settling and is for estimating purposes only.
Stated R -Value is provided by installing the required number of bags per 1000 sq. ft. at a
minimum installed thickness. Installation of the required number of bags may yield more
than the specified minimum thickness and minimum weight per sq. ft. Actual coverage will
be influenced by job conditions and application techniques, and may vary as much as 10%
without significantly affecting the stated R -Value. Failure of the installer to provide at least
the required number of bags per 1000 sq. ft. and at least the minimum thickness may result
;n a I^ -at, nefollu/i Q.\/el„p oHor eeNlinn f mm�orfinn mw Mr`s iI �rinn inctollafir`nc ohno R-