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0012-252 (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 / i1 \Date f ,4 1%) Signature of Contractors< OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1„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. (This•section need not be completed if the permit valuation is for $100.00 or less), O 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 thomprovlsioits. y Date: Applicant ' 's'',% /, f/fC.✓� '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 applicator 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'cancel lation. 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. Signature (Owner/Agent) / /ivs+l%G "f r%-� Date BUILDING PERMIT PERMIT# TRACT DATE VALUATION LOT TRACT S 1,94 ti'. `moi►' 29563 JOB SITE APN ADDRESS �1'e ��eL^ s�p� �t•� q rt c� c�A t v��P ���� R:i-M aR X.CAIMM .E ,AS d• .F1+l�L�;�.eX:e'J '(7oV'4•^us.��.•{��.� OWNER CONTRACTOR / DESIGNER / ENGINEER MXTf'i; RY CR(ANEU., C:OMSII:tiIRIUM CEMURY OW=. C:OMMMIUM9 1'Scis }3 . VD4 arpa r. um Citi I X 3 5 so, "DO MGM, Mill, Hz04 ► A3 f3fiNAYb'Ci 92AOS SAN PE£2?s3M1a+M C~4! 9240£ (90)381-60w C~F. "A- 2120 USE OF PERMIT afiPt%liP(WTw"M�VlT DOETIl01INCLtDE Zp.)(r..IIypJiP4O}f PJV�"WAy.I"Pye.WqCE,fS%PLAN ryi*} R8 R.�C3UC:'i'143N �r91�, lssi]'Ar1t:�: QJI� �r�xAf11? l'i.b9i� '1�E TRACT C01'ial,ie.Ur-71014 3,G°f1SatJil aw PORCHIPA.170 � 413.00 SP C'lAAA.0 FJCAJ1J':'fiKT (3F) %ma �+4.�J�7m SAA SY'6 n�.{+'+s.i<C.4,P�\' �j'�1 perry;y try +�y�'( j�yA�Ipp.`dmwIIi�Etd:M� CCiI`1S'X`1CQ,t4':3'J0}tlPEE 101-000-41S^OW dila ISO PLAN CI.1M'K xYEbp t of -00" 39.31. & $146.03+_ MOC'1��44d CAL iq1»f3�a)©��€ 1•(Ib?() 53,5 £';� sCTI f c4 � � 1 i';1 ZCTRICAL ITT O wO 0 2CD�C1uCl $112.12 1''I,i1M33PNG FEE 01;,000-419-012* 11406 { 1 S'R'it.OND IVI rION PEE - IRMID 101-000-241-000 $11.5 1n (.J GIt.CsMM l?., i?, 101-' o- 42:1, CaCfti Salf,Op DZV M AV FP_ IMPACT 1€XR, $1,907.OIS _ r� ra � J , Cawip mcrcnm A m �yy:'gg�r�����gg;. 'y��� , s.3,099.66 /�yy����yy� ' ,6 =9 T.Ftt.�t^.I.�J�J.i/ .i.'lOXIS 0.00 $' IAL Y,"U M 17ERi 1)'E Now 1$10911.6 RECEIPT DATE BY„ DATE FINALED INSPECTOR flt.d. FA:�. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings– Ducts Slab Grade %q Return Air Steel ale Combustion Air Roof Deck 2.y Exhaust Fans O.K. to Wrap -12—j F.A.U. Framing�� Compressor Insulation L.� / `� ��oL Vents Fireplace P.L. Grills + Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 712 Final 2v/*/— BLOCKWALL A PROVALS Final - 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 OX for Finish Plaster Sewer Lateral Z ?p (� Pool Cover Sewer Connection Z�?� a Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final / Utility Notice (Gas)�G 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 IC -1 79-395 AVENIDA LAS PALMAS LA QUINTA. Number and Street Riverside 29563 City County Tract No Lot Number Description of Installation , 1 ROOF Material Brand Name Thickness (inches) 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 Tvoe 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) . Declaration I hereby certify that the above insulation was installed in the Energy Efficiency Standerds for residential buildings (Title 2 Certificate of Compliance where applicable. 2, 3A m 8/6/01 Item is So nature, to Item #s Signature, Date Item #s Signature, Date 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) building and the above location in conformance with the current 4, part 6, Califronia Code of Regulations) as indicated on the PARAGON INSULATION Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner