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0012-269 (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 F,�;fessionals Code, and my License is in full force and effect. License # Lic. Class ' Exp: Date Signature of Contractor f OWNER -BUILDER DECLARATION I hereby affirm, under penalty.of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) .l, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) 1, 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.' aI1 GOLD N ZAO;,F, MS. Z C -.M4 if 0 (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 those provisions. Date: 12�j"{. ' Applicant , Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an.employer to criminal penalties and civil fines up to $100,000, in addition'to the cost of compensation, damages as provided for inSection 3706 of the Labor Code, interest and attorney's fees. t' IMPORTANT Application, is hereby made to the Director of Building and Safety . for a permit subject to the- conditions and restrictions set forth" on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or -pursuant to any permit issued as a result of this applicaton agrees to, & shall,. indemnity .& hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days, from date of issuance of such permit, or cessation of work for 180 days will subject permit to'cancellation. I certify that I have'read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and, hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes: } ' 11` ` r LI (Owner/Agent) +1't ��� . Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 00 2-2\ 0 TRACT iiliA�Sr . O 30 T . 29563 JOB SITE ADDRESS APN 79^4WAV}?. A XA1.9 L'%IM%t OWNER -CONTRACTOR / DESIGNER / ENGINEER C'MU ZY c."RC3'�F�1�:& , C'01,04UNM1?S CT�s'.�'ia Y M`.sWEU, CuartIJUN 't"JES 1115351=1 Te VIM, T, FIE ;1#4 00 1535 so, OV. iM.14 T, art, #200 SANI3 :i3V A�i,'!�WO CA, 512408 OfiN DYMNARirz O CA 92408 (909YMM-6009 C''1, Ut, . :12.0 USE OFj PERMIT 9.VM'OW.7-MJ I.��841SACJZ lJ W,�rLeL1:1� - SirD., aa7..,AN:3M l,.( TM PUMIT DOEM'NOT HNi::l,,;,,tl B PLAN C119c.r.. Vn`) : - RMOUCTIONFOR WSU, ANCE OV %NMRZ MAN TY14 w TRACT CONSTRUCTION 1.,479.00 9P POWN19ATIO F.I6,00 Sk, .RAGIUCA,1�YG�RT (SY) PSI' :gip -.R.i�opr, 11169A . .'4a/YY$N 00 4✓0.k n1RtTCn0 N '46,10. �yyy9 1 J��r�.!�Ht .�.L•.AS..� 1D�7.F.YAfAlb&� $., r �;>��;��;~c�ci�a0�:�•� •��aa•��0���a���� ��r9.�� ;r~; =;w- i•''LAN CHECK M9 MJ.R'•CRICALFE2, 301-IDMI-420000 $3f1£1.6d f 1-6 PL11iV1kIM0 E' . ., ' 301.000419.OW Sd.n?;,'/5 SSROIJO ASDVOW 11MR. RMY) 1i:x-QQ41- 8 -ti0t1 $10. ► 1_t t--) (311.ANNORE 101w:©00-423.000 TAN t� DEMOPOR 11AAA ter. z 3, a�x.ua c SUB `1OTAt`: C ONS-3�:C9(;'PION ,AAD PLAN 00= $2,996.46 LOU PRE -PAID F $0. Fin RECEIPTDATE,�6 A BY ±' DATE FINALED INSPECTOR INSPECTION RECORD �. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 3 2$ �r� Exhaust Fans O.K. to Wrap _ 2�� F.A.U. Framing $ Compressor Insulation Fireplace P.L. ��-� ' I Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -Int. Lath _$ s// �/Ql Final �[ d Final POOLS -SPAS BLOCKWALL 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 2�9 ��— Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure -. Shower Pans OX for Finish Plaster Sewer Lateral _ 2��� . Pool Cover Sewer Connection y I �o-�c Encapsulation Gas Piping Gas Test Appliances - Final COMMENTS: i 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) j M INSULATION CERTIFICATE IC -1 79-455 AVENIDA LAS PALMAS LA QUINTA Number and Street Riverside 29563 City 30 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 /Z. 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