0002-298 (SFD)LICENSED CONTRACTOR DECLARATION
I;^ereby 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
714188 B 1413 Ella(
/Date' ° Signature of Contractor/
1
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, ,im 6niusimy coniracting 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:
CarrierPolicy No. r 4
:43,,f3uhi RAG,
LL S, /1'v4C 5.4ub U1
(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 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 pryo jsions of Secti • n 3700 of the Labor
Code, sh II forthwit com I with �th9 > ro"visio•. IV
✓DateA5 / 040Applic nt Yi'
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 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. ` e
F "L1 Dat / /mss
Signature (Owner/Agelat).��_,
BUILDING PERMIT PERM10002-1198
DATE VALUATION '.5� ��� %:5 �,��� LOT TRACT 2399 -IS -13
JOB E
ADDRESS
ADDRESS r
OWNER
CONTRACTOR/DESIGNER/ENGINEER
/`Itlf•.i i9 i{) V ,�1>f171r'!11' r I"+I�'r.+E71#Y Tt+17I 0A,
.I.tIl V1�/. Yw�IY'J.I.lall R..R 10.l lwt.-/L it lIl..l./
�1;�aT' `1 11��+ CC>OY` XII f''flA�fNp�tAT!'i`r'/1�C
I. 4-lJ .d. 4.+1♦ V rR.. R -/L6 .A
1335 SO. "i3" SlstEU, �U) . C1,03
1.535 3t). "Irl" 91t3.1:.,E•T, SIE. #200
SAN'I*iRNA1ZE.D.fiNU CA. 924011
Snntnt.Ai1.BE9RNaAkDINO CA 92408
�1
�'YVZi 1�30A`ILVQ% 4. �Ir9f .4i�+!
USE OF PERMIT
i1LAN SGAR-KtUff U0r_i 1411.!. i1J'CLIME BBC kt X WALLS Oil
f'tl;Jl..
A RACI S OMST RUMIGN 2`10`/.00 SF
L1At"tA0FXAJU)01i a 4,16.60 SF
i:M8f, I YiA O fait! 8T OF 1.IO X./lf (10.1.ON,
.l A 6.,7.J.60
.i Yr;PwMU 'r, FE SUMMARV
C.UNWYRU(''IION IrkE 101 -NO -418-000 �!i99.ir3
117, AN r°l-W-PK FUP 101 -OM -414-119 $ +7G W;
t
U11LCzTA-ra CAL 1121 101-000.21.000 s4 t
LL TR1LA1..FEC
TILUINAB1NG FLE 101-0W-4) 9-000
A'MON(I lkl(7iICjNl 'M -17 -}RF?STfZ IAll -W(1-761.000 �11 6R
CRAIM14C FUE )01-00-10,-923 004OF,VE
LOPE It .NtE%Ai:•'1' 1; LIT,. S 1,90I.tA.f
;
AWI' If` PWILEC PLACE'S - I2.f S)1.`. 741 -(M -255-M $41.88
+ • :
,%f PI fC)TAi. t'f1N"a'iI.I ICT!( -)K AMID PIT A'N (11I"T` K
�+?,`ifi5 06
i.J.ESS PRE .11 A JL')FEiS
31
TOTAL, t ERINUT FU;8 DUR NOW
�.i,'S€►�.#lfi
RECEIPT
DATE
BYE
DATE FINALED
INSPECTOR
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-e-df(1
Exhaust Fans
O.K to Wrap
6-15-eo Ltz,F.A.U.
Framing
Insulation
y^^-=40
S- L4 -to
Compressor
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 APPROVALS
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
3 -23 -®®
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
kAkoo
Pool Cover
Sewer Connection
_
Encapsulation '
Gas Piping
Gas Test
Appliances
Final
Final 0 lao
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
1
Final
Utility Notice (Perm) Z
COMMENTS:
09/26/2000 TUE 14:16 FAX •
p
i�j 0 4
INSULATION CERTIFICATE
1C=1
' 78-705'WAKEFIELD CIRCLE ,
Number and Street
Lf, OUIN.TA
_..RIVERSIDE
`City
23995: . 20
• Cour
Description of lnsti llation
,
Tract No: Lot Number
1 ROOF .
Material
Thickness fnahes)
Brand Name
_
Terrnal ResistanceR-
( Vah'e .
2 CEILING
Batt or Blankat T a
'Thickness (inches) 12"
Brand Name - I
OWENS CORNING
Loose Fill T e
' Thermal Resistance R Va.ue R�BU
Contractor's min installed weight Square ft,-
Brand
Ib
Minimum thickness
Marlufactursr's installed weight per square foot to achieve Theimal Resistance (R•Value) - , inches
3 EXTERIOR WALL
A. Cpvity Insulation
`
Material
r Thickness (inches) —T1 /2
Brand Name OV%iENS CORNING
-:
s.. Exterior Foam Sheathing -
.Thermal Resistance f R -Value R13U
.
'Material , .
Thickness (inches)
Brand Name.
Thermal Resistance (R-VaILB)
4 RAISED FLOOR
Material
Thickness inches
Brand Name -
Thermal Resj---------------stanoe R-VeIL°
5 SLAB FLOOR/PERIMETER
Material
Thickness inches "
Brand Name _
�'' Thermal Resistance R -Valu:
6 FOUNDATION WALL
Material
Brand Name {
Thickness (inches)
Thermal Resistance (R -Value)
Declaration.
I hereby certify that the above insulation was Installed in the building and the above'location in
'Energy Efficiency Standen;rs for residential buildings (Title 24,
conform anc3 with the current
part 6, Califronle Code of Regulations) as iidlcated the
Certificate of Compliance, where applicable,
' on
l
PARAGON Ii4SUl-ATION CO
9/26/00
12280 EAST END Avg,
Item its Signator Date
:. Installing 18fiSbontractor (Co. Name) OR 3
General Contract (Co. Name) OR Owner" .
Iterp 115 Signature, Date "
Installing Subcont actor (Co. Name) OR
General Contract 'cu. Name} OR Owner.
Item #s.. 'Signature, Data
• -
..� ..; - .
Installing Subcontractor (Co. Name)) OR
'
"Name)
General Contract ICO, Owner
.OR
�� '
July 1 1999