0002-296 (SFD)LICENSED CONTRACTOR DECLARATION
1'4,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
'r1all u B 10,31./211(
Signature of Contractor <� I
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).
( ) 1, as owner of time 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
Sec ion 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:
Cartier Policy No.
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those- sions.
Date: ?_-__)__vwpplicant'�—
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.
`Signature (Owner/Agent) cF� y % — Data-
— UU
BUILDING PERMIT PERMITM
0112-14Dh
DATE VALUATION "% 7,372.V11 LOT TRACTJOB
ADDRESS %4•' J�� f�r b?� �1� � L� y.I�s APN OW 040-016
OWNER I CONTRACTOR/DESIGNER/ENGINEER
('FT .1'11J1�. Y CR 0W111,f.r l lti tFinai111:8 i`'llii i.. iii, i CIRIC lVE f is COit'1 11! fNfrl I
1.5aS St.). "la"'T'EI, .Fr, FFE. 42W 1535 SU "J)" S'.UREL'1', grE. 6206
SAN 13ERNAlt.DINO 0A 92,W8 KXN HE.1 NAk1AN0 CA 92408
ff1[t� Rl�e11ti7 Cft[ .# 2120
USE OF
!A;D-i,+. I i8 PLAN 2ii . - LJZA11 t DOCtS 140T WC%L1 N! &0( WAi!S Ok
Pt KAL..
'1kA. i CONI IMUCTION 1,460.00 sr,
tiblli,r 6J0C"'Ai2V,uitT 413.W 61
t'tl➢da'tiL[1;"f ICON Y E. 101 -000 -418 -OW, S585
Nf . AN ( II -Mm H f77 f. 1-0130_,.114-i t R 'S4r14)
XtM1AMICAIL moi" 101-000 421-00 _ I?
Uj i>M)CAL f6h 1.01-000-420-wo Sto
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1111 -000 -419 -WO Y1'218
C"!'iZ��1�i�itVtfYfTt�Nt�irF'o�t2F�i'O ffli-d)f1i)-��!�3} �1
G 112 flgG I -EL 1101-000-4234M wit
01,W :LOPEA. INIPxl01' FEE
.�9
PI,_AW i'hiFt' e gZ, til},139
LESS. P111- -AID FEES 00
I'U`1'it 1, PERMIT 1+'E€+wS;91lE NOW I $3.Z4)4.39
RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
d ZQkv
Ducts
Slab Grade
Return Air
Steel _
Combustion Air
Roof Deck
—I —
Exhaust Fans
O.K. to Wrap
_rS-lip
F.A.U.
Framing
RdCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
V cflP
Final
Final .�
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3 -Z3
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
pp
Pool Cover
Sewer Connection
l2$
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:
q--
09/26/2000 TUE 14:,15- FAX
. 0002
INSULATION CERTIFICATE
IC -1
78-725 WAKEFIELD CIRCLE, LFA QUINTA
Number and Street
city
RIVERSIDE 23995
Count 16
Tract No: Lot Number
Description of Installation
1 ROOF
Material
Thickness (inches)
Brand Name
Termal Resistance (R-Velue)
2 CEILING
_
Batt or Blanket Type
hs 12"
Thickn�n"
Brand Name OMENS CORNING
Loose
Thermal Resistance (R-Valve)R-38U
Contracors installed weight=qU2rat
Ib" Brand
Manufacturer's installed weight per, square foot toto
•Minlrn4m thickness inches
achieve TThermel Resistance (R -Value)
3 EXTERIOR WALL
Frame T a
A. Cavity Irisulafion
-
Materiah r
Thickness inches 3 1/2
Brand Name
m OWENS CORNING
8- Exterior Foam Sheathing
Thermal Resistance (R -Valu, R13U
Material
Thickness inches.
Brand Name
Thermal Resistance R -Value
4 RAISED FLOOR
Material
Thickness inches
Brand Name
Thermal Resistance R-VaIUE
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
Brand Name
-
Thermal Resistance (R.Valuep
6 FOUNQATION WALL
^^
Material
Thickness (inches)
Brand Name
Thermal. Resistance (R -Value
Declaration -
—
(hereby certify that the above Insulation was installed in the building and the above location in confornianca with the current
Energy Efficiency Stenderds for residential buildings (Title 24,
Certificate of Compliance, where applicable.
part 6, Callfronia Code of Regulations) as inlieated on the ' •''
PARAGON INSULATION CO.
9/26100 12280 EAST END AVE,
Item #s Signature; e
Installing r3 ro. ams) OR
General contract (Co. Name) OR Owner."
Item ids Signature, Dats
Installing Subcontrector (Co. Name) OR
General Contract (Co. Name) OR Owner '
Item #s 5ignature, Date
3
= ,
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
July 1, 1999
a