0002-295 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions (,If, -
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
714138 B I Ula V20i
Dateg/1 /19L Signature of Contractor
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
Setibn 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 (CiDirh EAGLE, IN.". Policy No. i,v h CS1AiJ
01
(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,.l-mall forthwith comply with thosp1`p-!ovisions? Z
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
.V/< ~
PERMIT #
BUILDING PERMIT
1114,11OZ-295
DATE VALUATION $99,342," LOT 10 TRACT 23995-8
JOB SITE
ADDRESS r`s �l }tZ i aC3�
APN 604-0Qi• .16
OWNER
CONTRACTOR / DESIGNER / ENGINEER
(�
rl:1 . Lf.:.+I
4w,/,vi1Y'.ivt4A )rJLU
1535 SU. "D" MI'RELT, S.fE. X200
1 535 SO. -D" MEET, &M. #200
S.AN BERNA.Rt:31NO CA 92408
SAN BERNt'1RDINO CA 92408
(`)()9)381-6W CBL4 2120
USE OF PERMIT
8751: VIJ� t'•i).Crrl �/� j�VY �iIA�l!`f�.i
SHj-L0T t ; f3Ltily' kA -PF_R l4. T I%. B N%+�1' INC,Liis�t;:13l.�iCK V< A j, � OR
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9`1gdY14a7V
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CONSTRUCTION F'E.B 101-000-4113-000 $(04.�iI
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PLUAabiwi 111.-H 101AM-414-t1W 51.34.75
WfV014(1 k4C)TION TTE -1Y)-;1r11 14)1.f(N�'I0-141.14)00 %991
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igqIJUSS l:►'*'1,
S3,40, '47
{{r ( r_
ry
to
W
TM Al, I'Fki1`>t T VMS DUE NOW
$3,405.37
RECEIPT
DATE
BYYJ/'f(//.
DATE FINALED
INSPECTOR
/ /
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-'ZQ -14 A
Ducts
Slab Grade
-60
Return Air
Steel
-'Lg-Qp
Combustion Air
Roof Deck
S - t - mp Iq
Exhaust Fans
O.K to Wrap
5-15-w
F.A.U.
Framing
Insulation
._V" - at
. y
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-440 .
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel POOLS -SPAS
Set Backs
Electric Bond j
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
2
Pool Cover
Sewer Connection
��25 (O�p�
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) q�-
COMMENTS:
09/26/2000 TUE 14:15 FAX -
Q001
INS ULATION.'CERTIFICATE
IC -1
78-735 WAKEFIELD CIRCLE
Number and Street
LA gUINTq
RIVERSIDE
City "•
County
23995 i1�1"7
Description of Installation
Tract No:.y–
YCot Number
1 ROOF
Material
Thickness (inches)
Brand Namg
'Formal Resistance '(R Value)
2 CEILING
—
Batt or Blanket,(Type
Thickness (inches) 12"
Brand Name
m OWENS CORNING
Loose FHl Ty0e
Thermal Resistance (R -Vane) R -38U
Contractor'g min installed weight square ft Ib.
Brand
Minimum thicknese
ManufaoNrer's installed wel ht per inches.
9 P quare togt to achieve Thermal Resistance {R -Value} •
3 EXTERIOR WALL
Frame Type
A. Cavity Insulation'
Material
Thickness (inches 31/2
Brand Name OWI;NS CORNING
S. Exterior Foam Sheathing
Thermal Resistance (R-Valu))R13U
Material
Brand Name
Thickness inches} _
Thermal Resistance(R-Value), .
4 RAISED FLOOR .
Material
_ t
Brand Name
Thickness Inches)
Thermal Resistance R -Value
5 SI AB FLOOR/PERIMETER
Material
Thickness inches
Brand •Na me
Thermal Resistance R-ValuE
6 FOUNDATION WALL ;
Material '
Brand Name
Thickness (inch esL` _
Thermal Resistance R=Values
Declaration
---------------------
I hereby certify that th® above insulation was installed in the building and the above location in conformance with the current
Energy
Efficiency Stef7derds for residential buildings (Title 24, part 6, Califronis Code of Regulations) as I ioated on the
Certificate of Co ce, where a licable.
PARAGON INSULATION Co.
�- 9/26/00
12280 EAST END AVE.
Item #s Signa Date
InstallingS o ( )
r o. ame OR ". ;'
General Contract (Co. Name) OR Owner`
Item ads Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (7o. Name) OR Owner
Item #s Signature, Date
Installing Subcontractor (Co, Name) OR.
General Contract (Co. Name) OR Owner
July 1, lugs