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0002-321 (SFD).. •�: ..,•r y row,+' Y 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 LO 7111' f"� i0I31�?Ot � Dat °> Signature of Contractor , OWNER -BUILDER DECLARATION t' 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 Codc). ( ) I, as owner of ,the property, am exclusively_ contracting with licensed contractors to •construct the project (Sec. 7044, Business & Professionals Code). ck, CV) O I am exempt under Section B&P C. for this reason ` N Date' 7; 'Signature of Owner rn. Q WORKER'S COMPENSATION DECLARATION. Z I- hereby affirm under penalty of perjury, one',of the following declarations: cc . (.) 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 Qperformance of the work for which this permif is issued:" C) �(jj .1 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 Z permit is issued. My.workers' compensation insurance, carrier & policy no. are: Carrier ' Policy -No. CC?,LDJ 2 N EAGLE INS, i WC r44e4$-02 J (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, y I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Caiifornia,rand agree that if I should become subject to the workers' compensatlon�provision s of Section'3700 of the Labor Code!I shall forthwith comply with those -pro Is ns Ate•.�r�i' �YApplicant .. �'— --- 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 r application. . Each person upon whose behalf this application is made & each person at' w1hose 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 o & 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 clays..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. �,.Slg ature (Owner/Agent)Date - BUILDING PERMIT.PERM�Qi01� DATE VALUATION +�2���, !98} • LOT''' ACT � . a��_ Q S, • 3 - toxo � _ _ .. .. _ ,.TR. �- JOBSITE -_]APN _40_Vr 3- E 9� a 604-04&016 .I .ADDRESS �-._ OWNER CONTRACTOR/DESIGNER/ENGINEER !'`%ATfVTY7'Ct./�T?Yl{A/67T'r ��r''+nags�'te.r7�nmc qtrn:-rrruve'+nn�Er&rr::'•r�n`;tn.�rrTnyY7�r..°c ' tu. �,.IY .1. 6-1� A \...1 \�_,r Yv 11 i.rV 5.,,.Jl,i lbG J. i,J1. V.1 .1 l.1:. i.+ \•.; {,%A tt'.� 1lA\: .f 4.1.L�J \v.t;sa., Sw. V1..f t14Jl\J 1'a.\ t,/l:. Lf 1535 a©r "D" STREET, STT. 000 - t�iUEr, 9FE. #200 SA:N.)3(?•lfttit.i\RMNO QK .92408 SA3� .13I?-h'Il�itlfLDINO CA 92408 - - - _ (409W l -6007 ;" rbu. - 212-0 . �. USE OF PERMIT s.NOLE•.. �ML U WEi,ir INO, . :34 ? -LOT 671�,i AW ars --%Rie I 'DOES st0:T; "LUDIF a- iJ' C're '� �i,S OR POOL, 7Yo PLAN Gf. CK FIEE ISSUANCE PJM SAME, 11LANTYPE. � AJ6iSL l.,e�}2V .1�Zil..rrfJ1V 1„D -79,1001Sr _ 0MW3�iCARPORT' Z -i.00 _SF .r ru•,•.�3.Y RUILA Y M'�..tl 'l.il'S -O C</1.trt,i.tl RIJACTAONY tb�"✓4.Vg�r%�0 PERMIT '�t):i�r ,Aild�� ''>i'ARY .- • , • . . CONSTRUCTION r'EE101-000-418-000 S639.50 <W Y � 3? AN CC %. rEVIIC' -000-439-318 $ 132,90 0 � �n .� - � t,:,�. ` fir. , EL-&,'TRU AlL FEE? ui 000-4I4 UOr'i $115.0 �N �101-006-419-00S134.75 ' t 4,`�t. `8. :'•. . C`i.RE.S!P 301.000-241-mU > GILAL'fft°fGi.t~ti? lC;=f T{3–ss^-i:f}f} $20,00 £:EVELOPER OOACT is S 1,yS►`�.tYi� { Y' ^ . CO SUB-IXYrAL CQNS"I'RUC.i'g0N AND PLAN CHECK $3,004669` LP S f -T -PAWFEES law TOTAL PERMIT FEES $DiTll`+' iNC3W W)06.69 RECEIPT' DATE BY '' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade t��• Return Air Steel 4 - G-®8 PT Combustion Air Roof Deck z-00 Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 7 o I? -.4a0 Drywall - Int. Lath t. •30 _W alp, Final Final o �o rp POOLS - $PAS BLOCKWALL APPROVALS 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 Lrg, . 04 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral !gdco C42 Pool Cover Sewer Connection $ Encapsulation Gas Piping Gas Test ccs Appliances Final COMMENTS: Final Utility Notice (Gas) p 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 o Utility Notice (Perm) �Jys 0 09/26/2000 TUE 14:.22 FAX 0027 INSULATION CERTIFICATE IG -1 78-740 WAKEFIELD CIRCLE LA QUINTA Number and Street City RIVERSIDE 23895 67 County Tract No: Lot Number Description:of Installation n 1 ROOF f Material Brand Name Thickness (inches) Termal Resistance (R -Value) 2 CEILING Batt or Blanket Type Brand Name OWENS CORNING Thickness (inches) 2" Thermal Resistance (R -Value" R -38U Loose Fill Type Brand Contractor% min installed weight square ft Ib Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) 3 EXTERIOR WALL ' Frame Type A. Cavity Insulation Material Brand Name OWEWS CORNING Thickness (inches) 31/2 Thermal Aesistancs (R -Value o R13U 8. Exterior Foam Sheathing Material Brand Name Thickness (inches) Thermal Resistance (R -Values 4 RAISED FLOOR " Material Brand Name Thickness (inches) Thermal Resistance (R-Volue , 5 SLAB FLOOR/PERIMETER Material 'Brand Name Thickness'(inches) Thermal Resistance (R -Valued 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 conformance with the current Energy Efficiency Stenderds for residential buildings (Title 24, part 6, Cdlifronia Code of ®®�Y `q��) �s'cte �✓°}. Certificate of Compliance, where applicable.o' 9/26/00 C;i�.,��., �,;� Item #s Signature, e " Installing Subcon'rector (Co. Name) OR . General Contract.(Co, Name) OR Owner Item #s Signature, Date Installing Subcomractor (Co. Name) OR General Contract(Co. Name) OR Owner Item#s Signature, Date Installing Subcontractor (Co, Name) OR General Contract (Co. Name) OR Owner July 1, 1989