0002-322 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714188 B irII31120f
Date L Signature of Contractor;—I.-
OWNER-BUILDER
ontractorOWNER-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 solei
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.
N ) 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.
COLDEV I ACLS 1N.3. NVX V4 4 00412'.
(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
Codd'l shall forthwith comply with those revisions. /
t.pee• 1-2-0 Applicant— r-- --✓
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��:.� `- Date 7�
1'
BUILDING PERMIT PERMIT,11�-�
DATE VALUATION 5116,751.0 LOT C:`j TRACT 2304%.-.8
JOB SITE ADDRESS � % Q3 d kl �', . i u y�a�f..I!,
APN 1►0"44.016
OWNER
CONTRACTOR / DESIGNER / ENGINEER
(tyH�.'Nv 1f)"� ('S(/'E (
^!JA's 1�d10 i. �.�� 4� tY . I.. L, ���St�YY I.I,ll Y.L1 4A.. �.1
�,. t.6 v A 4 911. 3, i�,l \.i.1�� Coi.el:• ,.,4.�AY {.�i.ja i.f. t lll. 1.�
1..53.3 S0. "i)" & FRE F1', SM. i► 2W
i j e '�C). "1-)" i t �' J ;1", S"I'i . i yUO
SAN BERN.A.ki. lNO i`A 92408
SAN BERN.ARLDINO CA 92408
(909)191-6007 N120
USE OF PERMIT
SNOLL fAMILY llVilFl,,:G.ING
t
SH), -LOT 68 PLAN SGBR-d-iviM -f DC)kS NOT t LOCK WALLS GR
P01A_ 7F%41aL.AN f f .'1: 't f u� �fC°x'tcply 'c;►�i. h:�ui ' 'ai�l.,t �ssf.rA c ►1 eek° .
SAMY :PLAN'1 P&
mitcr c,,TqsraucnoN _110100 3F
GARAO&C:A RPOItT 4W.00 SF
ES`.>;"i�• �' '� �`: ,�.' €�1' C:t3 �5S '.:I.iC�€. C
�Igg� ��yy,te'�aa �; ,err g,R
P l�i7.'►L.'�AT .$-.EE -S i.�IYAMAM7
C((JN3'I`t_tJC.'11f.>W flX 10.1-000-418-000
PIAN ("I FCV x7"f; 3,{)1-(Dftfl i ?- 1fI 5144 `3
it; C<ati'ti`ICfki,{'iT 101 0:30r.ia.l-VV3 x.7.00
, i`.( i'l2.lCAL Pi:h 101[ -000 -420 -GW $1206.1
!'l.UMBINOn- 1Gt•OW-4I9-000 $134,75
!719t4040N-R)TfON*31- RVISf:f) t0j-OA(1-141-000 $11 HM
ct3i�fNC t<# t�1 llU0M7 {1ti1) x.0 (If.)
Vtr4'f1.f PbR 1NVAC 1' FBE $1.V07.00
AXI' IN PUBlr JILACES - RESIl: 7014YO-255-000 a4 i.t
511.,911)TM,%'C.)NS`rR.IX-1.10N ANnP"', N, (IMC'TtC
IX SS PRI -PAID FEES
1,31t? 100
- TOTAL s'ERMi'!"'VE1♦;S1)IL►l:+:l bNV
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
, f3 -gyp
Return Air
Steel
4- $ .M
Combustion Air
Roof Deck
-i 'L -Go
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
1A .-da
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z
Drywall - Int. Lath
.0D V
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
Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
oo co
Pool Cover
Sewer Connection
t too
Encapsulation
Gas Piping
Gas Test
2
Appliances
Final
Final o 0
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 V257
Final
Utility Notice (Perm)
COMMENTS:
INSULATION CERTIFICATE IC�1
78-750 WAKEFIELD CIRCLE LA QU'NTA
Number and Street ` City
RIVERSIDE 23995 68 4
County -_ Tract No:. Lot Number
Description of Installation
1 ROOF
,.
Material'
Brand Name
Thickness (inches)
_ Termal Resistance (R -Value)
2 CEILING
Batt or Blanket Typs .
Brand Name OWEhS CORNING
Thickness (inches) 12" . "
Thermal Resistance (R-Va(ue) R -38U
Loose Fill Type
wand
Contractor's min Installed weight square ft
Ib Minimum thickness: inches
Manufacturer's installed welght per square foot
to achieve Thermal Resistance (R -Value)
3 EXTERIOR WALL
Frame Type
A. Cavity Insulation t
Material
Brand Name OWEh•S CORNING
Thickness (inches) 3 112
Thermal Resistance (R -Value) R13U
B. Exterior Foam Sheathing
Material
Brand Name
Thickness (inches)
Thermal Resistance (R -Value).
4 RAISED FLOOR
Material
Brand Name
Thickness finches)
, Thermal Resistance (11 -Value)
5 SLAB FLOOR/PERIMETER •
F
Material
Brand Name
Thickness (inches)
Thermal Resistance (R -Value;
6 FOUNDATION WALL
Material
Brand Name
Thickness (inchas)
Thermal Resistance (R -Valu o"
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 5, Califronia Code of Regulations) as indicated on.the,
Certificate of Compliance, where applicable.-".
F`� m itVEULATVJ CC"
1'n'„�•jD �`A Ei�:} F,�'F•
9/26100 .:,
Item #s ;. Signature; to
' • Ins irin •'S�6ebn�'a2t; a. Name) OR
General Contract 'Co. Name) OR Owner
Item #s Signature,.Date Installing Subcont-actor (Co. Name) OR ”
General Contract 'Co. Name) OR Owner
-Item #s • Signature, Data Installing Subcontactor (Co. Name) OR
General Contract ;Co. Name) OR Owner
July 1, 1999