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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 f
691684 7/3 19
vDate, M ` '� r Signature of Contractor'= & "- `" ' a
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, 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
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.
STATE FUND 1490931-97
(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 provisiogs.- jam.
VDate L ` f �Applicant ,/ 6 ti-.... 1' <•. • .�> ~ �""f.
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'
DATE
JOB SITE
ADDRESS
OWNER
BUILDING PERMIT
%/GI IIATIMI
416
PERMIT #
LOT
$120,647.441 ? 1
78-970 BAYBERRY .LANE
TRACT
APN
CONTRACTOR/DESIGNER/ENGINEER
604-302-010
TCO HOMES COP,.P, INCO HOMES CORP.
12.82 W. ARROW HATY 1282 W ,r1k'R0NV WATY
UPLAND CA 9.1783 UPLAND CA 91785
(909)981-8989 C13L11 3316
USE OF PERMITh
,PLAN 4BR - `.+FD - UESFA T PRIM @ LA. QTANT A - 75°$ PLAN cm' CK Q
REDUCTION APPLIED • � 1 � 1� l.1
TR_ACT CONSTRUMON ?,008.00 SF
POACII;PATIO 14.00 ST
OARAGF)Q RPORT 583.00 SF
.00
,79
.00
.44
.00
.06
.00
.38
.h2
120,647.40
SUB -TOTAL CONS' -RUCTION ANIS PLAN CHECK $3,m.2�
LESS PRS-PA1li FEf-,S $0.00
RECEIPT DATE
TOTAL PERMIT FEES DUE NOW S3,980.29
BY
INSPECTOR
ESTIMATED COST OF CONS` RUC'#"ION
PERAUT FEE SUMMARY
CONSTRUCTION FEC
101-000-418-000
$713
PLAN CHECK FEE
101-000-439-318
$147
NIECCHANICAL FV.
101-000-421-000
$al
FIEC IUCAL M101-000-
120-000
$130
PLUtN173ING FEE
1.01-000-119-000
$14$
STRONG MOTION Fhb - IRESID
101-000-241-000
$12
GRADING I�F,E
101-000- 323-000
S20
'117 NR!�.5`.[`RUC'�URI..1 ES
225-000-443-312
$2,710
ART IN PUBLIC'PL,�1.CES - RESID 701-000-255-000
SS1
.00
,79
.00
.44
.00
.06
.00
.38
.h2
120,647.40
SUB -TOTAL CONS' -RUCTION ANIS PLAN CHECK $3,m.2�
LESS PRS-PA1li FEf-,S $0.00
RECEIPT DATE
TOTAL PERMIT FEES DUE NOW S3,980.29
BY
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
0
�-`
Underground Ducts
Ducts
Slab Grade
(� 3 _ _
Return Air
Steel
Combustion Air
Roof Deck
_
_
Exhaust Fans
O.K to Wrap
_
(o -
F.A.U.
Framing
__
-
Compressor
Insulation
_a — Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
a
Exterior Lath
— 3TIF
Drywall - Int. Lath
/ _ yTJ
Final _/%Z (
BLOCKWALL/ AP ROVALS
Final
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
S "�l 8
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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
t "
Final
Utility Notice (Perm) �� `B
COMMENTS:
14'- 111/21/2
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SEP -24-98 THU 14:47
WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, CRUfornla 92501
(909) 686-8760
(909169"786 rAx
INSULATION CERTIFICATE
P. 10
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: DESERT PRIDE TRACT #:23995
LOT#: 21 P4.4.,v qB
SITE ADDRESS: 78-970 BAYBERRY LANE, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS : BATTS (::BLO11
MANUFACTURER: GREENSTONE IND. THICKNESS: 8.1 " R -VALUE: R-30
GENERAL CONTRACTOR: INCO HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: Production Manag
DATE: SEPTEMBER 24, 1498