9804-020 (PAT)LICENSED CONTRACTOR DECLARATION ' ur PERMIT# CONTROL#
cn1 I' I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
1— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 9104-020 p 7
DATE l� VALUATION LOT TRACT O /
�JW Professionals Code, and my License is in full force and effect. I` 111 51,795.50
n M License # Lic. Class Exp. Date
JOB SITE' APN
t I� p�Uai///, e691684 $ ,..--. [l, ��� ADDRESS 78-955 BA�rB.i+iRCt'i' 1I�AN�
0 Z `�`Signature of Contractor/"-' OWNER CONTRACTOR/DESIGNER/ENGINEER
t`
J U OWNER-BUILDER DECLARATION R CO'+ HOMES CORP.. tNCO HOMES CORP.
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1282 W. ARROW HWY 1282 W. ARR W HW'V
~ U) License Law for the following reason:
UPLAND Z_ ( ) I, as owner of the property, or my employees with wages as their sole,CA 91 785 UPLAND CA al s7
8$
compensation, will do the work, and the structure is not intended or offered for 09)981-V89 CBL# 3318
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals 'PATjO t
Code).
<o() I am exempt under Section B&P.C. for this reason LA fT1CM P.4, 10 .I aSSF730Af 11,AN CHECK RFDU4�3'10'i AP LDFD
O N Date Signature of Owner
rn "t
Q WORKER'S COMPENSATION DECLARATION
OQ Z wing declarations:
I hereby affirm under penalty of perjury one of the following
O O I have and will maintain a certificate of consent to self-insure for workers'
L}RCI iPrLTXO
X W < : compensation, as provided for by Section 3700 of the Labor Code, for the i35'40 Si 1
O J Q performance of the work for which this permit is issued.
m Q I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy NO.
ob U' STATE APUND 1490931-97 ESTIIat'A ICIV MIST OF C.'ORiSTit13CfION"
J (This section need not be completed if the permit valuation is for $100.00 or less). 3lsN.i i SEE SUMMARY
() 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
UNS'TAUCTtpN FFFfr• 101-000-418-000$11.4(1
workers' compensation laws of California, and agree that if I should become PLAN CIlECKFEE 101-M0439-318 $6•56
3 subject to the workers' compensation provisions of Section 3700 of the Labor STRONG MOTION 'FEE - RESita 10 1 -OW2414)00 x,54
Code I shall fprthwith comply with t>se•provisionsZ
Date ` 4 Applicant—
Warning:
pplicant 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 S(,TL,"r(7'1��.IS CONS.�R1 CTIO?�1:A.� D PLAN CHECK
& hold harmless the City of La Quinta, its officers, agents and employees. LESS PR.E-PAID FIEFS - $0.00
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. TOTAL PE Ri%11T FEES ,DUE NOW $48.06
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
tthhe'above-mentioned property for inspe�cti`onn�purposes. _ RECEIPT DATE BY ��! "' DNA INSPECTOR
/Signature (Owner/Agent) b4--^'""'' � ' " - Date �
,A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
- MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings O
Ducts
Slab Grade
Return Air
Steel .
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap d
Framing
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Q-%C� _ _
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
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 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
I
Final
Utility Notice (Perm) '
COMMENTS: AATI o
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SEP -24-98 THU 14:48
WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION 2 INC.
4211 Latham Street, Riverside, California 92301
(909) 686-8760
(909) 686-8786 Paz
INSULATION CERTIFICATE
P. 12
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#: 32 p«� 4C
SITE ADDRESS: 78-955 BAYBERRY LANE, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
CErLINGS : BATTS CE
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: k -IIA
TITLE: Production Nanager
DATE.: SEPTEMBER 24, 1998