9804-013 (SFD). - LICENSED CONTRACTOR DECLARATION
rrrr: 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
CN w Professionals Code, and my License is in full force and effect.
ch License # Lic. Class Exp. Date
Lu
/ fiy i0t54 13 !% 11 u:5
ro Z r-- / ate" ! -f.�- �Signature of Contract6r, k-= -
Or
U OWNER -BUILDER DECLARATION
W. W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
F- d License Law for the following reason:
Z_ ( ) 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).
co O I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
m
Q WORKER'S COMPENSATION DECLARATION'
p z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL- compensation, as provided for by Section 3700 of the Labor Code, for the
Om J Q performance of the work for which this permit is issued.
Q (,V, 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
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
"t Z Carrier Policy No.
°ro 0 STV;1+ FUNt:f 1490931-97
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,
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. �
vDate,/,Z e _ r riApplicant "_7 -"'`-' -J "
/
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) �.�-�., � Datel"-
BUILDING PERMIT PERMIT# CONTROL#- .
; °
9"4.01 h
DATEVALUATION $101595 .313 4 LOT TRACT
�
(J1t
4-11 ref t
JOB SITE]APN
-
ADDRESS 76-9A RA YHERRI' LAINE
604-.3002- 1 I
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO l:C%,MES COP.P .
1282W AR:idO'9+1.HAVY
1282 W..ARR.OW ffWV
L)PL=iM3 CA. 9.1785
UPLAND Cry. 91785
(9139)981.8989 CBL/# 3318
,
USE OF PERMIT
'KAN A li-2 , SIM - � , ER. T PRWIR LA t, MITA V 1'.
TRACT CONSTRUCTION 1,696.00 V
P43R.CF1 PATIO 97.0 .SI
G.r RAGEtCARPO:RT 419,00 3F
tilt
MAXED COST
PERMIT FE E SIT1ViMitR+ Y
CONSIR,I.%C.'Ti:t3T7.Ff~M 101_00041R -Mo 5646.50
PLAN C ECK FIX, 101-000-439-318 $544.93
ti1EC"NIC»L :FRE 101 -WO -471-000 $66.50
CLEC RICA:L F"t 101-M-420-00(1 S116,24
PLI A+W NG FEE. 1101 -ON -119-000 $148.00
3TIt.ONQNIt' TION FEE - RESH) 1.01•000-:241-000.
GRADING .ME 101-000-423-000 $20.00
9FitAVA.t1C'TU1RP FEE 2, -000-413-342 X2,2%rl
ART TN PU87,1.0 11,ACES < ttE SIC 701.000-25-5.000 $3.99
V.
SUB»r(rrAL C-ONSTRUCTIOIt1-AND .PLtXI\T CHIiCI
3.
LESS PIRA. -P. ;M PEZ S
MOO
iT0'CttiL ll'FXV1%r1T F1C 'DV E K01Vt
3,82 .1.9
RECEIPT
E
BY r
D NALED
INSPECTOR
I
,s
;• INSPECTION RECORD
OPERATION
DATEINSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
(p _ —
,
Return Air
Steel
Combustion Air
Roof Deck
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
121-3
Drywall - Int. Lath
Finale �'-
BLOCKWALL APPROVALS
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
-3(—
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
Final
Utility Notice (Perm)
COMMENTS:
SEP -24-98 THU 14:48 WESTERN INSULATION FAX NO. 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92503
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
P. 11-w
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#: 22 P4A/V 3 8
SITE ADDRESS: 78-950 BAYBERRY LANE, LA OUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS : BATTS BLOW
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: ,4 � - '
TITLE. Production M ager
DATE: SEPTEMBER 24, 1998