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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
6911784 B h 1 7/31/98
Date--� —'� Signature of Contractor
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 r1'1 is .F UNIa 1490931-9'7
(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 thee provisions
Date: V�Applicant—y/ %//j/A2,......--
-
�z�. 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 &r inspection purpI ses.
Signature (Owner/Agent) �� ~,pate
BUILDINGPERMIT PERMIT#�0� CONTROL#
DATE VALUATION $104,709-80 LOT 29 TRACT. 7124
JOB SITE
930 BAYBERRY 1-4wE,
APN 604,103-004
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES CORP.
INC -0 HOrviES CORP.
1287 %V..A.RROW .FIWii ,
12892 W. ARROW HWS'
UPLAND CA 91785
UPLAND CA 91785
(909Y)81-6989 CBL# 3318
USE OF PERMIT
s F D
a fi,r
LOT 29, PH 2C, PLAN 3B3. SFU - PERWIT DOES NOT INCLUDE ;
BLOCK WALLS OR POOL. PLAN CHEMX PORTION OF FFES REDUC'EI) 75%�
i
FOR IULT1PLE ISSUANCE OF, SAAM PLAN TYPE:
A
(All] Iiii Jv
TRACT CONSTRUCTION 1,695.00 SF
PORE:Ii1P.ATIO 94.00 9F tiT
- -- a
e "' t
GARAGE/CARPORT 583.00 SF
yf71;,
a,s Gi'
ES`A"[MINED COST OF CONSTI PC il' N
104,769.90
?ER.Ntfr FEE SUNTNVil~tit
CONSTRUCTION FEE; 101-00-418.000 $657.00
PLANT C4CK FF.F 141-000-433-318 $13$.3:.
MEC1•t 41CAL FIEF: 101-1000-421-000 566.50
'ELECTRICAL Fids '101-000420-000 $119.52
PL UNIB1NG TEE: 101-0004110-00() $148.00
STRONG MOTION FEE - RESID 101-000-24.1-004. $10.48
GRA1 ANG FhP; 101-000423-040 $20.00
1NFRASTRUC'rUPS FEE 225-000-443-342 12,329.19
AR'r f'N PUBLIC PLACF.S - } FSM 701-000-255-000: Si 1,92
SU840'rAL CONSTR1JCTICJPi AND PLAN CHECK
$3,504.93
" .. JASS PRE -PAID FEES
$0.770
'TOTAL PERAU T FEES DUE NOW
S3,500,93
RECEIPT
DATE
BY
DAJEtINAL7E
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
—
— ( ya
Steel
Final
Roof Deck
PLUMBING APPROVALS
0.K to Wrap
Framing
Waste Lines — /— —
Insulation
KIP
Fireplace P.L.
-
Fireplace T.O.
Shower Pans
Party Wall Insulation
Sewer Lateral _
��,
Party Wall Firewall
Sewer Connection �o - �-(• 9
Exterior Lath-
Drvwall - Int. Lath
BLOCKWALL APPROV
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Final
POOLS - SPAS
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 �o - �-(• 9
Encapsulation
Final
I COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
t
Notice (Perm)
JAN ---08-P9 FR I 16:41
WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riveralde, CaUfaraia 92301
(909) 686-8760
(909) 686-8786 Fag
INSULATION CERTIFICATE
Il,
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#: 29 iaL 14 IV ,3
SITE ADDRESS: 78-930 BAYBERRY LANE, LA QUINTA , 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:
LICENSE NUMBER:
BY:
TITLE:
DATE:
[NCO HOMES CORP.
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: L �4_s
TITLE: Production Manaber
DATE: JANUARY 8,1999