9810-022 (SFD)F�
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
619)1 684 B 3I0
at;�` Signature of Contractor, { y
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.
( 1 have and will maintain workers' compensation insurance, as required by
Seblion 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.
:'I A :"Is 11 1144D )49093.1-97
(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
ZaC de, I shall fort .with comply with th a provisions. J
te: �ZV 414aApplicant
Warning: Failure to secure Wor ers' 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 land 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 isnot 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 authorl• a representatives of this City to enter upon
the above-mentioned property for inspection p'urp ses.
Signature (Owner/Agent) '9! ate %
44
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BUILDINGPERMIT PERMIT#I�11x CONTROL#
DATE VALUATION S99i782 _510 LOT TRACT 2!5^18
8V
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/-t�=Ji% /l *S�lw[�!`al' if r
APN 6114-643.021
ADDRESS
+
.OWNER
CONTRACTOR / DESIGNER/ ENGINEER
/t
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1282 W..AkROW HW Y
1282 W. ARROW .f1\01
UPLAND CA. 91785
UPLAND . CA 91785
(909)98[-�9I.t9 CRIX 3319
USE OF PERMIT
SINGLIP FAIL IL -Y 17'tAE!,>t..NG
S,^D - LOT 2, RLAN ,W 3 .. PE.%tYvti T DOES NOT INCLUDE >.aLOCK 'W IALLS
OR POOL. tit
t r�
PORCH)PATIO Is 1..110 SIT
0ARf1{. OC:ARPt3ii r 5".00 St''
a smtymutli \,as' oye'•i iler7 i'P. UC M'b0N
",782 -MI
It'.�``1�����3qd�+yiE✓�trJ(.���,{3n�l`�•e't31.�`1~
.e.�
q{�a t��/� ,� {, �u� C r,y�
tyvp T,'I ai l%a574.. 1.�tV.l�f L'.I_'..4J kV 3�V!•/�/"�i.0`VV17 JnJ�:I.\,i/
of .•A %r E 11TPI(41K. 6F',iii � {3! .(►(1{}-d';Q.i� $ �$;� .i«
NlF..CIIANIC'AL t'L'rs' $53.30
.r f~. (JR JC.AL FEE 101-000-420-000 $11 J.29
1'.[,1tNIBINr"3 FEF! 1(1 x -WO -419 -Wo $14.81K)
(if AT) IK0 "7 17 l011-000-473-0tu) �. +
rAJI/RAs"1i L1Ce ft fr'�C r t l3 :25.1100-443.34? 3 21.77:12
.ESB RX—P POP ES
$0.00
RECEIPT
DATE
BY
DATE FI ALED
INSPECTOR
v
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
`_/
Ducts
Slab Grade
_
/�j��
Return Air
Steel
`
Combustion Air
Roof Deck
lj�
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
E�
Compressor
Insulation
Vents
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
e_
POOLS -,SPAS
BLOCKWALL APPROVA S
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
_ _ _
��(g'
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
_
3/
Appliances
Final
COMMENTS:
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
c
1.
Final
r - —
Utility Notice (Perm)
APR -12-99 MON 12:48 WESTERN INSULATION FAX NO. 9096868786
WESTERN INSULATION, INC.
4211 Lat ss im Strcct, Riverside, California 92501
TeL (909) 686-8760 Fax (909) 686-8786
t
INSULATION CERTIFICATE
P. 02
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:
PHASE: DESERT PRIDE
TRACT: 23995-3
LOT: 2 ?L..2
SITE ADDRESS: 78-890 BAYBERRY LANE, LA QUINTA, CA
EXTERIOR WALLS: -
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS LOW ^°
MANUFACTURER: Greenstone Ind. THICKNESS: 10.3" 4, 6E: R-38
GENERAL CONTRACTOR: INCO HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:�=j
TITLE: PR DUCTION ANAGER
DATE APRIL 12, 1999