9810-037 (SFD)/1, LICENSED CONTRACTOR DECLARATION
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W�/`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
UJ Professionals Code, and my License is in full force and effect.
C•,5: License # Lic. Class Exp. DIte 1
t- Q 691694 it rt31f1(i p
oZ r Date Signature of Contractor
co O
~ ( OWNER -BUILDER DECLARATION
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LLI W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 1, 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).
' ( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct,the project (Sec. 7044, Business & Professionals
Code).
C'') () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
O�
d Z WORKER'S COMPENSATION DECLARATION
�. 'T I hereby affirm under penalty of perjury one of the following declarations: r
O () 1 have and will maintain a certificate of consent to self -insure for workers'
K LJ �= compensation, as provided for by Section 3700 of the Labor Code, for the
D � Q p rf rmance of the work for which this permit is issued. 1
Q r) 1 have and will maintain workers' compensation insurance, .as required by
Q; Section 3700 of the Labor Code, for the performance of the work for which this
ur)i 0)H permit is issued. My workers compensation insurance carrier & policy no. are:
? z Carrier Policy No.
Cb CY
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
' s subject to the workers' compensation1provisions of Section 700 of the Labor
�1 Code, I shallvf rthwith comply with toe provisions./
Date: 'Applicant `�
b < 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
b 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
a Iany 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
M 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
t1;
correct. I agree to comply with all City, and State laws relating.to the building
construction, and hereby authorize represent tives of this City to enter upon
,he above-mentioned prope�,Y
'for inspecti poses f
Signature (Owner/Agent) � Date/
PERMIT# CONTROL#
BUILDING PERMIT S10-111.3�
DATE 1TVALUATION ; >'t�s,7f�ti $f! LOT TRACT
,
, l%t o 'TOJOB
SITE
ADDRESS _73-"5 BAYBERRY LANE_ .�
APN
CONTRACTOR / DESIGNER / ENGINEER
i 282 NV. AA ki'iW HWY
12-81 W. ARROW .i �, y�v Y
UPLAND a CA 91785
UPLAND CA. 9178.5
(969)9,41 "folt9 CMA, 3319
USE OF PERMIT
SINGLE FAMILY DWELLING
SM - LOT 28, MAN 313-3 - PF i ,1TT .DurS NOT iNC.i UDE BLOCK r �c
WALLS OR 11CKX. PLAN Ct!•i'Fr. K FEE !t>;s" AIC'f U 75J o i"Ulf dvt� l l `i !f`I.l
�'V
7' UANLE OF SAME P AN TYP.H.
, V
Tfi6tti"", f CONST" UC ION 1.6596,00 « -
1.10Ri V11AT ra 94.00 SJI
�1At�.r\GJ1f;tllttd�'U1t'I' S�3.UC! 5!�
'ESIMN rUED C05011 OF C:ONS'!"RUC'rViN
104,769.30
C0NS'flWCVUN .FEE 3014100.418-(M $657.00
KAN s; 4EV. Is FEE 1014W-43(018 Sl38 :�2
N'140JAIMCAL1-1.131 101-006421-000
P-1,1 t—_ rKICAL FIT, 161-000 420-000
k'l.4Ii1 8f NQ F EE 101-000-419d)0!? 1148.00
xCitohla NIOTFO, N 17ET,-)2EMY) 101 -OW -2414M $ 40.48
GR.ADINO FEB 101.0013-123.000 520.00
1N7,RAf3'I'RUC,rURE- FEE 225.000-11813-312 S;,3'19.1.9
AR,T IN PUBLIC PLACES - REM, 701-000-2ti540) t!l.az
USS P RE-MICI FEES
$0.010
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S.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION T77D.ATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksLL
Forms & Footings
/ `
Underground Ducts
Ducts
Slab Grade �L_l�J;�L� _T
Steel
Return Air
Combustion Air
Roof Deck
O.K. toWrap 2���
_
9
Exhaust Fans
F.A.U.
Framing
Insulation �.}Z"
Compressor
Vents
Fireplace F .L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall -Int. Lath
/
r�
Final
Final
�
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
l
l� –� J
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower, Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-222—
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wirinj
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
APR- 9-99 FRI 3:54 PM WESTERN INSULATION FAX NO, 16195302997
WES'TEW".. --I- _TTLA TION, INC.
4211 Latham Street, Riverside, California 92501
TeL (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN' !" e --r 1 r-^ ' i' ^^"'c^P^.AA.NCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
PHASE: DESERT PRIDE
TRACT: 23995-1
LOT: 28 �� 3
SITE ADDRESS: 78-865 BAYBERRY LANE, LA QUINTA, CA
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EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone Ind. THI ESS: 8.1 " R -VALUE: R-30
P. 12 t
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GENERAL CONTRACTOR: INCO HOMES CORP.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: S
TITLE: PRODUCTIO MANAGER
DATE APRIL 8, 1999
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