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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 A Exp. Date
Lu91c:�3 i3 7i31 i r
Date—_7�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.
W) 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.
�sTAri31'ir'.f�1:� 1419031.47
(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 rovis ions of Section 3700 of the Labor
Code, I shall forthwith comply with t J e provision !
✓Q'Date: •7U -•Applicant SGL k ti
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at'.,
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, A shall, indemnify t
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby autho ize representati es of this City to enter upon
th�bove-mentioned property • r inspectio pur ose
vSignature (Owner/Agent) fA . r ✓ 1 + Dates �®
PERMIT#�,. .� CONTROL#
BUILDING PERMIT
DATE l VALUATION ,%(��, LOT TRACT 14 3 9
JOB SITE
7i3' =$.�i " 7\'R�l2fi.itliXS1.1
APN 6ii3-fi40�iic
ADDRESS
.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Mrc,C IHOC*41:8 C0!11'
11`1CC)1 OM,11:' CORP.
1,282.1N. ARROW .11 VVY
1262 W.ARROW HAI t
Ul�i.ANI CA 91195
t'!1 LM141:f0 CA 91785
USE OF PERMIT
SINGLE FANGi Y I WEbLiNG
3M, LOT 4 5, PLAN 1 Ai..L VM- NU i` DOES NOT INCLUOi BLO+` K WAIL
UCt Ni3��1,.
ri%, i A CONSTRUCTION 1,411.00 SF
PO1#e;.I1lt'J rlo 70.00 V
GAKAO Jt AEi,Nt Wf 41.8.00 SF
'AMATED COn +.F iONNTRUC"ON
yERRgRl EE9UMNANRi
CONSTRUC"T10N FE 1014,X)0-418-000 $574.50
PL.4,14C3T}?G:fti F F lOt +7tt0 43+�-�1R gtS7. +
NWfOTANICAI iTL- 101-000-421-000 $47.00
RXCPltiCAL FG- 3 101.000-420-000 M6121
.PLVIVIBING FM 101-0W414.000 5148.00
ST'_?.ONO MCITI(DN I1✓,F, - R! SID 101-000-241-000 SR.57
CiRA;')1N0 FIa :01-000423-000
1NFRAS'i`Ii:I1L"' UW,F'EE 22-5-000-443-3.42 51,1+�7.3S
U 3-`f MAL CONSTRUMON AND PLAN RECD'.
JE I rWVD` MS
SS PRE fl
$0.00
TMAI,1w'EEMIT FE .'0l[JV N0'W
DEC 30 '1998
.
J
RECEIPT'. " �x
E
DATE
BY,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
9
Ducts
Slab Grade
z 99
Return Air
Steel
A
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Insulation G 0
_
BMW
Compressor
Vents
Fireplace
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
c �
Final
Utility Notice (Perm)
COMMENTS:
APR- 9-99 FRI 3:47 PM WESTERN INSULATION FAX NO. 16195302997
WESTERN INSULATION, INC.
421 1 Latham Street, Riverside, California 92301
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
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: 23995-1
LOT: 5
SITE ADDRESS: 78-830 BAYBERRY LANE, LA QUINTA, CA
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EXTERIOR WALLS: `
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS GLOW
10ANUFACTURER: Greenstone Ind. S: 10.3" R -VALUE: R-38
P. 1
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GENERAL CONTRACTOR: INCO HOMES CORP.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
'TITLE: PRODUCTION I
ANAGER
DATE APRIL 8, 1999