9810-094 (PAT)LICENSED CONTRACTOR DECLARATION
cn4,4 I hereby affirm under penalty of perjury that I am licensed under provisions of
I__1Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N"Lu Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
UJLO
rZ r, " Date S�% Signature of Contractor
O�
rU coo OWNER -BUILDER DECLARATION
W w r- I hereby affirm under penalty of perjury that I am exempt from the, Contractor's
~ U) 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 () I am exempt under Section B&P.C. for this reason
L
N Date Signature of Owner
O�
Q WORKER'S COMPENSATION DECLARATION
o z tr I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
Cal Q 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
11 rn permit is issued. My workers' compensation insurance carrier & policy no. are:
v z Carrier Policy No.
Cb O S'iME1,U D 1490931-37
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
subject to the workers' compensatio provisions of Section 3700 of the Labor
Code, I,shall forthwith comply with h se provisiod,�f ;g;
�eDate;� / Applicant / rf
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 y
construction, and hereby author"ze representatives of this City to enter upon
the above-mentioned property 1 inspecti n pur`oses.
VSlgnature (Owner/Agent) .Date)6�3
BUILDING PERMIT PERMIT��}al CONTROLN
DATE . VALUATION S,{;�;�, � LOT 0 TRACT 28,445
ADDRESSOB SITE 78-046�.ne tN
APN t{1►Q#1��4`Nf}�� �
OWNER
CONTRACTOR / DESIGNER / ENGINEER
y 7
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o>,r:i.i J. i ivI �+ i kl?,C .
,MCO LfOR,417C' 001t> 0
ERVC. L„f %a tYk,L,r4R f_
1129 2 51. ARR.OW .%',terY _
1-282 I%, riftltOW 14iht V
UPLAND CA 9179-5
U,PLANU CA 91'785
CIBLH; 3318
USE OF PERMIT
PCIR`"IITATIO 12 -.00 S;•
rm'i.rviA R: ,,D con. or '4on't ItUc 8 jloJ11
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ft R11t T ,F F, E SIfhl, ik(ARY
C 0NS'1`..R7UCV10N.Jrf 10.1-000-418-0011) S390)
FnIAN _117RFI21 TIFF 101,M-0439-318
STRONO X10T10141 FEM • RESI1) 104 -000 -241 -OW &so
i
as f
I\NID MAN CHECK
t A F.eyRE' _.P',tA.W FElse',
DEC 30 1998 A RNaT FEES : VE, NOW
S64:31
RECEIPT
DATE
BY .1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
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
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 I I
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.1.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm)
COMMENTS:
,
APR -12-99 MON 12:49 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
-1211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Pax ((09) 686-8786
INSULATION CERTIFICATE
P. 04
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: 19
SITE ADDRESS: 78-795 BAYBERRY LANE, LA QUINTA, CA
----------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS- 3 5/8" R -VALUE: R-13
CEILINGS: - BATTS CaBLOMANUFACTURER: Greenstone Ind. 10.3" R -VALUE: R-38
' -------------------------------------
GENERAL CONTRACTOR: INCO HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE. PRODUCTION MANAGER
DATE APRIL 12. 1999