9810-090 (PAT)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H - Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
W`14 19 // rii !00
C) ZO ate /C Signature of Contractor -"
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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.
(Y) 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.
(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 p ovisions of Sectiory 3700•,�o�f the Labor
Code, I shILI—
forthwith comply with tho'6 rovlsi0D
Date: lApplicant�i//r
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 authorvte representatives of this City to enter upon
tthee Zbove-mentioned property of inspecti�o pure es_.
/Signature (Owner/Agent) 1 'Date%
BUILDING PERMIT PERMIT91414J WO CONTROL#
DATE VALUATION � ,��(� LOT 17 TRACT 04,4 7
V 9
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ADDRESS 79-77-5 .B' A �'S�..��..P.1 LANE, JOB SITE
APN MW440-621
OWNERS!
CONTRACTOR /ENGINEER
p q i�
6i,� i Af Ai''..l,.e ' FST ..
I/DESIGNER
eat�6V ,ii..1 dNiF rS. C.'+iRI�.
082 W.A1� OW HWY
1282 W.:UWrW .i W 5;
Cts 9,1785
'UPLAND CA 91785
USE OF PERMIT
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,F l!l�ll I J{1rf0I"AOM4� ARV
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C ONS"fRiJ`L' T1.QN L'1. K 101-0)-41"00 $.54,00
JILANCHEMXIMS )!01_000.4 9_?}R $35,10
s`t't2ONG I4fiC)'t'. (NNI TTA3 - RUSE[) 101-W0411111-000 Vso
!
`i ! l' "may t f"i r1, U'f A P K
LESS PRE -PAID FEES
.r.0,11V
1 0 A11 PEf? MIT .J." MIS Dur lir(Av
$89:60
DEC 3 01998
FYQ
RECEIPT
DATE
BYE
DP AL
INSPECTOR
r( C-1
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.I.
Smoke Detectors
Temp. Use of Power
f �
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Final
Utility Notice (Perm)
COMMENTS:
APR- 9-99 FRI 3:56 PM WESTERN INSULATION FAX NO, 16195302997 P,17
WESTERN INSULATION, INC.
4411 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Pax (909) 696-9796
INSULATION CER` !7:" - "_
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 �� 3
LOT: 17
SITE ADDRESS: 78-775 BAYBERRY LANE, LA QUINTA, CA
----------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone Ind. T 8.1" R -VALUE: R-30
------------------------------------------------------------------
GENERAL CONTRACTOR: INCO HOMES CORP.
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION ANAGER j
DATE APRIL 8, 1999