9810-183 (SFD)r
LLi it
O :) M
du7
r`
W
o Z
CD 0
F- (
J 0
LLj r`
F -a
U)
Z
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
091684 B 7)2% 1 /00
Date ✓' 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
J
WORKER'S COMPENSATION DECLARATION 'r`
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.
( ) 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 S, TX MND Policy No. .149%3 fpr,
(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
q�oe I shall forthw'th comply with ttpldtse provisiont: %
D'ate:.,� 0 Applicants '�s�s�t'n ��
F
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 issuancerof 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
constyuction, and hereby authorize representatives of this City to enter upon
the ove-mentioned property, f r inspectiionn' p 'rpose .
Sjjature (Owner/Agent)' Date
BUILDING PERMIT
PERM,4
CONTROL#
DATE . VALUATION
1 �
$!k7tc�1.�11).r t'� LOT
ywe
' TRACT
8647
6 4
VV ��// i
h
JOB SITEADDRESS *?J -67B' A�J:>�iCkRY
LANE, w
afi,AI'`1CHECK Fri
APN
604-040-021
OWNER
101.000.4.21-000
CONTRACTOR/DESIGNER/ENGINEER
11E C,';' f.CAL F E -E
74NC10 HOMI's CORP.
l[NCO' MONTES CORP.
14f1- •419-fhAN
1282 W. .ATMOW HWY
c'I'ROW-w MOTION FIT, - MISKI
12$2 W', ARROW HWY
$9,79
UPLAND
CA 9.1785
tJ ILAND
CA 91781
225.000-44.1-342
SN_ 11111.42,
USE OF PERMIT
tiI1VCft,P,AMiirlt'.MR,-;.i,4140-
I
SI -D, LO 44, KAN 2Ar 3, .P%MrOT, J1OM ,;vOT lt'�it.'i.T.DE]BLOC Wf t.
OR POOL.
TUACT COWTIRUCIMON1 04(.00 .01
QMt1.QFJCP 1WC.KT W9,00 SF
ESQ ININVED CONTE fal,' C0w:N fRX1
4ON
4«Ot4S'i'ItLfC"t ON FET
10!-000418-Ufio
$630.iu
afi,AI'`1CHECK Fri
9
5530,01
INIE"'11A ICAt.IFT4
101.000.4.21-000
$ 3.50
11E C,';' f.CAL F E -E
101 -OW -420-000
PLUMBING 1-1X
14f1- •419-fhAN
$148W
c'I'ROW-w MOTION FIT, - MISKI
101-1-M-241-000
$9,79
ORADING FTE
101-000-423-000
$20,00
,ENFRrL;s's'l:UCIlim- Flim,
225.000-44.1-342
SN_ 11111.42,
K,
LESS P1' V -PA O FEES
OIA :i';� MWI .�+'FM :DUE NOW
-
BY
INSPECTOR
.$3,684.51
f..-_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings�%
Underground Ducts
Ducts
Slab Grade
_
�e
Return Air
Steel
Combustion Air
Roof Deck0
9
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing ,* (/r'i
Q
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
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
_ _
yJ
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
:7. 9
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
ZS-�
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
t
Final
Utility Notice (Perm)
MAY -12-99 WED 12:21 WESTERN INSULATION FAX NO. 9096868786
WESTERN INSULATION, INC.
4211 Lata<— = ± _ _Li rzside, California 92501
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
P. 07
THIS IS TO CERTir'T 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:
TRACT/ PHASE: DESERT PRIDE TRACT #:23995-3
LOT#: 8 /oLAA! 2 .
SITE ADDRESS: 78-770 BAYBERRY LANE, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 "
CEILINGS : BATTS BLOW
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3"
Where inaccessible for Blown Insulation: BATTS
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13"
GENERAL CONTRACTOR:
LICENSE NUMBER:
"-1
TITLE:
DATE-
R -VALUE: R-13
R -VALUE: R-38
BLOW
R -V ',6 1_!JE: R-38
INCO HOMES CORPORATION
INSULATION CONTRACTOR:, WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE:'Prod uction Mana er
DATE: MAY 12, 1999