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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 / Exp. Date
4 A
ate 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.
C r�
(This sectio'nTh At b"Pcompleted if the permit valuation 10 3WO&O 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' compensat/eon provisions of Section 700 of the Labor
Code, II 2 /Z6V forthwith comply withjil�ose prove �� -- �r.,
Date: Applicant ,//�-�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 authorize representatives of this City to enter upon
the above-mentioned property for inspectio : u� oses. r /A
ffO//
Signature (Owner/Agent) ✓ _ Date_
BUILDING PERMIT PERMIT#
w
DATE VALUATION LOT 6 99WJ29 TRACT
06/1.111199 S9&792.50 23 219�35»�1
JOB SITE ,
APN
ADDRESS
45..1% HIRCHCREST CIRCLE
F(1�ID4ii_!i2
OWNER CONTRACTOR/DESIGNER/ENGINEER
WCO HOMES CORT. 1NCO HOMES CORP.
1.282 W. ARROW HVA, -f 1282 W. A.RR0W' 14WY
UPLAND CA 91785 UPLAND CA 91755
(909)981-8989 CBL# 3318
USE OF PERMIT
l IN16 U it i lW f 10,,f.'.f.,Jrnia
kD - P:LA14 LOT 23, - PMUT DOES NOT INCLUDE BLOCK
WALLS OR POOL,
TRLACT CC3Nu'Y' UC:1101%1 1,566.00 SP
PORIC"A`:i*TO 151.00 SF
GARAGWCARPC)liI
C* TIMATED COS`[' OF CONSTRUCTION
?lS,786.3Q)
�'iM;t��11.�T �'JF:iL 3t1.T11i1i'1elti�'
CON4TRt.CTIONFESi 100-000-4.1"00 5635,00
PLAN C%1LCK FEE 101-000-439-�3/1�8 $533.22
tYlt`.n..+i7!l1..�4 CMf FE 101-000-4.21-000 35150
t-LEC,1' MAL r°F M-0001:20.000 $.115.29
PUJMBING FEE 101-000-119-000 $148.00
�. AD[,,NG FU 101=000..4.23-000 SZ0.00
INFRASTRUCTURE. 225-000443-347 6.1.,1VA2
' SUB -TOT Ct3tVST.R(.0 fl0N AND PLAN CHECK
ft
$3,657.43
'i. LESS .1,1`'.•x''-Pca.Ii) •i'EEs
S0.00
JUN 1 0.19990TA1.. 'PERMIT 1+'FTS DM NOVV
$3,652.43
RECEIPT
�
DATE
Bye, /
V
ATE FI ALED
INSPECTOR
J
In
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
f ICombustion
Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-f/- G7/6
Compressor
Insulation
b _/!2_9 ly
Vents
Fireplace P.L:
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
O -•Z �v `-� 6
Drywall - Int. Lath
-
/p -Z222 az
Final
Final 2 •9
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
4
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
I cz_
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
Final Z 7-'__7. 17E
Utility Notice (Perm)
COMMENTS:
I
NOV-19-99 FRI 11:51 WESTERN INSULATION FAX NO, 9096868786
P. 19
WESTERN I SZTLA TIONt INC.
4211 Latham Street, Riverdde, California 98801
1909) 686.8760
(909) 686-8786 Sic
INSULATION CE TIEICATE
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:
TRACT/ PHASE: DESERT PRIDE -PHASE 4 B TRACT #:23995-4
LOT*: 23 PLAN 2
SITE ADDRESS: 45-190 BIRCHBREST CIRCLE, LA QUINTA, CA.
EK[ERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GEISERAL CONTRACTOR: AMERICAN COMPANY
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU ER: 4$127$
BY:
TITLE: qroductiM4ager
DATE: NOVEMBER 19,1999