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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
ate 111 '�1
6 Signature of Contactor /
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.
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 $150.00 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 rovisions of Section 3700 of the Labor
Dode
, I s�Ilfort� hwit� comply with t ose provisionsate: .� dam.' Applicant �
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 author ze representatives of this City to enter upon
the above-mentioned property, o inspection 7',
oses.
ignature (Owner/Agent) Jr Date -
BUILDING PERMIT PERMIT#
1.
DATE. - VALUATION LOT TRACT
06110/1" $1,104.769.80 .14 2.'4595 4
JOB SITE
APN
ADDRESS 4
45..2I0 BI RCOC9..014T CIRCLE
604-040-021
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES CORP.
INCO HOMES CORP.
.1282 W. ARROW'14WY
1.282 W.ARROW AWY
UPLAND CA 91785
UPLAND CA 91785
(909ps t-8989 CRL4 3318
USE OF PERMIT
S s *'ii 2 t a WYY ' ee:1 t rns '•
Skill - PLAN 3A.=3, i:O. ?,.'d, - PERI1OT DOES NOT t1NCLUDE .PLO CK
*WALLS OR, POOL. PLAN IC HErK. PORTION OF FETE RED'LJCFJ) 75% FOR
RAMF PT.AX wpr.
l
-rPmar co- tsih (far (ow 1,696.00 -SF
_.
PORCi'aPATiO .t1ci Sr
4•iARA01YCA"ORT i.43<L10 S#'
LeSTI'R",.X SIS COST Of?" C ONSrfIRIUC 110
i91 ,?1;t.�4D
PERIAIT FEE15UKIM.1RY
GOa,VSI1•F2JCTIc:�lIrrh 101 -000418 -OW $07Jkv
PLIA14 CHECK, FLIP' .101.000-41)--318 S138.32
r.�t�:�'rr�wa�•a c i.. W ilii AfkA 4'94 hr411 Nrtch
itlAlit•:•,f.•!tU`t.R�atMe.r Ze, lV11VAP _4&4_VVV '04U. W
OUC"iW(,"AL 10.1-000-420-060 91.19.3z
Pf.(TN1WN0.FEf3 10.14104419-000 $148-00
4'1"x2Gt•lQ!Y1f,MfyNF1R .-12NAD 101•.f}(iO.241-0,0 Ci(,>A�
ORAD1ICi RE. - S20,00
1.�k.BLA,Trt3.'li(`.'f1.Y".hr9 st:4,2 ,19
AWr N {.''t1F4E,10 PLACES - RT..,,SI_ a '20 1 000-255-000 $.11.92
, 'act. C31�15IRlfCIit�1~iANe 1°1JA CkIL•C ,
$3,500,93
r� U USS PRE -PAID - 1i,S
JUIN 1®1999
T0T PE12N fT fii+'.,1 S OUE NOW
�aDATE
RECEIPT
BYfY
D F ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade V,Return
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
O—
F.A.U.
Framing
e — "j,
Compressor
Insulation
fi .
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Watt Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�o
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
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
Final �o
Utility Notice (Perm)
r
NOV-19-99 FRI 11:52 WESTERN INSULATION FAX NO. 9096868786
WESTERN I1 SULA`T'ION t INC &
4211 Lam a gmreem, Riser ide, Calif rnia 92501
(909) 6864760
(909) 6864786 Fox
INSULATION CERTIFICATE
P. 21
THIS JS 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#: 24 PLAN 3
SITE ADDRESS: 45-210 BIRCHCREST CIRCLE, LA QUINTA, CA.
FXTEIRIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS-: BATTS BLO
MANUFACTURER: GREENSTONE THICKNESS: 8.1" R -VALUE: R-30
GENERAL CONTRACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
AMERICAN COMPANY
INSULATON CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY
TITLE: troduction an er
DATE: NOVEMBER 19,1999