9905-131 (SFD)U)
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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
Date Signature of Cont actor
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 37001of 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.
r� tN -, Q,�1,� �n
(This sectib"hj�n I �t bI completed if the permit valuation M1011f n"2 0.0b 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' compensatiorip rovisions of Section 3700 of the Labor
Code, I shall forthwith comply with tho�'e provisions
Date: ✓ 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 authorize representatives of this City to enter upon
the above-mentioned property or inspection purpose .
/gnature (Owner/Agent) • _. Date U G1
BUILDING PERMIT • PERMIT #
9 TRACT
DATE VALUATION LOT 05.131`
06/141/199 $120,647.40 23 23995-4 '
JOB SITE
N
ADDRESS 17
r
45- 10 JAIRERCRENT CIRCLE
604-040-0211
OWNER CONTRACTOR/DESIGNER/ENGINEER
1NCOHOMES CORP. ]NCO HOMES CORP.
1282 t)t%.. ARROW ff% Y 3282 W. A.RR1".iW HWY
UPLAND CA. 9178.5 UPLAND CA 91785
(909)3131-8983 C.BL# 3318
USE OF PERMIT
..•�1v d ,. „ , '[`tAR. r L v -,,. .1...44 �
t,
5170 - PL A14 4.AR-3, .LOT' ,-,5, - PMMIT DOES NOT INCLUDE BLOCK
WA1.,LS' OR. POOL. PI Ai'4 :'HECK PORT,TON Cir FE -E REDTJr,.M 75°/O FCiR
,14n VMJ V7 TQ1ct IA1 41 A A.fr W A t.
77tACi CONSTiWCION 2,008.00 SF
PORCHIP.ATTO 14.0 aF
f.rARAGEICARPORT 583.00 SF
CSTIMAXUD C`i2ST tilt CONST R11C`1'iL' N
1120,6 :7.40
PE:RMiT FEE SVKMARY
CON31rR[7C'!'lc)N FOR I01-000_`118-000 $713.00
PL.;N, N CHECK :h EE 101-000-139-318 $147.79
MECHANICAL .F' 101-000-421-000 $47.00
RL.ECTRICAL M. 101-000-420-000 $130.44
PLUMA1WO FEE 101400-419-000 $14$,00
S'TRONO MOTION Fa - RESID 101-000-241-000 $12.06
GRAMING.FIR 1.01-000-423-000 $1�0-00
INN.R.ASTRtJC'rLT4t1, KEE 2��-000-443.342 x2,71(1.38
ART IN PUBLIC PLAC04 - RF•S1C -40.1-000-255.000 551.62
A
¢: SLIB-T(YFAL CON SfRU01ON AND PLAN CHECK
$3,180.2.7
•ti 7"L�Si n7)!? 03,o 1 L'('Y^tti
►BEY.. t ^ld "F Kt V .L' Lr 40
J.•n flrt
TOTAL P'ERWf f EES DUE Now
$3,980.29
SUN 10* 1999
REC€IP.Ttj b 11,
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BY$
DAT NALED
INSPECTOR
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[DATE,
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it
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
_2 6'
Exhaust Fans
OX to Wrap
e
F.A.U.
Framing.
d —/7_ y 'V
Compressor
Insulation
4,2Vents
Fireplace P.L:
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�.
Drywall - Int. Lath
Final
Final f -z - 2i" °?
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
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
/ G
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 �—
Utility Notice (Penn)
COMMENTS:
4OV-19-99 FRI 1154 WESTERN 1 NSULAT I ON FAX NO. 9096868786 P,26
WESTERN INSULATIONS INCe
4211 Latham Street, W"iside, C&Hf raia 92501
(909)'686.8760
(909) 666.8786 FaN
INSULATION CERTIFICATE
TH)S 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 #:239954
LOT#: 25 PLAN 4
SITE ADDRESS: 45-230 BIRCHCREST CIRCLE, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTSBLOW
MANUFACTURER: GREENSTONE THICKNESS: 8.1°
GENERAL CONTRACTOR: AMERICAN COMPANY
LICENSE NUMBER:
BY:.
TITLE:
DATE:
R -VALUE: R-30
INSULATIO CONTRA T R: WESTERN INSULATION, INC_
LICENSE NUBER: 481278
BY:
TITLE: rodu i n Manigit
DATE: NOVEMBER 19,1999