9905-133 (SFD)H
CN U)
W
O CY `M
' W
oZ�
CSD 0. O
I.—
(-) (D
J
LU W 1�
I— a
Z
co
L0
N
ON
U °)
Q
CLZ
LO
a Cc
0
X LU
LL
O. J.Q
co < U
O
2 H
"t Z
C6 5
�O
J
LICENSED CONTRACTOR DECLARATION
I hr 13_ y affirm under penalty of perjury that I am licensed under provisions of
,.,Cha' 1Cr 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
� ,Jt63-4 1
ate !•� , Signature of Contractor ,_ /;
7�
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 sectibqn'QeGfin t be completed if the permit valuation is for $100:0 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 37 0 of the Labor
Code, I shall forthwith comply with those provisions
Date: ��1 �� Applicant—
Warning:
pplicant 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 persomatf
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. #4
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 represen atives of this City to enter upon•
the above-mentioned property for inspection p rpotes.
Signature (Owner/Agent) Date s�y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9905-7.33 TRACT
0611011ai $120.647.40 a2%
JOB SITE
APN
ADDRESS
4-%.2.70 14 r.. t"uii:1 VillR ,
a:i�.l3�4i.ii2!
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES COO.
1NCO HOMES COU.
1`821` ,. A R.ROIN FRVY
12M W.ARROW H%Vf
[UPLIAND CA .91785
LIPLAND CA 91785
(909)981-8981, CBLU 3318
USE OF PERMIT
Sty 1`a - FILM 4 R-3, OT W, - PERMIT DOES N0i NcLUUE B1.00r,
WALLS OR POC .L. PLAN CffECK PC)RTION OT FFF, RFIDUC`;.F,73 75% FOR
AT T1 IPT"I r. Ir 0 Or T. 'hT -"+Y. ^r VA rAr. nt e A4 T .ir,
'IRAC:"1" CO'AI; '.1"RUC'T10N 2,0138.00
180i1,O1- PATi0 .14.00 SIF
GARACxN CARPORT 583.+00 3
ESTINIATIA) MU OF CO NSMUCt'.' ON
120fVA0
t ERWT PEE SUMMARY
CONSTRUCTION "'I-,; 101 -000 -41& -WO ST1100
MAN CjH4M :PIM 101-000-439-318 S147.79
iLifit;HANICAL FFE 101-000-1121.000 $47.00
FLEC'IMICAL F:E 301-000-420.000 $130.44
PLIJMAI.NQ .FIRi 101-000-419-000 $148.00
STRONG MOTION FEE. - RESID 101-000-241-000 `f:12.06
fY"RADWO FFX- 101-0004'2300 $20.00
lNFR:A.S'1(1K1;C. F( 9:F'U 2:25-000-443-342 $2,710.38
ARAN PUBLIC iI.,ACES - RESID 701-000.155.000 $51.62
.3
'fit 1
t
4 e,
SM -TOTAL + ONSTROCTION AND PLAN CHECK
$3,980.29
LP ,SS 1".RE.,PAID FRU,
$0.00
'f0TAF, 'PE` tiil�Yr FEES DUE NO'vVr
$3,980.29
JUN 1
01999
Y7
RECEIPT A N�Gd Q
DATE r „•
BY
DATE FIPALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Hacks
Underground Ducts
Forms & Footings//,
Ducts
Slab Grade y^ y
Return Air
Steel
Combustion Air
Roof Deck —
Exhaust Fans
0. K. to Wrap
Framing C7-tv—�
F.A.U.
Compressor
insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath D
Drywall - Int. Lath —
Final
Final z j I C17 k
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 T
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral A 4
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test / —
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Ro h Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final4-4—
Utility Notice (Perm)
COMMENTS:
'NOV-19-99 FRI 11:55 WESTERN INSULATION FAX NO 9096868786
P. 27
WESTERN INSULATION, INC9
4211 Latham 9tseeto Ri"roldo, C&Uforx" 92601
(909) 686-8760
(909) 4864786 Pax
INSULT-I.Q i CERTIFICATE
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#: 27 PLAN 4
SITE ADDRESS: 45-270 BIRCHCREST CIRCLE, LA QUINTA, CA.
IEMERi R WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 8.1"
R -VALUE: R-13
R -VALUE: R-30
I N—f-RAL. CONTRACTQIL- AMERICAN COMPANY
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU ER: 481278
BY:
TITLE: ProductimaNager
DATE: NOVEMBER 19,1999
r
I