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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
69163 13L
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
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.
ST1VT) k U, 1) 1.490931-97
(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 A revisions of Section 31700 of the Labor
Code, I }�ortlywjih comply with t rovlsio s�
Date: �"" y�{" Applicant— Z—a � �
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 authof)ze representatives of this City to enter upon
the above-mentioned propertyll` 1 inspectio purp�ses'
Signature (Owner/Agent)
BUILDING PERMIT PERMIT* CONTROL#..
/
DATE VALUATION LOT TRACT TRACT 7'
7
$1104,769.80
JOB SITE
ADDRESS 4.5.290 BIRO.11Cit.EST C3 RCL
APN
604-302-014
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1'NCO HOMES CORP.
1NCO HOMES CORP.
1232 Gl' . ARROW 14WY
1282 W. ARROW 14WY
UPLAND CA 917135
UPU0113 CA 911T5
(909)981-89899" . C;13 O 3313
USE OF PERMIT
R\
l
a
LOT 25; PH 2C, PLAN 3.83. S D " PE1l11ai"T.DOES NOT rNC'I<1. DE �.
BLOCK WALLS OR P=0
AUG 12 1999
TRACT CONSIRUC IO:N 1,696.00 SF%.e � J ,
J ;� `� !. y' = t
PORCHMA TO 94.00 S'1
0ARACYRECr1ltPbli'1' x x.00 Sr
ti
FSTUMAX ENYCOST OF CO�'+i `ti'1Ri.IC. ION
114,769.811
PERNUT .IEE SUMMARY
COM. TRUCTI[ONN EEE 101-000-418"i100 $657.00
PLAN CEECK.FEE 101-000-439 318 S553.26
NECH�.,'1ICAt M 101-000.4.27400 $66.50
ELE("1` ICAL IEE 101--000-410.000 $119.5
PIIU111NCI i^ ER 101-000-419-000 $ 148.00
STRONG N10TION FEE -12ESID 101-000-241-000 $10.48
GRAL'�1NG M 1.01-000-423-000 520.00
fIRF 2ASTRUC"'rUk2E.1:RE 225-000443-142 329.19)
ART 1N PUBUC: PLACES RES1L X0.1 -000.25? -000 $11..92
Sr.Y�-'1'O•dAL COwSM {CInCIN PLA- :N CHECK
LESS PRI -PAID FEES
1;f).L"0
TOTAL i'ERIMIT FUS ME NOW
$3.915.97
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�y,
-o"7
Underground Ducts
Ducts
Slab Grade
-- a 14:Return
Air
Steel
Combustion Air
Roof Deck
/� — L— P _
Exhaust Fans
O.K. to Wrap_
p — 3
F.A.U.
Framing
Insulation aAQ S o�+�
_ _y _
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�/ • — a'
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROV LS
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
— p —
beater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
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
t
Final
tility Notice (Perm)
COMMENTS:
JAN -0.8-99 FRI 16:41 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
P. 01
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
TRACT #:23995
LOT#: 25
SITE ADDRESS: 45-290 BIRCHCREST CIRCLE, LA QUINTA , CA
-----------------------------------------------------------------------
-EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS LOW .
MANUFACTURER: GREENSTONE IND. THICKNESS: 8.1 R -VALUE: R-30
-----------------------------------------------------------------------
GENERAL CONTRACTOR: INCO HOMES CORP.
LICENSE NUMBER:
TITLE
DATE:
INSULATION CONTRACTOR, WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
.. BY:- S
TITLE: Production Man ger
DATE: JANUARY 8,1999