9806-020 (PAT)4, LICENSED CONTRACTOR DECLARATION
' I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. ClaIL
Exp. Date
r- Q u7
LLJ
r
oZ Date"' Signature of Contractor `
toot
OWNER -BUILDER DECLARATION
Ha I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) 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).
C'') () I am exempt under Section
ur) B&P.C. for this reason
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
o Ir I hereby affirm under penalty of perjury one of the following declarations:
O 1 have and will maintain a certificate of consent to self -insure for workers'
X w �L- compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
Cal Q I have and will maintain workers' compensation insurance, as required by
O Ua" Section 3700 of the Labor Code, for the performance of the work for which this
LO
H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
DD 5
0
J (This section n ed not be or completed if the permit valuation is 1 .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' compensati n provisions of Sect' 3700 of the Labor
Code, I hall forthwith comply with th se provisio _
Date ^ C r Applicant �- ,��. jK —
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
4 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 representativesiof this City to enter upon
the above-mentioned propey, for inspection rppo
Signature (Owner/Agent)
rt
•C/
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT, 9806-p20 TRACT 7129
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO 41.0MES CORP.
INCO HOMFS CORP.
1.282'W. ARROW HWY
1382 W. ARROW HW Y
UPLAND CA 91785
UPLAND CA 91'85
(909)981-8989 C8L# 3318
USE OF PERMIT
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06S.F. 0PFN'1'1"7Fi.1,1S F'!1.'rzi3 COV1'R. J -'.,LJ
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All
FORCH&AVO SF,., FN 0'F
i_, ;,1:
IESTIMA'fED COST O_ti CO NS'1 kUC7ION
.1,05.80
PERhfff FEE SUMMARY
CONSTRUCTIONFF„E 1:31-003418-030 $39.00
PLAN CHECK FEE 101-000-439-318 $25.35
STRONG MOTION FEF - REsID lfll -000-241.OW S.50
CUB -TOTAL CONSTRUC' ON AND� PLAN CHECK
$04.85
1JI.JSM3 Pi��-P1�11� ll.Cai.1.5
�G.U11
TOTAL PERMIT FV DUE NOW
$64.85
RECEIPT
DATE
BY
DA NALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings L
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA S
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
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
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
UWity Notice (Perm)
COMMENTS: