9806-021 (SFD)II v
LICENSED CONTRACTOR DECLARATION
C/) �I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
O n M License # Lic. Class Exp. Date
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,-- X 691.6184 B ?t31.1 $
oZ Date /1 -Signature of Contractor 1,�•J,�
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U
CD OWNER -BUILDER DECLARATION
W W r I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ � License Law for the following reason:
Z ( ) I, as owner of the property, or my employees with wages as their sole
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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 ISignature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
(K) 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 eed not be3completed if the permit valuation i1490931-97
Rfor $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 rovisions of Section 3700 of the Labor
Code, I shall forthwith comply with th p e provisions)
Date,,�T 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 f this City to enter upon
the above-mentioned property forinspection purpose .
Signature (Owner/Agent) ate
PERMIT# CONTROL# ,
BUILDING PERMIT
DATE VALUATION LOT .9806:-021:1 TRACT 1
$95,567.40 271
JOB SITE
APN
ADDRESS
45-325 BIRCHCRES'! CIRCLE
6041-303-0112
OWNER —
CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES CORP.
:NCIH I.OMES CORP..
1291W, ARROW HVVY
1282 W. ARROW HWY
UPLAND CA. 91785
UPLAND CA 917135
(90svp81.8989 CBL# 3318
,
USE OF PERMIT
4r�t1
LOT Z7, PH 2C, .PLAN 2118. SigD - PERMIT DOES NOT INC'I:(M
FLOCK. WALLS OR POOL, PLAN C1If'CK PORTTON OF FEES RI -MIX ED r iu
rOR X41 rf.TTPI.F TSST J 1„ OF S N LA
AU
3 1 t" 1999
TRACT CONST.R11C710N SF ��
PORCHIPATIO 1 Si' � � �
r r" � mT, A
/6.00
-a . 7 9' !
rxaRA.GEICARPORT 41.8.011 S1+
'
E, ST COST Or CONS1 R&.rMN
6'; 1
PERI1iT"f FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 5621.50
PLAN CHECK FEB 1.01-000-439-313 $130.67
NfEC RANICAL FEW, 10.1-000-421-000 543,50
ELECTR(CA), FEE 101-OS10Wd20-0Gt) $111.67
PLUMBING FEE 101-000-419-000 $148.110
STRONO MOTION FEF. - RESTD • 101-000-241-000 $9.56
GRADING FEE 101-000-423-000 Sa0.f1tD
1NFRAS 1'l UCTURE F13- : 2154 NO -443-342 $2,097.60
SL S =1'C nkL C VN -muCTiU'N AND PLAN CHECK
LESS ,PRE -PAID TEES
$0.00
TOTAL PtRtNUT FEES DUE NOW
'33,'19Z,gt1
RECEIPT.
DATE
BY
DATFINAL D
ZI
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
/4
Compressor
Insulation Zu}Ilcio�t�
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
!� _
Drywall - Int. Lath
-
Final
Finalt
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Sewer Connection
�o= Q Y ��
Pool Cover
Encapsulation
Gas Piping
Gas Test
30`�
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
r
Final '/
Utility Notice (Perm) �9 3�� � I
COMMENTS: