9806-016 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H 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 =) M License # Lic. Class Exp. Date
OLLJ 691634 B 7/31/98
oZ r- Date ,,�;�T.LSignature of Contractor � p` � ,.•,,,,
CD 0
I- ~C) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 1, 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).
( ) 1, as owher'of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
co() I am exempt under Section B&P.C.'for this reason
N Date Signature of Owner
ON
d Z WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one,of the following declarations:
LO O 1 have and will maintain a certificate of consent to self -insure for workers'
X W c6mpensation, as provided for by Section 3700 of the Labor Code, for the
00 � Q performance of the work for which this permit is issued.
. Q 0 ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
F- permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
�a
J (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
3 ,subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. i t
Date: 0Applicantg¢ � �./ • 7-"'"
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 r inspection purposes
Signature (Owner/Agent) �! .Date '
PERMIT # CONTROL #
BUILDING PERMIT.{�,
DATE VALUATION S98,7$2,,.S0 LOT 1 i TRACT
271,54
` ?y i
JOB SITE
1118 LA,
APN
2
ADDRESS LtRF.SACIR
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IN'(110 H()kf cs COARXI.
INCY) f 10AIJ."s CORP,
12K W.ARROW MY
1282 W. A111ROW ffWY
UPLAND (;A 91[785
U )T,ANb CA 91795
Cit.# 3315
USE OF PERMIT
SM
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man
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IRAC1 CONSTRUCTION 1,566.00-Sp00IM!?14K1'l.0
yp yu��
151.00
VA92A10i:aiCArt7.!1QR:f• 591J,00 SY
+'.'€�hi3'1'Rt7E"'�xfytJ �`ias' If)l-f1(i(j_F.IDS-UtH) �3as.tt4}
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ctiif�4`Lirif llt X11, 3%1: i01-OQO-)tid-(iQ(? $5150
Li}..t (A'3•+tfr'_`Af_.,hid iCii• )4-a2O th?(1 $115.29
Pl IM131,14+FRE $148,00
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LESS PR -1AIU i"TuES
r
RECEIPT •
DATE
BY
D E INAL
qq
INSPECTOR
/ I I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
,e fj ,
Underground Ducts
Forms $ Footings
-"�T
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- :2 ---C
Exhaust Fans
O.K to Wrap
-p _ ys
F.A.U.
Framing
insulation
r�� y - Q g'
. 90'
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
g -.70 -yr
1 4
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 Pibg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- /B -
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
�p .�_Q
Pool Cover
Encapsulation
Gas Piping
Gas Test
/�. • D - ,�
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
I
Final
Utility Notice (Perm)
COMMENTS:
;.,IAN -14-99 THU 09:28
WESTERN INSULATION
FAX NO. 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760 -
(909) 686-8786 Fax
INSULATION CERTIFICATE
P. 03
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 #:23995-2C
LOT#: 23 �G.42icr �2
SITE ADDRESS: 45-330 BIRCHCREST CIRCLE; LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13
• now
CEILINGS : BATTS
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR:
LICENSE NUMBER:
TITLE:
DATE:
•
INCO HOMES
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: Production M nager
DATE: JANUARY 14,1999