9806-023 (SFD)LICENSED CONTRACTOR DECLARATION
+F r� 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
WProfessionals Code, and my License is in full force and effect.
5 M License # Lic. Class Exp. Date
O 691684 i3 7/31198
oZ � Datej—�'�:��Signature of Contracto r
C5 0
J I.—C) OWNER -BUILDER DECLARATION
U W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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
LO B&P.C. for this reason
N Date Signature of Owner
O rn
Q WORKER'S COMPENSATION DECLARATION
C) 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 U compensation, as provided for by Section 3700 of the Labor. Code, for the
00 J Q performance of the work for which this permit is issued.
120
Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O 0 QSection 3700 of the Labor Code, for the performance of the work for which this
rn permit is issued: My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
ob a STATE FUND 14911931-97
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' compensati . n provisions�f Se tion 3 00 of the Labor
Code, I s all ort It,�}, comply with ° se provist ns.
Date: :P' 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
anypermit 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 propertyAr r inspectio purpl ses.
Signature (Owner/Agent) Date �-�
PERMIT # CONTROL #
BUILDING PERMIT
980&023
DATE VALUATION $86,646.20 LOT 28 -`.a4:^ TRACT 9a q .3
V
JOB SITE
ADDRESS 45-345.BIRC11CR. r CIRCLE
.
7GOAD 3O3-O�I�3
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES CORP.
XNCO BIOMES CORP.
1282 W. ARROW HWY -
1282 W. ARROW HXVV
UPLPLND CA 91785
UPLAND CA 91785
(909)9§1-8989 C13L# 3318
USE OF PERMIT
LOT 28, PN 20, PLAN 1B. SFD - POU41.i' DOES kOT 1NCLUDF, BLOCK
WALLS OR, .POOL.
AU1,�-
'12ACT C O't4STRUCT10- +I 1;411.00 3
t
- ��9�
PORCWPR T IU °141.00 SF 1 4„
(VARAGWCARPORT 416.00 SF JI 1
0'.,
i.
w. �b
TIMATFD COST OF CONSTRUCT [ON
86,64620
PERrklff EEE SUMMARY
�1
rONSIRUCTION FEE 101.-000-418•-000 $581..00
PLAN CHECK FEE 101-000439-318 5190.','»'
1\4ECHANICAI. FEE 101-000-421-000 547.00
E1.FCTRJC:.4L FFix. 101-000420-000 $106.21
PLUMBING FEE 101-000419-000 $1:18.00
STROMG R.t YHOV' FE.E . RES113 .101-000-241-000 88.66
GRADING FI 101-000-423-000 520.00
1tO RA.STRUCf`URF FEE 225-000-443-342 $.1,907.35
$UB -TOTAL. CONSTR(.!C"1ION -AND FL11N CHECK
$3,308.94
LESS .PP03-PAID FEES
-
TOT.,ILL FER1111T FE ES DUE R OVV
$3,308.94
RECEIPT
DATE
BY
D IN L D
INSPECTOR
00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Ducts
Forms & Footings
_Underground
Ducts
Slab Grade
?4y
Return Air
Steel
Combustion Air
Roof Deck
�/= Q�
Exhaust Fans
O.K. to Wrap
Q d ,{_
`r/ "
F.A.U.
Framing
` o �V
Compressor
Insulation WM5 O.,V L"j-
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
POOLS - SPAS
BLOCKWALL APPROVALS
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
Q� .,�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
�0 /- 4 JS
Pool Cover
Encapsulation
Gas Piping
Gas est
J/
Appliances
Final
COMMENTS:
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
1
Final
Mty Notice (POm)
_