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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
6916843 Oit?►1/20f
I9a�=xf� 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.
( Yl have and will maintain workers' compensation insurance, as required by
SgXion 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 eO nNIWe completed if the permit valuation isibr $lolA6�0 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with pg4e provisions.
Vate: r Applicants u _>
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose'request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers,agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above mentioned propertyRfor inspection' urpos s.
/Sgnature (Owner/Agent) / /7 v� Date �� s
BUILDING PERMIT PERMITq .
DATE /' {/o�j�/' VALUATION LOT ��a,�,..,�� TRACT
�//►/` Y/4f S96.646.20 9 239()5-4
JOB SITE
APN
ADDRESS
7&755 Ll111101CREST CTRCLj'11
604-040021
OWNER
CONTRACTOR / DESIGNER / ENGINEER
[NCO HOME CORP.
iNCO HOMES COP.P.
1282 W. AR.RaW fAVY
1282 W. ARROW WY
UPLAND CA 917 85
UPLAND CA 91785
(u09}a1�389 CW 3318
USE OF PERMIT
1
ftANR
Si D - PLAN 18, LOT 9, - P 11T .DOES NOT T 3NCLbM,3 BLOCK WALLS
OR POOL
TRACT CONSTRClC"1',ION 1,411..00 SF
Poll i"i-i pkrlo 141.01) SF
GARA.G&CARPO.'R.'1' 416,00 S
h�
+CSTIMATED COST Or, CONSTRUCTION
86,646.10
FrP,RMIT F IC SUi!$MA.€ Y
CONSTRUCTION FEE 101-000-dt$-{100 5591.011
PLAIN CHECK FEE 111 �0� ��31i3 Si:tO.?s
MECHANICAL FRE $47.00
OXCIWCA1., FEE, 101-000420-000 $106,21
PLIfMt31NQFEE 101,-000-419.000 $1418.00
STROM MOTION FEE - RES LD 101-000-241-000 X5.66
GRAMNO FIEF t01--000-423.000 $120.00
1N`F'1t.AS1'1ZiJMURE FrT, 225-000-443-342 $.1,107.35
S"M-'1'O'I"...Al, CONSTI LIC170N AND :PLiW CHECK
$3,308.94
L'US PkE.'- .A1`f: FE1,:S
$0.00
TOTAL PERMIT FEES .DUE NOW
$3,308.94
RECEIPT
DATE
BY
DA E FIN LE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
E BUILDING
. APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
72 Xg 23
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
?p 6'XV
F.A.U.
Framing
— 3J — 6
Compressor
Insulation
v—
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
lei L
Heater -Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
cge7
67
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
--
Appliances
Final
COMMENTS:
Final Z — _ 2;7 r4
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp, Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final 1
Utility Notice (Perm)
NOV-19-99 FRI 11:41 WESTERN INSULATION FAX NO 9096868786 P.02
WESTERN INSULATION, INC.
4211 Latin 6tmet, RlversWe, Caldaraia 92501
(909) 686.8760
(909) 6x6.4796 F2m
INSULATION CERTIFICATE
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 -PHASE 4 A TRACT #:23995-4
LOT#: 9 PLAN 1
SITE ADDRESS: 78-775 BIRCHCREST CIRCLE, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS : BATTS BL�O
MANUFACTURER: GREENSTONE THICKNESS: 10.3"
GENERAL CONTRAOTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
AMERICAN COMPANY
R -VALUE: R-13
R -VALUE: R-38
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE:rodu - n M nager
DATE: NOVEMBER 19,1999