9905-099 (PAT)U)
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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 # Lia Class Exp. Date
t,
Datg 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.
(� ),41 have and will maintain workers' compensation insurance, as required by
Section 3700 of the L or Code, for the performance of the work for which this
permit is issued. My w kers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section rneed n tt bejcompleted if the permit valuation is forr$$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 provisions of Se tion 3�0 of the Labor
C2de, I shall fo With comply with se provisions `
Date: �__ 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 auth nze representatives of this City to enter upon
the above-mentioned propertAr it insJpecttiion pu ®p�oos�es/t,,,,,.,.. / I
Signature (Owner/Agent) ��°�� f/ `��� ''Date
BUILDING PERMIT PERMIT#
DATE 6.1%1; VALUATION LOT "05-0-" TRACT
$1,675.808 23995-4
JOB SITE
APN
ADDRESS 78-7,95
8-7:n5 ,q IR FPS $CIRCLE
"041021
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1NCO BOOM -S CORP.
[NCO .1101MES C( R_R
1282• fir. ARRIOW Fi` - Y
1282 W. ARROW MVY
UPLAND CA. 91785
UPLAND CA 9:1785
(909)9814989 CK -9 3318
t
USE OF PERMIT
DA'rif"11 .
12.6 S k OPI~N LATT.iC 3, PATIO COVML PLAN CHECK: POWf ION OF
'FEES REDUCED 75°%FOR 14WLTME ISSUANCE OF `.3AME PLAN TYPE.
PORC;10KRO 126.00 SF
�".� T:ii1'IATED CCAST Or CON:4TR UMION
1,675.80
PERMITFEE S[MMA.RY
CONy'T UCT1ON PCL 1.0.1-M-419-4100 .539.00
PLAN CMCK FEE 101-000-439-3,18 $35,35
. S'rP,QNG MOTION FEE - RESID 101-000-241.-000 $.50
SC:IB-",AL CONSTRUC1710.N AND FL.tW C;!'1T•CK
$64,84
LUSS P1: -1PA1l;7..'E?aS
IWO()
TOTAL P.PRNIT.T IC.EES DUE NOW'
61
RECEIPT
DATE
By r
DATE FLN4ED
INSPECTOR
INSPECTION RECORD
,OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Bac';s
Underground Ducts
Forms & Footings
/
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
—
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVAL'S
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
COMMENTS:
'
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
NOV-19-99 FRI 11:43 WESTERN INSULATION FAX NO. 9096868786 P.06
WESTERN INSULATION, INC.
4211 Letham Street, Riverside, Calltcrda 92501
(909) BSB -8760
(909) 688-8786 Fax
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#: 8 PLAN 2
SITE ADDRESS: 78-795 BIRCHCREST CIRCLE, LA QUINTA, CA.
EXTERIOR_ WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINGS BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3"
GENERAL CD CTO
LICENSE NUMBER:
BY:
TITLE:
DATE:
AMERICAN COMPANY
R -VALUE: R-13
R -VALUE: R-38
INSULA lON CONTP.ACTOR: WESTERN INSULATION, INC.
LICENSE N UMBER: 481278
BY:
TITLE: Produ ion Mandg
DATE: NOVEMBER 19,1999