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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
/s9 68
✓V��f '
Date-
Signature of Contractor I I Ak_!Z�i
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). 1
( ) I am exempt under Section , B&P.C. for this reason
Date I 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.
(\)• 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 M Pot'6e completed if the permit valuation iso or $116 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' compensatio provisions of Section 3700 of the Labor
Code{I h with comply with a provision .
V/.1 2 Applicant
Warning: Failure to secure Workers' Compensafion 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 resulYof 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 represent ti es of this City to enter upon
the above-mentioned propert f r inspection pur ose
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE ) fi VALUATION LOT 9"5.105 TRACT
5120,647.40 2 • ini15
JOB SIVE `
APN
ADDRESS
11
OWNER CONTRACTOR/DESIGNER/ENGINEER
[NCO HOMES CORP. [NCO DORIES CORP.
1282 XV. ARROW HW' 1282 W. ARROW HWY
UPLAND CA 91,785 'UPLAND CA 91785
(90919131-8989 CRI.# 3318
USE OF PERMIT
FD - Pi. F144.8P, LOT12, - PERNT DOES NOT INCLUDE BLOCK WALLS
OR POOL. PLAN CHECK PORTION OF FEE RFDUCFD 756/o FOR. NIULTIPLV
C, Q? T Ttl-i' nC 2 AT. AAt C
TRACT CONSTRUCTION 2,008,00 SP`
PORCH/PALT10 14.00 SF
GARAG&CARPORT 533.00 SF
t:S TMATED COST OF IWNS RUCTION
1.219,6147.41)
PE1R11f (T F EE SYAV MARY
CONSTRUC1'ION'FF.E 101.000418.000 ,$713.00
PLAN C111X_% IFEB 101-000-439-318 $147.79
NIEC HANICAL FEE 101-000-421-00.0 $47.00
ELECTILICAL nM' 101-000.420-000 $00,44
PLUM RING FEB 101-000-419-000 $.14$.00
VRONG MOTION.Fa, - RID 101-000-241-000 $12.06
GRADINO FM 10.1-000-423.400 $219.00
INFRASTRUCTURE FEE 225-000-443-342 $2,710.38
ART IN'PU7BILIC PLACES-,RWS1r 7P1.-000-25$-000 $.51.62
t
k
N
Mh-TOTAL CONS'? i%UC'1`10N AND PLAN CHECK
$3,980.29
t L.L'SS PRE -.PAID FEES
SE
$0,00
� OT.tii..1'.TEii11'MIT FEES DtfE NOW
$3,9813.:69
RECEIPT
DATE
BY .F
DA EN4tED
INSPECTOR
� as
o
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION DATE
INSPECTOR
4 BUILDING
`
APPROVALS
MECHANICAL APPROVALS
Set Backs
Main Drain
Underground Ducts
Forms & Footings
Approval to Cover
Ducts
Slab Grade
Return Air
Steel
Underground Plbg. Test
Combustion Air
Roof Deck
Gas Piping
PLUMBING
Exhaust Fans
O.K. to Wrap
Waste Lines
:V/
F.A.U.
Framing
Plumbing Final
Compressor
Insulation
v -
Shower Pans
Vents
Fireplace P.L,
Sewer Lateral
Grills
Fireplace T.O.
Encapsulation
Fans & Controls
Party Wall Insulation
Gas Test
Condensate Lines
Party all Firewall
Exterior Lath
Drvwall - Int. Lath
VD— q?
E 44 --
mnar r/o-y 1 4,
Utility Notice (Gas) ir
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
TemD. Use of Power
Notice
Final
COMMENTS:
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs-
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
—r/'
Gas Test
mnar r/o-y 1 4,
Utility Notice (Gas) ir
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
TemD. Use of Power
Notice
Final
COMMENTS:
NOV-19-99 FRI 11:48 WESTERN INSULATION FAX NO. 9096868786 P,14
WESTERN INSULATION, INC.
4011 Latham Street, Ri"raide, calif6mia 92501
(909) 686.8760
(909) 686-8786 Sass
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WIT 111.1 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 0:2399.5-4
LOT#: 12 PLAN 4
SITE.ADDRESS: 78-800 BIRCHCREST CIRCLE, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8
CEILINQ: BATTS
MANUFACTURER: GREENSTONE
LOW
THICKNESS: 8.1"
R -VALUE: R-13
R -VALUE: R-3.0
GENERAL ,ERAL CONTRACTOR: AMERICAN COMPANY
LICENSE NUMBER:
BY:
TITLE:
DACE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC,
LICENSE NUMBER: 481278
BY
TITLE:P odu ion anag
DATE: NOVEMBER 19,19