9905-106 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F- 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.
p 5 ch License # Lic. Class Exp. Date
to ZO � '
Date ,� //i ignature of Contractor
t` I.— �
J OWNER -BUILDER DECLARATION
W W r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co 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).
LO
() I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:.
r< O () '1 have and will maintain a certificate of consent to self -insure for workers'
X W L compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C0 Q U ( ) 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
Q 0 Z permit is issued. My workers' compensation insurance carrier & policy no..are:
Carrier Policy No.
DO n ,.
r C'1
STA.°C'F FLU-) 1490P.1-98
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.
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sha forthwith comply with t o e'provisions.
4�te�� /nom Applicant 7
Warning: Failureto 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 6. inspection purposes.
t /
Signature (Owner/Agent) f d ate /i/t!i
Y �!�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 994)5-106 TRACT
$85,701.9013 23995-4
JOB Slfd- ' r
APN
ADDRESS
78-11.10 Bff(CHCRiEST CIRCLE 5
604-040-02.1.
OWNER - CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES CORP. INCO HOMES CORP.
1292 W. ARROW I- WY 1282 V.ARR W HWY
UPLJOI13 CA 91785 UPLAND CA 91785
C,BL# 3318
f909}.981-898��
USE OF PERMIT
, 4i "�i+ Y lY
4 1' VA,
SFD -PLAN 1A, LOT 13, - PI,R t1T DOES N43T rNCALMF, BLOCK WALLS
OR.POO.1—PLAN CUEC.K PORTION OF FEE '1110i 11110U05375% FOR MW.TIPLF
*%R 1A NWF O9 _AW TVPF
TRACT CONSTRLVrION 1,411.0(3 SF
PORC" EDVATIO 70.00 9F
C, tARAI30CA;12F'ORT 416.00 SF
CSTUNIA'1ED COSTOF CO NS''URUC"I'ION
PE RNITT FEE SUM.r% RY
CONSTRUCTION FEE 101=0100-419-000 $576.50
PLAN CHECK Fes• 101-000-439.3.113 $121.88
MECHAN:IC.AL, FEE 10.1-M)-421-000 $47.W
0" XC 17RICAL ME 101000420-000 S 1,0 c.21
P11UMB NCx FR6 101-)(3 A 1.9-000 $118.00
STRONG MOTION .P' - RESID 101-000-241-11013 $8.57
GRADING FEE :101-1X30-4233-000' $20.00
1NHRA:S'i12tIG�l il3 'FFE ^:' 225-1100-443-342 $.1,967.3.5
i1 'ikL CONSMUC'IION AND PLAN CRECK
$2,935,51
®1999 LESS P.1'.l;-.PAID FEES
< <,
' PERNUT FEES DUE IOW
52.,935m
QU 6b�
RECEIPT
DATE
BY j
DATEF ALE
INSPECTOR
e: 9 1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs `
Underground Ducts
Forms & Footings 4e. d
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-$. /�-
Exhaust Fans
O.K to Wrap
_
-
F.A.U.
Framing
Compressor
Insulation
--
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
d - Z -
Drywall - Int. Lath
/O- - 6 P --
Final
Final Z— -
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
Gas Test
Appliances
Final
Final zjD-
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
Final
Utility Notice (Perm)
COMMENTS:
NOV-19-99 FRI 11:42 WESTERN INSULATION FAX NO. 9096868786 P,04
WESTERN INSULATIONt INC.
4211 Latham Street, Rfvtxsidt, CoUtbram 92501
(909) 686.8760
(909) 6864786 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#: 13 PLAN 1
SITE ADDRESS: 78-710 BIRCHCREST CIRCLE, LA OUINTA, CA.
EXTER(OR WALT' c;
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS; BATTS `LOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: AMERICAN COMPANY
LICENSE NUMBER:
BY:
TITLE;
DATE:
Ih15ULA "ION CONTRACTWESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
.. gLA.�
TITLE: r—oducWn nager U
_
DATE: NOVEMBER 19,1999