9905-096 (SFD)`r LICENSED CONTRACTOR DECLARATION
( 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
W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
I-- (3 In r
$ &Q-3rZ41
CS Z r- Date / /� 1,5!0 Signature of Contractor �i1 •�,
t0 O.
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_J OWNER -BUILDER DECLARATION
J
W 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).
LO () I am exempt under Section B&P.C. for this reason — A
O N Date 1Y/J. �, Signature of Owner CI: • .�•._./� .. .:
rn
Q WORKER'S COMPENSATION DECLARATION
CL
O Z I hereby affirm under penalty of perjury one of the following declarations:
LID - O () 1 have and will maintain a certificate of consent to self insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor'Code, for the
Om J Q performance of the work for which this permit is issued.
Q C)).--1�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
LO
H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
�d
57'A: T P. FL)YdI3 1490-31-98
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall, forthwith comply with thit e provisions. % ,of_
Date: Applicant�1p� Aa�-
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 property for inspection pu�oses.
Signature (Owner/Agent) 4 ✓�^ ».,Date �'1111ki?
BUILDING PERMIT PERMIT#
9905-09ii
DATE L. VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 7Q• -[f 15 RCHCRES����{' CLE
604-440-021604-440-021OWNER
CONTRACTOR / DESIGNER / ENGINEER
INCO HOMES COP P,
INCO HOMES CORP-... '
1282 W. A:RROXV MY
1282'W. ,ARROW fiWY
UPLAND CA 91785
UPLAND CA 91785
(909}9�.t�8z389 CBL# 3313
USE OF PERMIT
viri : VAIkA 11 V 0 VV I t IMC'
rU - KAMA, :LOT7, - PERMiT DOES NOT i'NCi:;W E BLOCK WALLS O
POOL- PLAN 1CCK PORTION OF FE1?..€2EDUCED 751/a FOR 141[AMPY rl
TSST_fANt^_E OF SAkM PLA 14 TYPE.
'r.RKCT COKSTRUC 1014 2,0l1.'i,00 SF
PORGUTATIO 14.00 SF
GARAWC;ARPORT 513.00 Sr
GATEMA.'TK+DCOST O Ci).ms;fI<iL'TC`1'ioN
1.21'PAV7.40iii
PERMIH FEE SL111 MARY
CO.NS'nZVCT.ION M 10.1 -OW -11)9-000 $713.00
FLAN CHECK FES 101-000-439-313 5147.79
N1F..CH4kNI.CAL, FEE 101-000421-000 547.00
ELECTRICAL FRE 101-000-420-000 $134.44
PLUiV BINO FEE 101-000-419-000 $143.00
STRONG MOTION FEE -RESH) 101-000-:241-000 $12.06
GRADI No FIT, 101.000-423-000 X70.00
1Nb•RAST'RUCT URE FEE 225-000443-342 $2,110.38
ART 1N:iPUELIC KAVES - RESIE '701-000.2:55-000 $51.62
SUR -TOTAL CONSTIZUC CION AND PLAN CHECK
$3,980.29
ESS .P.ttE-:PA.t.D 17,11"CS
$(1.0(1
TOTAL PERMIT FEES DUE N08Y
$3,980.21
RECEIPT
DATE
BY /
DA LED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
22 1 56K
Return Air
Steel
Combustion Air
Roof Deck
—8 9 9 666
Exhaust Fans
OX to Wrap
V-20— p B AF.A.U.
Framing
ZZ— 9 6,<4
Compressor
Insulation
8
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
O
Drywall - Int. Lath
d —/— B
Final
Final — —V-91 /—`1
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
F
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Neater 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
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: