9905-098 (PAT)N_
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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
Date ffl� B IP.20(
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., r this reason
Date—Signature of Ownei ''
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
Secti n 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 need nottiejcompleted if the permit valuation is foor'$�0:00 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' compensationiprovisions of Section 37 0 of the Labor
Code, I shall;forthwith comply with ths. e provisions.
Date: � y� Applicant,Z21/24 ► ^
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 fo°inspectionpQurrp/ses..
Signature (Owner/Agent) r, r % '�.ers r,�'��1 Date
r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 99055095 TRACT
$1,795.311 6 23935-11
JOB SITE
APN
ADDRESS
78-935 BtRCfiCREST CIRCLE
604-04+1-021
OWNER
CONTRACTOR/DESIGNER/ENGINEER
[NCO HON%FS CORP,
INCO.HOMFS CORP.
1282 W. ARROW H41 Y
1282 W. AIMOW WY
UPLAND CA 9.1785
UPLAND CA 91785
(909)48.1-8989 CBU 33.18
USE OF PERMIT
P 001a
133 S.F. OPEN I.,AT'I"iCT PATIO COVER.
a
:PORC. PAT 1O 139>i30 Sl:
1.STIRIA.'I`LA COST Of i:tDNSi`ti'CWOFIO el
1,795.5w. -
PERMIT FlEdt; SUMMARY
COIv:3TRUCT.ION FEE 101-000-4194)00 1111.00
PL AN CHECK M 101-000-439-318 326.25
STRONG MOTIOIN' 1±13-E - RESID 101-000-241-000 $.50
5i7H�'!'C7T 11�. CO:NSMUMON AND PLAN CHECK
$67.75
1.IFSS PPE -.PAID 1+ ES
$0.110
TOTAL P.Uit:t OT FTES DUE4 NOW
$67.75
RECEIPT
DATE'
BY
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
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 _ a—
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final — v -
Underground Plbg. Test
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
NOV-19-99 FRI 11:47 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATIONINC.
4211 Lat am Street, JUvexside, Ca Wornie 92601
(909) eas-3760
(9o91686.8726 pax
P. 12
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#: 6 PLAN 4
SITE ADDRESS: 78-835 BIRCHCREST CIRCLE, LA QUINTA, CA_
EX[ERIOR, WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTS
MANUFACTURER: GREENSTONE
GENEKAL CONTP.ACTOR:
LICENSE NUMBER:
BY:
TITLE:
DATE:
Law
THICKNESS: 81"
AMERICAN COMPANY
R -VALUE: R-30
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
• BY:
71TLE: rodu n M age
DATE: NOVEMBER 19,1999
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