9905-122 (SFD)LICENSED CONTRACTOR DECLARATION V
I ! ere) y,4,ffirm under penalty of perjury that I am licensed under provisions of
Chapterd1commencing 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
691614 3 % 6/ Ot
Plate f�� r✓� Signature Of Contractor ,� w
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 coniraciing with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() 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
S � , ion 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 secti0'i� M FA if the permit valuation its#fbrl$1t 0. 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 mariner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation Ap ovisions of Section 3700 of the Labor
Code, I shalt -forthwith comply with thos provisions./
Date: // Applicant , I
k^ ning: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 propertyJfor inspection pur oses
1
$ig ture (Owner/Agent) V. , U -v �� Date_,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9€l5-1,22 TRACT
916/18/199 5120,647.4{! - 3 -- .... 2-3%)5-4
JOB SITE
ADDRESS -
"J"9-835 PAb4KBROO1K.00ii1' T
6f34-4: )4)21
OWNER '" CONTRACTOR/DESIGNER/ENGINEER
INiCO HOMES CORP. INCO ROMES CORP,
1:182 W, ARROW HWY 1282 W. ARROW HWY
UPLAND CA 91785 UPLAND CA .91785
(909)981-8989 CBL# 3318
USE OF PERMIT
SFD-•:PLPLN 4CT2.-3, LOT 3, - PERMYr DOES NOT INC"LtOR 13I.6eh,
WALLS OR P010L.
TRACT CONST R.U'*CTION x,0t)8.t1() SF
PORCHAPATI.O 14.0 SP
CARACTFYCi,WO.R`C 583,00 5F
I.P-M AT.CD COST OF CONS't'[tifC"1'fON
120,647.40,
PERMIT FE E S[1N1MARY
CONS RUCnONFLE 101-000-419-000 871,3.00
PLAN CIiECK FEE 101-000-43.9-318 $591.16
ItitFXHAXt1CrAL- FEE 101-0W421-000 547.00
ELECrKICAI. FEE 101-000-420-000 5130.44
PLUMBING FEE 101-000-119-000 $148.00
S 1'.KO' G MOTION F 9r, - RCSU.i 101-000.211-000 $1:2.06
GRADING .FEE, 101-000423-000 $20.00
1NFR.A.S'1TKOC:'1:' IKE FEE. :2.25-000-413-342 $2171039
ART I' NJ POBUC PLACES - R'ESII: 701<000-255-000
StJ13- TOTAL CONSSTRl3G' ION AND PLAN CHEICR.
$4,E42166
LESS Pli,&PAID 111!.5
TOTr4l'., P.ERAHT F E FS IDtFE NOW
$4,423.66
RECEIPT
DATE `�
BY V
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
S
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground. Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K to Wrap
—28—'57GJ
F.A.U.
Framing
p — 6
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
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
t 7 -'
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
UU14 Notice (Perm)
COMMENTS:
NOV-19-99 FRI 11:53 'WESTERN INSULATION FAX NO. 9096868786 P.23
WESTERN INSULATION., INC. 4
41 Latham 9t=ct, Rlwadde, C4ifbrata 9150
(909)686-8760
(909)686.8786 Fax
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TIT -E 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: DESERT PRIDE -PHASE 4. B' TRACT #:239954.
LOT*: 3 PLAN 4
SITE ADDRESS: 78-835 PARKBROOK COURT, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER:. JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE:. k-13
!CEILINGS; BAITS B� LOQ
MANUFACTURER: GREENSTONE THICKNESS: 8.1' R -VALUE: 1-30
GENERAL CONTRACTOR: AMERICAN COMPANY
LICENSE NUMBER:
BY:
:. TITLE:
DATE:
INSULATION COLlITRACT�Ri WESTERN fNSIJLAT.ION, INC.-
LICENSE NZ481278
BY:
TITLE: J Prod to Mar r
DATE: NOVEMBEk 19,1 9'