9810-195 (SFD)LICENSED CON TRACTOR'16ECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
ham- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
t 04 UJ Professionals Code, and my License is in full force and effect.
=) License # Lic. Class Exp. Date
d 619ia4 B li3i/
t`
oZ r— Pat j — Signature of Contractor At"
CD Q
J U C:) OWNER -BUILDER DECLARATION
HLU r I hereby affirm under penalty of perjury that I am exempt from the Contractor's
a- 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). '
t'r) () I am exempt under Section B&P.C. for this reason
LID
N Date Signature of Owner
O C\I
Q WORKER'S COMPENSATION DECLARATION
D I hereby affirm under penalty of perjury one of the following declarations:
LO 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 J Q performance of the work for which this permit is issued.
m QU ( ) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
d M Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
,t tUNID
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 shall forthwith comply with thse provisi
oons. �
[date:Applicant "V 4,A-n��
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..) agree to comply with all City, and State laws relating to the building
construtction'and hereby authorize representatives of this City to enter upon
thee -hove -mentioned property for inspection P', poses,
Sfgnature (Owner/Agent) �`� e A Date A�✓s�
r
BUILDING' PERMIT PERMIT#
DATE r 1/ VALUATION LOT }S =TRACT '4995
JOB SITE
ADDRESS Fh--fljjO.'dCg�Ysgf:A1V �'. I
APN3U-SE�t1-{/�.�
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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ARROW
UPLAND CA 91.185
UPLAND C.A. 91795
USE OF PERMIT
A CL FAMILY La'E .LING
;Tr.0. L(,,T 413; �?l AQ4 1A, .0 BRIWT DOES NOT.1- iJl��i SL( 1— WALL
0K POOL. '
r
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tai?tdi'T1l2'1iid:4J 70.00 B
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c4.A(0AGbYCAf(P1(*t' 4J6.0f) :ar
- 03"1' a°.i�IATED COST OF CONSTRUCTION
g 6 ,g�?-yy �y
10
t C)MISI 'RLTMON ,1 f4' 101-000-418-000 $Y16. K 0
PT1J fdC9uC'?%F.i�N 10!-OQQ-439-;t�3Z V117,50
+Ei;r'%1'1k�Z410-ALF11 Ef?i-{}f�U K1-0300 1i;•M3
E, U60`.► KICAL FEE l �i 1-fk?1)-�2()-�►CfO $ iEiC,. r i
Pt.a: NI.WNG PL 101-000-419-000 $i.3i3:i_►0
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rIP. IIDD[ tc, FEW 1101.,M0423-QU0 ZA0.00
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80—B..V:%A.11 CONSTRUCTIONAND PLAN l:'.i EC,'"
LUSS I'RY-PAID FF1-S
$0.00
1
RECEIPT
DATE
BY `
t..r,
DATE FINALED
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
OX to Wrap
F.A.U.
Framing LCA
Compressor
Insulation
Vents
Fireplace PL.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 6POOLS
BLOCKWALL APPROVA S
- SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 411
Neater Final
Water Piping 7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral p
Pool Cover
Sewer Connection 71,
Encapsulation
Gas Piping
Gas Test 5`
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:
MAY -12-99 WED 12:22 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
P, 10
THIS IS TO CERTIFY. THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORRIIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: DESERT PRIDE TRACT #:23995-3
LOT#: 15 e04.9w / `
SITE ADDRESS: 45-3* COLDBROOK LANE, LA QUINTA, CA
--------------------------------------------------- ---------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKN 3 5/8 " R -VALUE: R-13
CEILINGS : BATTS BLOW
MANUFACTURER: GREENSTONE IND..THICKNESS: 10.3" R -VALUE: R-38
Where inaccessible for Blown insulation: BATTS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
-----------------------------------------------------------------------
GENERAL CONTRACTOR:
LICENSE NUMBER:
.BY:
TITLE:
DATE:
[NCO HOMES CORPORATION
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
:BY.-
TITLE:
Y:TITLE: Production Manag r
DATE: MAY 12, 1999