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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. ClaExp. Date
691694 13 "7131/00
s��
ate / /V—y�Sissgnature of Contractor k�_.
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. for this reason
Date 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
Section 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 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 Secti 'n 3700 of the Labor
9de, I shall forth it comply with those° provisions.
Date: Applica6t
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 pose
Sig/nature (Owner/Agent) 1,1111"4w r Date
PERMIT # CONTROL J1
t
BUILDING
VALUATION 'PERMIT
DATE111, /,,
20.647,41) oT ,,� �-�
TRACT 2QAS.�7
V
ADDRESS 4:'-k;-,; cau)B;to4a K Lir-4c i JOB
APN 604-040-021.
OWNER
CONTRACTOR / DESIGNER ENGINEER
frNI./ 0�'
Acrl OE111111COV.
=W. ARROW tt YF?Y
1282 W.APUROW HW Y
UPLAND CA 91785
UPLAND CA. 91185
(909)981-9989 c; r, 3318
USE OF PERMIT
SWiI,L FAWL1' DtiVC.LLINC
SF'O, L0>: 4'14, I.Af 40: 1�$3€21t.fii' Nv'%SiJ fad 1NCt,L�UEI3L( b:, (A�t1I;t g f
Uti 1jt�1.. P.L�1 C2'1T1 f. f kR•14�r1;tUCl'll TS',�.Pf:9it iLtu1,'flf )'..E F�i;�UA,`�f�;�? Ur
��`'� `\
SAME I'LL AN .TYPE. �✓✓ �� i
I'VtCTGCiNSanti UC, 110'14 SF
PUiiCi•I&as:r1U 14.00 .'I
0A1tA100CA£t.I'i::M' 583MI) SF
FST.'.IN?iATED COST OF 4; ONST'RUCIaGN
1.20,647.444 ,
PERM';a I:.ECSSU11 71'IA>?' V
CIONS1111t iC; lION FEE 1014lt)1i4ltg-OW S'1.13.�tt1
'K AN OPEC€ rTF
NTY-11AXICAL OFE 101-000-421-000 MIX)
'F.L1%C tYt3CAC Ffi-E 1101-nO00- 20-000 MO."
PLUMBING 4 jEE . 101440 419-000 S 1d13.Ofi
STRONG, MOTION FIR, _ RESID 10141W.7 -41 -WO
GRAMM FRE 101-0(30-4.°13-000 ti�tJ.OJ
INP, RASTRUCTURE. FFM '225-00044.3-342 g:, no:m
AWr I[N PUBLIC P.LAC08 • RE.81.0 70.1-000-255-000
SO T(Q ALI CON; TRUCTION1 .ANP M ,AN Cl-tEV ,
LESS PRE-PARYFETES
$0.00
t'4L:IWI, PEW MI [' FE"ES1587E NOW
53,980.29
t
1
RECEIPT
DATE
BY ;
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
//
Underground Ducts
Ducts
Slab Grade
/�Retum
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_
Z
F.A.U.
Framing
_
Compressor
Insulation �d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
FinalEEE�o
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
/ _/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans_
O.K. for Finish Plaster
Sewer Lateral/�o_q_y
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
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
c
Final
Utility Notice (Perm)/�/
MAY -12-99 WED 12:20, WESTERN INSULATION. FAX NO. 9096868786 P,05
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760
19091686-9796 Fax
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATIC�� SEEN 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 TRACT #:23995-3
LOT#: 14 "� v
SITE ADDRESS: 45-355 COLDBROOK LANE, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS : BATTS Br LOWS
MANUFACTURER: GREENSTONE IND. THICKNESS: 8.1" R -VALUE: R-30
Where inaccessible for Blown Insulation: BATTS BLOW
MANUFACTURER: JOHNS -MANVILLE 1 � i,vi�iVLSS: 11 R -VALUE: R-30
GENERAL CONTRACTOR: INCO HOMES CORPORATION
LICENSE NUMBER:
BY:
TITLE:
DATE:
'INSULATION CONTRACTOR: WESTERN. INSULATION, INC.
LICENSE NU BER: 481278
BY:
TITLE: Production Man er
DATE: MAY 12, 1999