9810-196 (SFD)r' LICENSED CONTRACTOR DECLARATION I
I hereby affirm under penalty of perjury that I am licensed under provisions of
911 _ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
O=)M License # Lic. Class Exp. Date
r- O LOcisioh i W31IWI
oLLJ
Z DatZ �`f' `9 Signature of Contractor _
CD O i
J l`_C) OWNER -BUILDER DECLARATION
W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N 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). r /
N ( ) I am exempt under Section- B&P.C.'for this reason
O N Date Signature of Owner
0)d < Z WORKER'S COMPENSATION DECLARATION
C:I hereby affirm under penalty of perjury one of the following declarations:
FF- p () 1 have and will maintain a certificate of consent to self -insure for workers'
K W �= compensation, as provided for by Section 3700 of the Labor Code, for the
D J Q performance of the work for which this permit is issued.
n Q U ( ) I have and will maintain workers' compensation insurance, as required by
j 0 Q Section 3700 of the Labor Code, for the performance of the work 'for which this
L � Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
L�'I' l+7•sp T A11 AR
ago � Olt �1ii'cs
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 thosep •ovisions.
te: !� !✓ / Applicant �-
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 purp ses
signature (Owner/Agent) '� Date
v i
BUILDING PERMIT ""';-^ t CONTROL#
DATE VALUATION $1,20,647.40 LOT \16— TRACT 1,85-6
JOB SITE �•
ADDRESS
f. 14.&113-fiZ1
4
�APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
tf4co fi:i'lt-'s CORIP.
ITNt:011ONI1:kS'. ORP.
i 28211x. ARkOW H W k'
I2$2 W. AR ROW HW Y
UPLAND CA '41785
UPL,rMND CA 91785
(909)9f1! -,g989 r'f3L# '4319
USE OF PERMIT
5 iNGLE rANi LY DWRLI ING,
SF, D. L,OT 4 16 ,PLAN 413R, PlrRAUT DOES NOT INCIME BLOCK XVAL1:
O.R :f 0011,.131,1W CUEM, I riEg t -WCEJ) 75",o FOR MU1.,11lye.81SS3J.ANC11, OF
SAM-- PLAN'x`YPE,
w v
,.[2t�..'r C;OMI, 1s "I:dc)��1 2r40Y1V SF
ISO::ttCN/PATIO 14.00 S3'•
GA tA.tlfYCAItYS)RX 83.00 SIP
CONS'1'3tUt:;".ti'11,1NFIM 101-000-411WIN 5:/13.UU
1)LAV- r:3.0".CF PIT,1111'000 439-3IR
Pa`s°'. RA\X1CAL M4 1.01-000_1 1_000 $47.W
ELECTRICAL KX 101-000- 420 -OM $130.44
1'I;03fi�f31N%i f tib' , lOt t1UU-X119-U00 $148.00
'bras 9011 OTfONNfl? -1tsaq) 101.t1!?li241-000 $120
G.R AID1,14C x7.13 101-000-123.0) $20.00
INFRASTRt1C"f'URE Fi"h 2225-000-443-342
ART IN PUBLIC PLACES . ItMW 7011-M-255-000 $51,62
SUA,- (rAL, CONK -IR XCIIOi;►.ANT) I`LANICN-IFI 'I;.
$3,gszo. o .
LESS Pki-min :vus
�co.o0
p.
RECEIPT
DATE
BY a �)
DATE FINALED
INSPECTOR
INSPECTION ION RECO ` D
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 eller
Vents
Fireplace r'.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final V.,
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
j5
Heater Final
Water Piping
7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
v
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
S ZG g
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
i
f
Final
U ility Notice (Perm) ���/�
COMMENTS:
MAY -12-99 WED 12:21 WESTERN INSULATION FAX NO, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside. California 92SOX
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
P. 06
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 TRACT #:23995-3
LOT#: 16 A4,�W `7'
SITE ADDRESS: 45-340 COLDBROOK LANE, LA QUINTA, CA
-----------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS : BATTS CBLO!5
MANUFACTURER: GREENSTONE IND. THICKNESS: 8.1 " R -VALUE: R-30
Where inaccessible for Blown Insulation: BATTS BLOW
'MANUFACTURER: JOHNS -MANVILLE THICKNESS: 11 R -VALUE: R-30
-------------------------------------------------------------------------
GENERAL CONTRACTOR: INCO HOMES CORPORATION
-LICENSE NUMBER:
BY:
TITLE:
DATE:
.INSULATION CONTRACTOR: WESTERN INSULATION, INC.*
LICENSE NBER: 481278
BY:
TITLE: Produc ion Man ger
DATE:
MAY 12, 1999