9810-189 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cla W Professionals Code, and my License is in full force and effect.
O=)C ) License # Lic. Class Exp. Date
LU
r`
oZ r,- +Date /—/J ": %Signature of Contractor J44-l�
Q�
UC:)
� OWNER -BUILDER DECLARATION
HWW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
co O I am exempt under Section'_, B&P.C. for.this reason
O N Date Signature of Owner
0)d Q WORKER'S COMPENSATION DECLARATION
0 Q 1 hereby affirm under penalty of perjury one of the following declarations:
r O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= , compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q C) ( ) I have and will maintain workers' compensation insurance, as required by
Q U QSection 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier g y 1 Policy No.
C) I1it�Stiti D .1i9V.+a119"r
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 sr�ould become
subject to the workers' compensatio�r rovisions of Se tion 3700 of the Labor
Cag(�e, I shalJ.forthw'th comply with tbo a rovisions°
C�late: /-��'y� 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 authoriz�j representatives of this City to enter upon
the above-mentioned property forf/inspection purptoses.
Sigrfature (Owner/Agent) %1 Date�'1���7
PERMIT# CONTROL#
BUILDING PERMIT 9R1(W"
�r w
DATE �j 1 VALUATION S't 20.(,g.'�,7.40 LOT { ;,'�1 - TRACT
JOB ADDRESS! 45.315( Jill)-3t2'€3O
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
fi�3iJo !SI` /� 9 ` CORP
11 I.s4XINi E' l L1.R
YAi 1�/�as �A i'!'C !"'I'll] l)
11-CR.l E. �Oif�.fiw)-.�.J11.1 .
'1 282 W. l4.lit OA I i W 1
1282 W. ARROW 1•.%NV
UPLAND CA 91785
Ui 1LKND CA. 9178J
-
(901491-6089 Cltl.,# 3zfR
USE OF PERMIT
SINGLE FAM -LY t—1
AM -LY V LI N
SFL�„ L01.'#;.2, kfiillhil't DOES 140T T, C [lN3111,0i"X WALL
f:)12.HQV.L1.A..,AN C;IilICK 4 BL f EOUC:E'd 7Y- o..F00. MVIL`1'i PPE ISSUANCE Oil
SAME PLANTYPE.
Y`
t F
TRA.C`i' C0N.T1Rucc"noA,T ^,fiii£i.00 SF
'P0(tC1 1*A.Ti0 14.x(1 Sh
(JARAUWCAR-PORT 583.00 SF
1
• S=.��s� i /bA.Y �O! CMSY It i A/.L'S i9 Ki Y1t�.1. ��11ir
a 40
9��Adly1*0
PE, RMIT FEE SUMMARV
CCSNS'TRLYCEICYNFER, 102-000-418-000�i7.l1-4.00
AN (7—WCK TTM ! 01-ClOtZ-434-31 £? 1147.79
. ULAAN I C;, % rEe 10 t-000-4214)00 V .W
&0-
ELECTRJOAL M, 101-000-420.000 5130.44
PLUMSINO.F.EE 101 -000 -419 -OW $148,00
S't'12c1�x�� �±c»'rc�N r"1T• - Ri^gfl) !.0?-110t).2a1-400 �l.2.t,>ti
GRA1i3NG F.FO`r 101-000423-000 3�tl.flQ
1"fd ill,a"743�30Tti C.1r.EE 225-000-443-342 $B,'iIC�.3f3
AR.•r I.N PUKIt: PLAC 1S - IZES.IT' 701.-000.255-000
Si: B-T(Y'AL CONS'��tlJG1'I,ON ANT) PLAT) CHECK
$3,mr
LESS PRE -P. ID 1.-TUIeI
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION ,
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
If
Forms & Footings —A
Ducts
Slab Grade "
Return Air
Steel 1A
Combustion Air
Roof Deck 3 /i 9
Exhaust Fans
_
O.K to Wrap
F.A.U.
Framing �f
�
Compressor
_
Insulation �-�'�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 9Q
Drywall - Int. Lath 9-7
Final
BLOCKWALL APPROVA S
Final
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
OX for Finish Plaster
Sewer Lateral Q
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test s/zslq�
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Loan Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r
Final
UWlty Notice (Perm) 7
COMMENTS:
MAY -12-99 WED 12:20 WESTERN INSULATION'
FAX N0, 9096868786
WESTERN INSULATION, INC.
4211 Latham Street, Riverside,•CaMbraia 92501
(909) 686-8760
(9091686-8786 Fax
INSULATION CERTIFICATE
P. 04 • -
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#: 12 pL�Q�/ Z/
SITE ADDRESS: 45-315 COLDBROOK LANE, LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS : BATTS BLOW'
MANUFACTURER: GREENSTONE IND. THICKNESS: 8.1" R -VALUE: R-30
Where inaccessible for Blown Insulation: '?. 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 NUMBER: 481278
BY: `
.TITLE: Productiolh Mana er
DATE: MAY 12, 1999