9907-579 (SFD)wi
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (comgencing with Section 7000) of Division 3 of the Business and
Profess;mals'Cbde, and my License is in full force and effect.
License # Lic. Class Exp. Date
691694 H 07/11/-A
Date — ignature of Contractor
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.
u 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.
;TATE, FIINP I1%"11..93
(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 thou provisions.
Date: 5"?/Applicant
LWarning: 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 autho ize represea
s City to enter upon
the above-mentioned property inspection
LSignature (Owner/Agent) Date
PERMITP'/M_M
BUILDING* PERMIT
DATE VALUATION 3M781 % LOT 20 TRACT 773995-51It I7.
.
'OB SITE
ADDRESS COLMROM LAM
21
OWNER
CONTRACTOR / DESIGNER / ENGINEER
P. HOMES (.`ORP.
INCO HOLIES CORP.
1282 W. ARROW HIGHWAY
1282 W. ARROW HWY
UPLAND CA 91765
UPLAND CA 91785
(909)961-m CRIA 3318
USE OF PERMIT
S i►LE FAMILI DWFLLINi.i
iJ- L( -P '1 �v, PLAN XJ -R, - I'iiRMil' t: .' N01 IHC LUM BLOCK
WALL (JR f"i.1t.)L.
OiRtADPAT10 151.06 Sli:
tJi%RAt.}1j('A)6-X-)Rt' wWAM SF
Ir -S (MATED (T*T OF CONITRUCTION
"AS,782�0
PFIRAIJ f >a CE UMi►MAU
(t.)NS'f'iil't l(_:,rtt.1N Fa till AXk-419-4)01) 305-00
NI AN ("71'K H F'R 14) { -4iM)- JV_ 11 K 15,31 r
ti0'.('tl,lidiC.V Ft;1' 1171 UtNi •121 tK)C 5�} Sf)
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6/L1.IA4611 NO f- U 1 u 1- txMl-4 t 9-000 $ ta8.00
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LF&S PRETAID FEES
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01 A] PEMMIT FIVES DI!6: N0W
S3.,412.01
i
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Saab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
�_ 4,
`� -Ud
F.A.U.
Compressor
Insulation
7 _ Z , d
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
++Q
Drywall - Int. Lath
Final
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower PansO.K.
for Finish Plaster
Sewer Lateral
% v 'Z!o_
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
F'odutes
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final —�
Utility Notice (Perm) ,10e - g
MAR -09-2000 15!46 WESTERN INSULATION 909 686 8786 P.11,77
WESTERN INSULATION, INC.
4111 Latham Street, Riverside, CallfoMia 92501
TeL IM) 686-8780 Fm (909) 686.8786
ENSULATION CMTIFICATL
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 #23995-58
LOT# 20 P4,9ti 2
SITE ADDRESS: 4"55 COLDBROOK LANE LA QUINTA, CA 92253
------------------------------------------------------------------
MANUFACTURER: Johns-Monville THICKNESS:
BATTS
3 5/8' R -VALUE: R-13
BLOw
MANUFACTURER: GREENSTONE THICKNESS: 10,3' R -VALUE: R-38
GENERAL CONTRACTOR: AMERICAN COMMUNITIES ..... .. . -
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR,: WESTERN INSULATION, INC,
LICENSE NUMBER: 481278
BY: az&4110
TITLE: PRO TION MANA R
DATE MARCH 9, 2000