9905-112 (SFD)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. Class jj Exp. Date
601684 il
0713/201
Date�Ignature of'Contractor
i �/ - r;
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).
( ) 1, 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.
STATF .r 1,�J003gi
(This section need not a not if the permit valuation is or $1 1 .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 t e Labor
Code, I shall forthwith comply with thos provisions.
i Date:�Applicant Y
✓
1_
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 authorze representatives, of this City to enter upon t
the above-mentioned property f inspection purpos S. / r
Signature (Owner/Agent) »r - ate ��' /�✓�
BUILDING PERMIT - PERMIT# /r
DATE t VALUATION LOT !TRACT
r �• $1.20,647.40 17: 23995-4
JOB SITE I r
APN
ADDRESS
4f5-115 SUAI1 ERRY C URT64d4-0441-021.
OWNER 'i-" '""
CONTRACTOR / DESIGNER / ENGINEER
1NCO HOMES CORP.
INCO HOMES CORP.
1292W. ARROW HWY
1282 W. ARROX HW Y
UPLAND CA 91785
UPLAND CA 91785
(909)981.8989 CBL#, 3318
USE OF PERMIT
,M, - PLAN 411, .LOT 17, - PERMIT DOES NOT TUC-itID1 BLOCK WALLS
OR POOL. PLAN CHECK PORTION OF FEE REDIXED 79D/a FOR I4t(,fVrM.E
T.RACTCONS'17tUG"1101N 2,008.0ri SF
PORCH/PATIO *14.00 8F
GARAGEXARP.ORT 593.00 ff
E,5TINlATF D ta`O,Wr OF (,YONSTRUt~TION
120,647.40
PEi11;MIT FEE Si1NIMARY.
CONSTMICrION FFE 101-000--118-000 $713.00
11LAN C1iEC'K .F'EE 101-000439-318 $147.79
MIXIIANICAL FEE. 101-000-471-000 547.00.
I;LEC' IUCAL FEE 101-EMO.420-000 $130.44.
PULIMB1NOFEE 101-000-419-000 $149.00
STRONG MOTION PM-fZESIJ) 101-000-741-000 $12.06
GRADINGFEE 101-000-423-000 $•zo:N
DWRAS'l`RUC'i'[ RE PW,a `�� 22_5 -1M,-03 -3A2 $2,710.38
ART IN PUBLIC .M.ACES - RESIC 701-000-25.i-000 S51.62
SUB—TC7CAL• CONS1RLKTIOAl IW ?PLAN CHECK
$3,980.29
M LESS PRE -PAID ILLS
$1'1.03
TOTAL PERMIT FEES DL' E NOW
1999
S3I 980.29
;1UR 1 4
RECEIPT
AFE
BY " '
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
O.K to Wrap
_ Z — 9 44-
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final IZ-2 f•
BLOCKWALL APPROVALS
POOLS - 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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 /a —
Utility Notice (Perm)
COMMENTS:
AlO6'- 24-39 WF) 11 CSI AM. WF87'FRN I NSU' Al I )X �'AX -NO. . I M686642a r, 2
' 'WES'TERN INSULATION, +INC.
` + 4211'Lathem Street, Riverside, California 09601
• (909)686-8760 ,
(9091686-8786 Fag
. INSULATION CERTIFICATE'
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=PHASE 4 •TRACT #:23995-4
LOT#: 1 11•
SITE ADDRESS 457,115 SUNBERRY,COURT, LA'QUINT&'CA. ° F
' +f � - r • � p • .' * .� -T.a ! i'4. +� r.. - '� � `- 'may` . .•• F• .
'EXTERIOR WALLS:
MANUFACTURER: JOHNS-MANVELLE :THICKNESS: 3,5/8 R-VALUE rR-193 y _A
> is .. , ..:....,,.a.......+ - ........ - .,. 1 .. ,• . > « , r . - '
CEILINGS:BAITS BLOW
..%AANUFACTURER: ' GREENSTONE, THICKNESS: 8.1 a R-VALUE: R-30
GENERAL CONTRACTOR. .AMERICAN COMMUNITIES
.LICENSE.NUMBER:
'TITLE: y, r
DATE:
*„
INSULATION CdNTRACTOR: WESTERN INSULATION, INC.
LICENSE N U r R: 481278 '
BY:
TITLE: troductioryManAzer. _
DATE: NOVEMBER 24,1999
. -