9905-113 (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 Exp. Date
)F,,ei ;z
Q;:P�_
Date I �! Signature of Contractor, 'F f
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 intend_ed: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 Alb note completed if the permit valuation isio V 000 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 rovisions of Section 3700 of the Labor
Code, I shall forthwith comply with th l e provisions.
Date: ZZO Applicant I �—
v
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 tlie 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 11610"
application. r ,
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 h
Signature (Owner/Agent) AL -4.1,11 ses.Date
BUILDING PERMIT PERMIT#
DATE - VALUATION LOT 9905-11 TRACT
-
/z4,9 S99.792ZO t 23995-1
JOB sitt. ' I
APN
ADDRESS t►
OWNER H Ula 1) i aH31(H CONTRACTOR / DESIGNER / ENGINEER bU"4t V.Z1
[NCO HOMES CORP. INCO HOMES CORP.
1282W. ARROW HWY 1282 W. ARROW F' WY
UPLAND CA ' 91785 UPLAND CA 91785
(903)981-8989 C.BL# 3318
USE OF PERMIT
,
511. ..w 1r11.tl i v 1a, 1euv`
S1•- - PLAN 2CR 3 LO;t 18, - P .iT DOES NOT INCLUTYE BLOC
WALLS OR POOL, PLAN C`BFXK PORTION OF FM REDUCED 75% FOR �
a, r TQVTr YX-x nx Q A RTV DT ear
TRACT CONt3 AUC'1° ON 1,566.00 SF
FORCINPATIO 151.00 SF
GARAC3F-JCARPOR'r 539100 SF
IALATED CAST CST C;OI`+INTRUICTION
98,782.-51)
PER3AHT FEE SLT1 C ARY
CONSTRUCTtO.N FEE 101-000-41.8-000 $635.00
PLAN CREC"K'FEE 101-000-439-318 $133.31.
ME CAI, iF"1 E 101-000-421-000 , $53.50
13LECTR1CAL::F`EE 101-000-420.000 $115.29
FLUNWIN0 FEE 101-000419-000 $148,00
GRAf HiG:FEE 101-000-473-000 V0.00.
.IN RASTCRCIC 1"URE FEE. 225.000-443-.342 $2,177-42
o'
SUB -TOTAL CONS-MUCTIO'N AND PLAN CHECK
$3 "'282.52
LESS PR&P.MD FEES
$0.00
TOTS., PERMIT FEES DUE' VOW
Tti r JUR 101999
W.V1152
RECEIPT' p P
DATEmJ
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 9— —
Exhaust Fans
_
O.K. to Wrap
F.A.U.
Framing (d—
Compressor
Insulation --7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath2—
Final
Final 11-`L, -
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
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.— 6�s� _
Appliances
Final
Final
UBlity 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
Utility Notice (Perm)
COMMENTS:
NOV-19-99 FRI 11:44 WESTERN INSULATION ;FAX NO. '9096868786 P,08
uVwTEESTERN INSULATION, � INCe
421.1 Latham Street. MlMrslde, Causbmil 92801
(61091 d86-8760 -
a (909) 485-8786 Pas
• { . INSULATION CERTIFICATE
TH15.15 TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT; ENERGY REGULATION, CALIFORNIA ADMI N ISTRATIVE CODE,,TITLE 24, STATE OF f ;
CALIFORNIA, IN THE BUILDING LOCATED AT:
i
TRACT/ PHASE:DESERT PRIDE -PHASE 4 A TRACT #:23995-4 '
1
LOT#:' . 18 PLAN 2 :.
` SITE ADDRESS: 45-120 BIRCHCREST CIRCLE, LA QUINT& CA:
EXTERIOR W ?�
S MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8 R -VALUE: R-13
cE>tLaNcs : BATTs Low
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: `R-38 - -
GENERAL CONTRACTOR., AMERICAN COMPANY ..jr
LICENSE NUMBER:
r TITLE:. f a +
- `DATE: y • � �. '. -
11�►T90N CONTRACTOR: "WESTERN] SUL A*TIO'N, INC.: • -
LICENSE NUMBER: 481278 -+
By;.
TITE: rodu on Manager
DATE: NOVEMBER 19,1999 t
'{ - ` as �, � .. Y -. ' V -, 1 � ; ,• f - 1• ,. , ^�• ^ ' _ .
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