9905-111 (PAT)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
h, e
Date � Signature of Contractor, < A /
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.
( ) 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.
STAT F F c . f4�t t -9q
(This section need not tiet� 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 thos provisions.
Date: / t✓ " Applicant- y77OA�-��
777
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 , t
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 represents ives of this City to enter upon
the above-mentioned property% or inspection pur oses.
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Signature (Owner/Agent) �� abate � ,1�� 1
BUILDING PERMIT PERI
DATE_ VALUATION LOT TRACT
I , $11,838.60 I.ti - " 23995-4
JOB SITE
APN
ADDRESS
5-135 SUNRERRY COURT
04-040-01
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1NCO HOMES CORP.
INCO HOMES CORP..
1-282 W. ARROW 14WY
1682 NY. AR''POW HW Y
UPLAND CA 91785
UPLAND CA 91785
9t39}911=$' 8 C8L# 3318
USE OF PERMIT
m
r
1428.1` . OR NI LA t TICTG PATIO 00 -VER. PLAN CHECK PORTION Ol'
FF:FS REDLTCED 75% FOR h1ULTIPLE ISSUANCE OF SAME PLAN TYPE.
PORCH/PAT1.0 142.00 SF
4.
ES"C>!MATED COST OF CONS"I':R rION
1,988.60
PERMIT FEE SUMMARY
CONS'1'it.WrION.F1rE 10.1-000-418-000 S-13.00
PLAN MCK FEE 101-000439-318
STR NO MUTTON FEE - itt3aSID 101-000-241-000 .SQ
t'
� w
;r.
5 s. X11.. CONSTRUCMON AND t'LAA! C:11k;ClZ
$40.49
LESS PRE-PAWFEE
$0.00
•:. JUN 1®1999. TOTAL PERMIT FEES 1111E NOW
$50.49
x '`
RECEIPT
DATE
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
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final i7 Z I.9 9
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
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
COMMENTS:
•
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
Utility Notice (Perm)
NOV-19-99 FRI 11 43 WESTERN INSULATION .FAX NO, 90.96868786 K05
WESTERNINSULATIONOINCe
4211 Latham Street, Riverside, CaMrafa 93301 R
(909) 686-8760
(909) 686-87861'8=
INSULATION-CERTIFICATE
;
-THIS 15 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:
A, . r
TRACT/ PHASE:' DESERT PRIDE-PHASE 4 A ' TRACT#:239954
LOT#: 16 PLAN 1
SITE ADDRESS: 45-135 BIRCHCREST CIRCLE, LA QUINTA, CA.
EXTERIOR WALLS• ' ..
• • .1• ` ♦ � ail ' . .. ' ..
MANUFACTURER: JOHNS-MANVILLE THICKNESS:. '3 5/8 R-VALUE:..R-13 ,
CEILIP+lGS : BATTS
MANUFACTURER: GREENSTONE THICKNESS:. -10.3" R-VALUE: R-38
GENERAL CONTRACTOR: AMERICAN COMPANY
LICENSE NUMBER:
BY; •. .
TITLE: • '
DATE:
•INSULATION-CONTRAC3'OR: 'WESTERN INSULATION, INC, f `
-LICENSE NUMBER: 481278 ,. Y
BY.: ,
TITLE: rotiuct M naiger•
DATE: NOVEMBER 1'9,1999
a