9905-108 (SFD)LICENSED CONTRACTOR DECLARATION
I hereuy 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
Pe6tesAi6hals G' &, and my License is ih full t6'rce and effect.
License #. Lic. Class Exp. Date
Date � 4 6, % Signature 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.
( ) 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 sectio meed not be completed if the permit valuation is4forr $10 0 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'lprovisions of Section 3700 f the Labor
Code, I shall forthwith comply with t rose provisions.
D11 ater Applicant /� 6w-.1_.."".
Warning Fail re 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 o
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 purpo es.
Signature (Owner/Agent) Date / / /"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �'TRACT
—
fJ. { �:a p 2dl,. (! 15 23495-4
JOB SITE '�� i'
ADDRESS �+y
APN
41a i�:� SUt�1Hk�I C RT
6411¢-040-021,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1NCO N.OMES CORP.
INCO HONIES CORP.
1'28.2 W. ARROW .HNVY
1282 '%1% .AR R0W HWY
UPLAND CA 91785
UPLAND CA 9.1785
CHIN 33:18
USE OF PERMIT
rrt i y CA 41r 1 -1$3.3 r Irn
SFD - PLAN 4DR LOT t 5, - PERMIL T DOES NOT INCLUDE, BLOCK WALLS'
OR.POOL, PLAN CHECK PORTION OF FE s REDUCED 75°4, FOR M1 M11PLF
ISSUANCE of smiE PLAN TYPE.
TRACT CONSTRUCTION 2,008.00 SF
PORCH/PATIO 19.00 5'F
OARA.MCARPORT 583.00 3F
ESTa'M TE'D COST OF CONST RUC`[`fIGN
120,64 7.40
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-4.18-000 $7:1:3-00
PLAN CHECK FGR 101-(400.439-318 $1:47.79
WCHA;NICAL fUE 101-000-421-000 $47,100
EL TRICAL FEE 101.000 -420 -OW $150.14
PLUMBINGF01' 101 -WO -419-000 $148.00
STROAki MOTION FEE. - RE -SID 101-000-241-000 $12.06
GRADING FMM a. 101-000.423-000 M.f)0
e-
MRA9`t RUC TUtRE FfM 225.000-443-342 $2,7103$
r1RX IN PUBLIC PLACES - RESIC 701-000-255-000 $51.62
9
A
s
,
t SUB-10TAL C0.NS'! R.1J_1t11 N AND PLA N CHEC ;
$3,980.29
UJSS P1tt:-Pari rEE
o0.;;c
®.1999 TOTt>* VERMIT !!i EVS DUE NOW
$3,980.29
.: ,JUS
R EIRT
DATE
BY �
DATE FINALED
INSPECTOR
V
s
4f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fc -.ms & Footings
Underground Electric
Ducts
Slab Grade
Final
Return Air
Steel
Gas Test
Electric Final
Combustion Air
Roof Deck
6
Exhaust Fans
O.K. to Wrap
Equipment Enclosure
F.A.U.
Framing
—
Compressor
Insulation
— 8
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
nriwall - Int I afh
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptac
G. F.I.
Smoke Detectors
Temp. Use of Prn
Notice
Final
COMMENTS:
Final
Final I 11- Z t-
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 Piaina
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptac
G. F.I.
Smoke Detectors
Temp. Use of Prn
Notice
Final
COMMENTS:
NOV-1M9 FRI 11,48 WESTERN INSULATION FAX. NO, 9096868786 P•, 15
'WESTERN INSULATION,,- INC.
4211 Latham Sheet. ft v x9de, Call mia 92601
(909) 686-8760
• ` . (909) 686-8786 Fax
INSULATION CERTIFICATE
THIS 1S TO CERTIFY THAT INSULATION HAS BEEN IN IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE,OF -
CALIFORNIA, IN THE BUILDING LOCATED AT:lol
-
TRACT/ PHASE: DESERT PRIDE -PHASE 4 A TRACT #:23995-4
LOT#: 15 PLANA, ; !`
•
y
SITE ADDRESS: 45-155 BIRCHCREST CIRCLE, LA QLJINTA, CA:
r ,
EXTERIOR WALLS:
•. Y 1
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 35/8 R -VALUE: { R-13
CEILBNCS : %-BATTS BLOW i
THICKNESS: 8J" R -VALUE: R-30
MANUFACTURER- GREENSTONiE
GENERAL CONTRACTOR: AMERICAN COMPANY -
LICENSE NUMBER: t • '
BY:
TITLE:
DATE: '
INSULATION CONTRACTOR: WESTERN INSULATION, INC: '
LICENSE NUMBER: 481278
BY: '
TITLE: Producti6n A4anage-
DATE:-, NOVEMBER 19,199 '
-