9905-109 (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
ftteS5i0nalt 6"bde, and my Lftnsg is lh fUll Wee and affect.
License # Lia ClaIle,
Exp. Date
Date r ��r Signature of Contractor / G
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.
STArF.1f BIND 149003_38
(This section need not be completed if the permit valuation is for $1 0.00 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 rovisions of Sect n 3700 of the Labor
Code, I s aJ ('forthwith comply with t ho ee provisions.
Date: ! f��l Applicant -
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. - V
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuiant,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 authorife representatives of this City to enter upon
the above-mentioned property for Aspection purpo°es.
-Signature (Owner/Agent) -✓ ate .�
ti.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9905-.1109 TRACT
(" lou S-1,795-50 is 23395-4
JOB SITE
APN
ADDRESS
45-155 SIN.RERRY COURT
04-0401 021
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO HOrvfl S CORP.
[NCO HOMES CORP.
1282. W. ARROW HWY
1282 W..ARR.OXV HW'V
UPLAND CA 91785
UPLAND CA 91785
(w)981-8.189 C BL0 3318
USE OF PERMIT
Y3 n • Y'r '
135 S.F. OKEN LATTICE PATIO COVPA. PLAN CWC'K PORTION OF
'FE-65—REDUCED 75%rOR MULTIME. isst_tiwm or. SAW PLAN TYPE.
PORC'FiIPA170 135.00 SF
fffIil ATED CX)S t' Gfe CONST Rtf rfON
1,705.,511
PERM[' i9E SUMMARY
COH.TTRUCTION FES 101-000-118-000 $41-00
P.I,rA'N' CHECK P'EFE 101-000.435-318 $6.56
STRONG.MC410N FU, - RESID :101-000-241.000 $.50.
a n
.
rrDTA r. �C? T � tC l tt?i�f AND PLAN CHECK
06
LESS PR.EoPAID FEES
$0.00
JU14 I O� 1999 TOTAL PERMIT 1FE,ES DUE NOW
$48.06
S;
RECEIPT
DATE
DATEFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fcfms & 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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs,
Electric Bond
Footings
Main Drain
Bond Beam i.
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
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)