9905-115 (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
NYotesgionals Code, ana My License Is In iuii forge wid effect.
License # Lic. Class Exp. Date
691684 it F 071. • 1201
Date r✓%0�/ Signature of Contractor ( -a- 4 9 �tq4�,;
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:
Cartier Policy No ,
(This sectibRell not Wcompleted if the permit valuation is forr$$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' compensatio provisions of Section 3700 of the Labor
Code, I shall forthwith comply with tho e provisions
Date: l� Applicant _A{ el 61--y
A -� ~
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 authorize representatives of this City to enter upon
the above-mentioned property /fbr inspection purposes:.
;Signature (Owner/Agent) �l'��;1i� Date
BUILDING PERMIT PERMT#
DATE VALUATION LOT 9905-115) TRACT
!0 $9701.." 24 t9�?a4
JOB SITE s
APN
ADDRESS _ _
suJM COURT
644.
OWNER ' CONTRACTOR/DESIGNER/ENGINEER
1NCO HOMES CORP. WCO HOMES CORP.
1282N. ARROW HXVY 1282 W..ARROW 14i1+Y
UPLAND CA 91785 UPLAND CA 91785
(.909)981-8989 CBL# 3318
USE OF PERMIT
v. 1H 1
- PLAN 2A3, 'LOT M, - PERMIT DOLS NOT .INCiL10E LOCK
.WD
WALLS OR POOL.
f%
r
'MACT C014S RUCTION 1,566.003F
PORC", A"O 81.00 sI:
GARAGE/CARPORT 599A0 SF
y
TI.lNIAsfE D'COS OF CONSTRUCTION
PERAW FEE SUMMARY
CON.Tr1ti1C•Pt.ON FEE 101.000-418-000 $6.10.50
PLAN CEiECKF$E 101-000439-318 SS30.01
'NOCHANICAL FEE 101.-000-421-000 $53.50
ELECT' ICAL M 101.000.420-000 $111.29
PLUNWING FEE ' 101-000-419-000 5148.00
5TrJkONG A2U'n0N FEE , REM 101-000-241.000 $9,79
GRADING FIFE .10.1-000-423.000 $20.00
{.NWRA:i`f fttJCTIU.i F FhE ,. 12.5-000-443-342 5!2,177.4`
is
O
kL (;ONS RUC! ION AND PLA CHECK
-
$3,o8.1.i1
.CESS P'R%; PAII) SEES
50.00
{ JUN 10 1999.
4 - TOTA► P1±,C6MIT FEES DU1E'NOW
53,684.51
PP�j a •
RECEIPT.
DATE
By,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs 0
1
Underground Ducts
Forms & Footings
Ducts
Slab Grade
157=
Return Air
Steel
Combustion Air
Roof Deck
—99 C.
Exhaust Fans
O.K. to Wrap
— —919
F.A.U.
Framing
O Z/--*
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall. Firewall
Exterior Lath
—/ AV
Drywall -Int. Lath
Final
Final
i z. • z t .
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 I
I
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
Z.
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_ 6
Appliances
Final
COMMENTS:
Final
U61ity 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 Z
Utility Notice (Perm)