9804-007 (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
1311998
Date5--Z'Signature of Contractor,]
OWNER -BUILDER DECLARATION
I hereby'affirm under penalty of perjurythat 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.
(\/j 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.
STATEFUND 1490931.91
(This section need not be 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
9ode, I shall forthwith comply witb.these provisions -14-- ,
VDate�� Applicant f j✓- �+
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 propertyyfor inspection purposes.
,,Signature (Owner/Agent) !F S -�' - Dat/` /.
PERMIT # CONTROL #
BUILDING PERMIT _ i'
9804-0807
DATE 1 VALUATION@ ay p�+y ¢o LOT TRACT
/(/j /
JOB SITE f w^
APN
ADDRESS 41.290 SUNBROOK 1(.A E
604-361-405
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WCO H014ETS COKP,
INICO 1-101v:1ES CORP.
1282 W. ARROW ciWY
1,282 W. ARROW R%FY
UPLAND CA 91785
UPLAND CA 91785 _
()ti9)981-8989 CBL# 331.8
USE OFPERMIT
Pf. 11? 2AR-3 - SFD - DESERT PRIDE @ I.A. QUINTA
TRAi; P CONST R1:7IL71y_ 1d 1_.566.00 SF
PORC'NiPATIO 81.iH) SF
GARAOFJCARPORT 599.00 115F
roti
EST IMATED COST OF COi`dS., kuC'"I ION
9",,851."<)
PERMIT FEE SIT��`ii kY
.
CONSTRIUMION.1<'F..1 • •101-000-418.000 $630.50
PLAN CHECK FEE 101-000-439-318 $530.01
MECHilk 1CAL FEE 101400-421-000 $53.50
i LEC'MICA1, FEE 101-OW420-0()0 $115.E
P1,U1ViBD1G1 FEE 10.1-000-419.000 $148.00
STRONO MOT ION FFT _ RESID 10.1-000.241-000 $9.79
G%. DING PEE 10.1-OW423-000. 5120 YJ
,
i NFRA:3`.f'WO IVRE FRE . 225-000443-342 32),177.12
SLIB-10TAL CONSTRUCTION FIND PLAN CHECK
$3,684.51
LESS PPE -PAID FF A4,
. $OM)
TOTAL PERMIT FEES DUE NOW
$3,684.51
A
RECEIPT
DATE
BY
DATE F ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
(o — j —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
,
F.A.U.
Framing
Compressor
Insulation
2—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— Q�
Drywall - Int. Lath
—
Final—=_T
Final
POOLS - SPAS
BLOCKWALL AP ROVALS
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
—4
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-- /7— —
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
t
Final
Utility Notice (Perm)
�— _
Y I' �� �i
SEP -24-98 THU 14:46' WESTERN INSULATION FAX NO. 9096868786 P. 05"
t
WESTERN INSULATION, INC.
4211 Latham street, Riverside, CaHfaraia 92501
(909) 686-8760
(909) 686-8786 Fax
INSULATION CERTIFICATE
THIS IS 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:
TRACT/ PHASE: ;'DESERT PRIDE TRACT #:23995
LOT#: 5 ' 1064w �pz. A3
SITE ADDRESS: 45-290 SUNBROOK LANE , LA QUINTA, CA.
-------------------------------------- 7 ------- - -- 7 ----------
---
EXTERIOR WALLS: i,
MANUFACTURER: JOHNS -MANVILLE' THICKNESS: 3 5/8" R -VALUE: R-1 3
CEILINGS : BATTS " BLOW'
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R -38
----------------------I ----------- ----------------------------------
GENERAL CONTRACTOR': INCO HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278 }
w
BY:
TITLE: Production M Hager
DATE:. SEPTEMBER 24, 1998 r