9804-006 (SFD)LICENSED CONTRACTOR DECLARATION
M I hereby affirm under penalty ofperjurythat I am licensed under provisions of
Qbhapter 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
691684 B� %r98
v`DatV / 4 ` / 4t' 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
Stion 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.
STATE n ND 1490931-97
(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 SectiorC�3700. of the Labor
Code, I shall forthwith comply with ,those •provision`s- --/
✓Date $%—�� Applicant /
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil tines up to $1 OU,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 for inspection purposes
uSignature (Owner/Agent) 4- d'' � � Date
PERMIT# CONTROL# ;
_BUILDING PERMIT
_... _- lMI:l
DATE,y f •VALUATION' LOT TRACT 11 7
� oy
6 � i $104,'769.80 4 • . ,#).5-2
JOB SITEAPN
ADDRESS 10 SUNBROOk LAN,
4
604-301-004 '
OWNER
CONTRACTOR/DESIGNER/ENGINEER '
INCO HOMES CORP.
INCO HOMES CORP.
1282W. ARROW HWY
1252 W. ARROW HWY
UPLAND CA 91785
UPLAND CA 91785
(909)981-8989 CBL# 3318.
;
USE OF PERMIT
V
FLAN 313-3 SFD DESERT PRIDE L.A. QUI TA N '
- - @ ..
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4.
TILkC'T CONSTRUCTION 1,696.00 Sl
,
K)RCtiHMAT10 94.00 SF
GAR' AGWCARPOR T 5133.00 SF
'ES6'nMATED COST OF CONSTRUCTION
104,769.80
PERMIT FEE SU'MMiltRY
CONSTRUCTION F EE 101.-000-418-000 1657.00
PLAN CHECK FEE 10:1.-000-439.318 555326
MECHANICAL FEE 101-000-421-000. W;.50
ELECTRICAL FEE 101-000-420-000 1119.52
PLUMBING F EE, 101000419-000 $.148,00
STRONG MOTION FEE - RESID 101-000-241-000 51.0,48
GRADING FEE 101-000-423-000 520.00
INFRASTRUCTURE FEE 225.000-443-342. $:1;329.151
ART.TN PUBLIC PLACES - RESID 701.000-255-000
SUB'1'0'I L CONSTR[SCTION AND PLAN .CHECK
$3,915.137
LESS PRE -PAID PEES
$O.UO
TOTAL PERMIT. FEE, DUE NO'"'
x:#,915.87
A
RECEIPT
DATE
BY
DATE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ _
-`
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-023
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
7-17 -
Compressor
Insulation
Fireplace P.L.
%' -
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
7 -2 % -
Drywall - Int. Lath
.�
Final f?
BLOCKWALL APPROVALS
Final
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
Gas Piping
�p _ ,�
Encapsulation
Gas Test
Appliances
Final
Final
Utility Notice (Gas) = pG
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)
COMMENTS:
SEP -2-4-98 THU 14;45 WESTERN INSULATION FAX NO. 9096868786 P.04
WESTERN INSULATION 9 INC.
42 11 Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Fax
y }
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:
I
TRACT/ PHASE: DESERT PRIDE, TRACT #:23995
LOT#: 4 PLR Al 3 8 3
SITE ADDRESS: 45-310 SU,NBROOK LANE , LA QUINTA, CA
------------------
-------------------
EXTERIOR WALLS: r
i
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8' R -VALUE: R-13
t
CEILINGS : BATTS. ' BLOW y
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MANUFACTURER: GREENSTONE IND. THICKNESS: 8.1" R -VALUE: R-30
------------------------------------------------------------------ --
.'GENERAL CONTRACTOk INCO HOMES
LICENSE NUMBER:
BY:
- r
TITLE: {
DATE: F
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER:.481278
I
BY
TITLE: Production Ma ager
DATE: SEPTEMBER 24,`1998
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