9804-004 (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
I
f 691684 B"' -" 311j
Dat�7/"/� " 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.
STATE FUND � '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 Section -3700 Of the Labor
Code, I shall forthwith comply with,jbose,prowslo sJyT,,/-'
1%Dat�"� Applicant—
Warning:
pplicant
Warning: Failure to secure Workers' Com pensation`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 for inspection purposes
/Signature (Owner/Agent) Y � "t.f Date4"f
PERMIT #. CONTROL #
;, BUILDING PERMIT - _
DATE f VALUATION .' LOT 980"04 TRACT '
1 S93,792.50 2s9S's��3
JOB SITE
APN
��y Y
ADDRESS 4y - 350 S "ROOK L AIME
J
6�� 301-W2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
IUCD HOMES CORP.
rnrCO HOMES CORP.
1282 W. ARROW HWY
1282 W. ARROW MVY
UPLAND CA 91785
UPLAND CA. 9:1785
(9050981-8989 CBLff 3318
USE OF PERMIT
cV
,•1
PLAN MR -3 - Sr, D - DFSERT MDE fati LA. Q UiNT A,
TRACT CONSTRUCTION 1, 5".00 SF
PORCI.1lPATIO 151.00 SF '
GARAGE/CARPORT 393,00 SF
C, STIMATED COSH' Oft CONS RUCTION
91,782.50
I'EItMIT FEE SUMMARY
CONSTRUCTIONFEE 101-000-41$1000 $635.00
PLAN CRECKF'EE 10.1-000-439-314 $533:22
ME HAN.IC:AL r•EE 101-000-421-000 $$150
8LEC1-R1.CAL FEE. 1014000-420000 $11529
PLIM. 1NO Fr_ 101-000-4.19-000 $148.00
011ADINQ FEE _ 10.1-000-423-000 SZ0.00
tN'FRASST RUC CURE FEE 2:25-000-443- 422 52;177.x.2
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,682-43
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
53,681.43
A\LD
.RECEIPT
DATE
BY
D ANAL D
INSPECTOR
INSPECTION, RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
(p - 3 Cry
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
— Q
F.A.U.
Framing
=L7_
Compressor
Insulation
= _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-oZZYZE
Drywall - Int. Lath
Final -v2 �— it,
71f
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
j7-,,2 .2 , i —
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
2,� 7 -
Appliances Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) Q Q_"
SEP -24-98 THU 14;45 WESTERN INSULATION FAX NO. 9096868786 P.02 •
i
wE6
TEAN INSULATION 9 INC.
4211 Latham Street, Riverside, -Ca ifornia 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:
i
TRACT/ PHASE: DESERT PRIDE TRACT #:23995
LOT#: 2 P4,9N . B3
SITE ADDRESS: 45-350 SUNBROOK LANE , LA QUINTA, CA
---------------
----------------------!
EXTERIOR WALLS: I
I _
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3 5/8" R -VALUE: R-13,
CEILINGS : BATTS BLO
F
MANUFACTURER: GREENSTONE IND. THICKNESS: 10.3" R -VALUE: R-38
—----------------------------------------------------
------------------
a
GENERAL CONTRACTOR: INCO HOMES '
LICENSE NUMBER: j
BY:
}
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
f
BY:
TITLE: Production manager
DATE: SEPTEMBER 4,11998 r 1
I -