9907-583 (SFD)LICENSED CONTRACTOR. DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000),9f'Division 3 of the Business and
Professionals Code, and my License is. in full force and effect.
License #.,_ ie Lic. Class Exp. Date
c>
t
VD/ate Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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 fo'r 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 Na•
Mlikl% FUND'
. 9�9f39�x1.5�8
(This section need not be completed if the permit valuation is for $1.00.00 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 700 of the Labor
Code, I shall forthwith comply with those revisions. _
Date: c1 'Applicant �y ,�I.* . 1•.% %/r-�r*�;.
/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 37.06
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, A 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 author zi a representatives of this City to enter upon
the above-mentioned'p rope rty ortnspection 'purposes
:
ig ature (Owner/. Date- ,✓ 1+
`-BUILDING PERMIT PERMITk
DATE VALUATION LOT
TRACT
09/271499 :.slac,769.l o :ifs
723993-5 &11
JOB SITE
ADDRESS 7N_
SWNRIMOK LAM?
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CNCO HOMES CORP.
INCO HOMES CORP,
1282 W. ARROW ir•1(!,'t: MV Y
12W) 'W+J..A.R:i OW ,t l"lV'Y
UPLAND C',A. 91.M
UPLA14D
CA
91785
(w.:o8i-11989
CB1.10
3318
USE OF PERMIT
SINIGI 1AWRI I JWO
3FD- LOT 36, PLAN M, - FgdffF DC)P MT WWWE BLOCK WAII
OR POOL. 759'o RO ICx'ION' ON PLAN CH Cern. FFX FOR, R, N!K'ILTIPLP,
1WR11R,AN17 CIF SA 4E PLAr TYPE.
TI7.rk,C`E' C NS'I'IaB.; TION 1,696,00 SF
PORLCNiPATiC> 98.00 SF
0ARAf I,'CARPO1RT SZ13.Of1 ':'
EST It4 AT11,13 CUSS Ole sl.'ONSTRWJC AON
104,769.90
PERAUff FEE 81 4`.4FR!1t#R
ICONS RIJerION FF:G 101- M 43 ^S-600 . 3657.00
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I is VE't.,OPER DVIP.M•"t:i rnp 6l.f i7llfD
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Sd-11't40TAL CO TRLICr'4aN•l+ND PLMN CHECK
LESS ME -RAM PEES
TOTAL :PERMrr FRES DUE NOW
:$3,074$,74
RECEIPTDATE
BY r.'& i
I DATE.FINALED
INSPECTOR
399:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATIONDATE
INSPECTOR
BUILDING
APPROVALS '.
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forma, & Footings
%C? -.V -Fe --
Ducts
Slab Grade
_ ' — 'j_�
Return Air
Steel
Combustion Air
Roof Deck
p )_ o(E,_ p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
! _ a -p
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
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
eater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
-.. 3 - sao-
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test t
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 Q7o t
Utility Notice (Perm) 3 t . 06
MAR -09-2000 15:53 'WESTERN INSULATION
909. 686 8786 P.25i27
O
ATE i1viT TION g I •
4111 Latium Street, Riverside, Calltbrnin 94301
TeL {904} 686-8760 F" (4091686-8786
1X,9V 0X CERTIFICAT
THIS 15 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 #23995-1
LOT# 36 /',.Ati _q
SITE ADDRESS: 78-750 SUNBROOK LANE LA QUINTA, CA 92253
EXTERIOR WALLS"
MANUFACTURER: Johns-ManvllleTHICKNESS: 3 5/8' R -VALUE: R-13
BATTS BLOW
MANUFACTURER: GREENSTOME THICKNESS: 8.1" R -VALUE: R-30
GENERAL C NTR WTOR: AMERICAN COMMUNITIES
LICENSE NUMBER
BY:
TITLE:
DATE:
INSU A'j(ON CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481279
BY:
TITLE: PROVION MANAG1110
DATE MARCH 9, 2000