9907-586 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of Deriury that I am licensed under provisions of
bhapter 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
• ti ,
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).'
O I am exempt under Section B&RC: for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION"
I hereby affirm -under penalty of perjury - one of the. following declarations:
() 1 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 whichthis
permit is -issued. My workers' compensation insurance carrier& policy no.: are: $
Carrier Policy No.
S't'i4'1'E FUND I tgt3431- ;
(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, 1.shall forthwith comply with -t, oo e'provisions. %�--�--^
ate: �/` / Applicant—'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,0000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees..
IMPORTANT Application is hereby made to tfie birector of Building and -Safety,
for a .permit subject ,to the conditions- and, restrictions 'set_ forth, on :his
application.
1. -Each person upon.whose'behalf this application is made & each person at
whose request and.for whose benefit work, is performed under or pursuant_to
any permit issued as a result of this applicaton agrees to, .& shall, .indemnify
& hold harmless -the City'of La. Quinta, its officers,, agents and employees.
2. Any permit issued, as a result of this application becomes null and void if
work is not commenced within 180 days,from date.bf,issuance of such
permit, or cessation of work for,180 days will subject permit to cancellation.
I certify that I have read this'application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property, f Sr inspection purdoses.
/igatui�en (Owner/Agent) `f �f^ . .Date
BUILDING -PERMIT PERMITk
u�
DATE VALUATION, LOT TRACT
06,646.20 -:38 TZYN.5-5,15�321
JOB SITE
APN
ADDRESS •"fl8070:SITNUR,a.+OK LANE
664-040-021
OWNER
CONTRACTOR / DESIGNER / ENGINEER
11NIC0 HOMES CORP....
NC`.r� BIOMES CORP.
1292 W. ARROW HIGHWAY
129-2V ARROW H.WY
UPLAND � f;1?f 91785
UPLAND CA 91.1,185
� 1981-1198.E .;BMA -.1318
USE OF PERMIT
SINGLE T`ifirR1 t``'
SF -D- LOT 38, PLAN il3-R,'- FIERN4117 EYOR Noil, INCIAME U LICK WALL
OR POOL.
r
CT%IONSTRUC ION ,1,411.0 aF
ZT
Z4"HIPA O 141.0 SF
GAitACYWA WF 416.€ 0 SIF
FS fl'i.lt9fA" D T Oi�" QCAN1' fVCf 1thN
S ►, ,2�t
PERMIT FEE SUAIMAKY
,CC):�l•�" P17tJC11110N FW_ i (31. �!?i3-=1 i-C}i)t7 ti$ t • 4Da�
PLL, N t;R4"sCK FES 101.,000-439-318 X490.72
ME;HANICAx FEE 1031,000A21 -OW
Et.�I'itlt.'.Ai,:1•FE i0T-4i4}43--42ffi�g130 $8.4!5..21 �
-� �i"f
PLl•It'.sfB.]NG FM 101 -000 -410 -OW
STRONG MOTION FEE T E2FSID 101.000-241-00()
C"MNQ FFZ101 $100-A23^t1t0 820.v0f`
OE 10PFR'.14 .%CT FM $11907.00
t.,�y
tet•..✓
I.XSS 'PRt-PAW F.E S
$0.00
RECEIPT
DATE
BY'j
DATE FINALED
INSPECTOR
. I
M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS .
Set Backs
Underground Ducts
Forms & Footings
" Z
Ducts
Slab Grade
�7- .. 9
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U. -+
Framing
(. -Z5-4F6 if64
Compressor
Insulation
1 - '7-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
'L t rF -m0
Drywall - Int. Lath
"L _ 1�- pd R
Final
Final
POOLS - SPA&;
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
p—_o -`J
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
`Equipment Enclosure
Shower Pans
'.O.K for Finish Plaster
Sewer Lateral
2
Pool Cover
Sewer Connection
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
Final a
Utility Notice (Perm) j --LI iD0 �,
MAR -09-2000 15:4^ WESTERN INSULATION 909 636 97EG P. 131-277
1
WFATERN INS ULATION, INC
4211 Letham Street, PJvmKe, CaUbmis 92501
. Tel, (909) 686-060 Fe: (909) 6864786
EffS V BA i 8®N CBRTIEPI i
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 #23995-1
LOT# 38 /IAV 1
SITE ADDRESS: 78-770 SUNBROOK LANE LA OUINTA, CA 92253
ANTERIOR WALLS
MANUFACTURER: Johns-ManviNe THICKNESS: 3 5/8' R -VALUE: R-13
CEILINGS: ;BAITS LO
MANUFACTURER: GREENSTONE THICKNESS: 10.3' R -VALUE: R-38
2MRAL C® TRACTOR: AMERICAN COMMUNITIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
IMLATIOfN CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: IPROPYCTION MA GER
DATE MARCH 9, 2000