9907-588 (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
-S Professionals Code, and my License is in full force and effect. • '
License # is,
Class Ekp. Date '
' • =�n � -ter.. • � . ti �.p.., ¢M �;
ate °�''' Signature of, Contractor �+
OWNER -BUILDER DECLARATION.-
1-hereby
ECLARATION-1 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&F.C. for this reason .
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby -affirm under penalty of.perjury:one of the following declarations:
( .) l 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.
STNIT FUND 1490931-98 .
(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'Sectioh.3700 of the Labor
Code, 1,Pso, forth with. comply with tho� provisions: F
D Ye:,r�..�/� Applicant17�V 1itira '� ��rr.t s
i. .
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.eesult'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 Cityto enter upon
the above-mentioned property foi inspection pur oses.l
/ioature (Owned—gent) 7�Date
BUILDING PERMIT •: - PERMT#
DATE VALUATION ;- LOT TRACT
09/27/1"1120,'647.40 40", ( T23"" z ➢72
JOB SITE I •
APN
ADDRESS
Wi9fiS NB.R0ib:K LAN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1P3fr0ROARES COR.P...
INCO HOMES CO.R.J .
1282 W, AR.i 6Air Wi31RVAY "
1282 W. ARROW1.1WY
UPLAND CA 91795
UPLAND : -.CA. 91785
(9f)9y)81-8989 C CLO' 1318
USE OF PERMIT
SFA- LOT 40, PLAN 48, •--.PERM.F..t' :DORS NOT INCL VDE TSL CXX. WALL
OR POOL. 759/0 REDUCTION ON T'T,."AN CHECK ME fiOlt .4<ff31.TYPI.1:
ISSUANCT O SAAM'. P"1d nW.
TRACT CONSTRUCTION -Z,W3.00 S1^
PtCA°I'ls� . l4.Eb) SF
G3.A.1iAGEICARPORT 583.60 SF
WMATED CWT Or, CONSTRIXF10N
41,20,647.40
CONST.12UCTIOATFEE i01 -M-419-000 $733.00
P1IAN CuW1KM. 10.1-00(1439•.31.8 $147.79
�, In�,��
:rr>1-6111(-�Z1-aQC1 t�4a. ►
n�ANIC�ti'1�E
.
w,p, .
.'1
t,:1..?C flUCAL k w. . 101-000420-000 $1_10A4
PLUMBING FEE" 101 -WO -4119400
STRONG MOTION 1 ER - RE.SID 101.-000.241.-000 $12.06
ORAOING EE 10 JAW- 423.000 $20.30
ART IN PUBLIC :PLA CES .- RESH) i{21-000-253-000..' -$51.62.
DE•4&'!1 r -It M PACT l IF,, x1;Sti7 00
SUB-1.7lY'f1,,L C0M 1-R -;T10N AND �'.LAN.C:HECK
53,17&.91
LESS P RE,•P.A11) 1''Ea S
$0.00
J
TOTAL. PERAlff FEFUS )1RTE NOW
S.1,176-91
RECEIPT
DATE
BY S'
v
DATE FINALED
.
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�5 ,QL-
Return Air
Steel
�`- a, IG4-•
Combustion Air
Roof Deck
Of _ OS - dp cr,
Exhaust Fans
0. K. to Wrap
Framing
_ _
F.A.U.
Compressor
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
'
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
i
Exterior Lath
2- ((, -00 t Z:
Drywall - Int. Lath
�—
i
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2e." -!9!9 1 eg
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
j
OX for Finish Plaster
Sewer Lateral
[- 7-4-00 i 1A
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
UU14 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 j
Final
Utility Notice (Perm) two
COMMENTS:
MAR.-09-2000 15:54 b1ESTERIJ INSULATION 909 686 8796 P.27i27
IMAMW
mioTERN�PSULATIOAll
w X Cs
42.111 athem Street, Riverside, Callfomin 92501
T*-L (909) W6-8760 Fax (909) 686.8786
IVfl U"TION 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 #23995-1
LOT* 40 Fav
SITE ADDRESS: 78-780 SUNSRUOK LANE LA QUINTA, CA 92253
EXTERIOR WALLS
MANUFACTURER: Johns-Manville THICKNESS: X355//8"RR-VALUE: R-13
CEI BATTS �BLQ�6C�
MANUFACTURER: GREENSTONE THICKNESS: 8.1" R-VALUE: R-30
-------------------------------------------------------
GENERAL CONTRACTOR: AMERICAN-COMMUNITIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATIONCONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM ER: 481278
BY:
TITLE: P O TION MANAOR
DATE MARCH 9, 2000
TOTAL P.27