9907-587 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 700 0) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License# Lic. Class f Exp.. Date
p5te 50 Signature of Contractor a'� - +
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&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.
( ) 1 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.
'rAm FUND 3d91t*i31-98 .
(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 Section 3700 of the Labor
Code, I shall forthwith comply with th0 eiprovisions. /
Date: Applicant
y46rning: Failure to secure Workers' Compensation -coverage is unlawful and
shall subject•an employer to criminal penalties and civil fines _up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby,made to the Director of Building and Safety
for a permit subject- to the conditions and restrictions . set. forth on his
application.
1. Each person upon whose behalf this application is made & each person. at
whose request -and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &•shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application. becomes null'and:void if
work is not commenced within 180 days.from date of issuance of such
permit, or cessation of work for 180: days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree.to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of .this City to enter upon
the above-mentioned property for inspection purposes
iVf
gnature (Owner/Agent) !/sl , ~... Date!
BUILDING PERMIT PERMIT#
DATE VALUATION LOTJ�N3 TRACT
JOB SITE �s 4S�
ADDRESS
APN r
OWNER
CONTRACTOR/DESIGNER/ENGINEER
iNC~O HOMES COR P.
WCO .iiO.1MES CORP. .
1282 W. ARR61hr 1416 1 VAY
1282 W. ARROW HIV
I.1MAND CA 91785
LIMA•ND CA 91M,
(909)981-898' _ M'.03318
USE OF PERMIT
Sn- LOT 39,1Px AN 2C-3-R,-'P9R_M7T DOES NOT 1Nt:;LLt E BLOCK
WIUL OR POCA. 75%REDC.fG"HOrT ON PLAN C --CCAS. FTX FM WILT11PLE ;
WUANCE Or SA bSE PLAN' grPi.
TRA..Cr CONSTRUCTRYN 066,00 3l
POlP.lMIPATIO 151.00 SI
CSAR A:C'aEiGr0RPOR'1' 599.00 SF
IS T IhIA:F1 0 C UST OF C0i�ia��M IJ(31 'i W
I) ;82.50
PEitt1;MFF FEE SUMMARY-
CONS'E'i U :'k'l0N M 1{31.0J0418-f1N O
LAN t"N�l3CIK FE.E, iQi �"T��d439-31$ ��.33.3'1
NIFICNANIC- L,IF t�'1- X421-OUt3 S .Sa)
Ef.�C'd'1CNCA:l.1:'f:Q� ' .ftyl •131iN3-42+0-fld3Ny ffixl.^i.".w�
L1nL4B1�iC3 Il E1< t 101 ••(N,3 - 419-000
GRAD G ME KA -M-4.23, 1 T20.00
DEVELOPER OPER VMPA JCT.1'FE �1:9L�'➢.N3C►
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RECEIPT
DATE
BY 7
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
4 BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
0? tp
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
6�0(a�Q�
Exhaust Fans
O.K to WrapZ�
Framing
�� t
7
F.A.U.
Compressor
Insulation
-L '7 —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z 1 -00
Drywall - Int. Lath
'i- _ co - 00
Final
Final:
BLOCKWALL APPROVALS
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
D —Zcs— p
Heater Final
Water Piping
Plumbing Final.
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
f - 2 ro _ o O % 14
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
r
Gas Test
_
Appliances
Final
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
Utility Notice (Perm)
COMMENTS:
MAR -09-2000 15:47 WESTERN INSULATION 909 685 8726 P.14i27
XMTERN l�LATl�� Ye
4211 Latham Street, RNmide, CaWornio 99501
TeL (909) 6884760 Flit {909) 6"-8786
INISM ATION CERTIFI�l�'T�
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 1123995.1
LOT# 39 pGA/v 4
SITE ADDRESS: 78-780 SUNBROOK LANE LA QUINTA, CA 92268
------------------------------------------------------------------
EXIB,LOR WALLSr
MANUFACTURER: Johm-Menvllle THICKNESS: 3 5/8" R -VALUE: R-13
Sc91LING12l BATTS
MANUFACTURER: GREENSTONE THICKNESS: 10.3' R -VALUE: R-38 '
GENERA CONTRACTOR: AMERICAN COMMUNITIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: RO CTION hAA GER
DATE MARCH 9, 2000
4
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