SFD (9901-078)LICENSED CONTRACTOR DECLARATION
Ir"I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commenci�,g. 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
la �iiiWOO
,% ] + qj�ate l' fit Signature of Contract —
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). ,h
(') I am exempt under Section- B&P.C. for this reason
Date Signature of Owner
'WORKER'S COMPENSATION DECLARATION
I hereby affirm ,underr• 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, Ifor 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.
>J.�'�i e� f'1 «11}�L •fu .i�ie°.">�t�i.�i'sir•tlt3' .
(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, an c 'agree that if I should become
subje Vto the workers' compensation prov ion of ection 3700 of the Labor .
C� I shall forthwith comply witl, Lh+ose p ovisi'• S.
ate:- + Z; Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up -to $100,000, in
addition to the cost of compensation, damages as provided for in�$ection 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
constructionand hereby authorize repre ennatives of this City to enter upon
the above mentioned property for ins cii • n u oses.
1 .
/,nature (Owner/Agent) Date , t f "h 9
V a
PERMIT #
BUILDING
.PERMIT r���„
DATE VALUATION LOT ' `'^•�-.a., TRACT
IS21Jt 696:;10 ' + 1'„- A340
z
JOB SITEf Yt'w+
ADDRESS �g . AfIRRON
APN -
7614966 030
OWNER
CONTRACTOR/DESIGNER/,ENGINEER
9NIVEN, 16EP1 Hem E. y1'
161 IN111Xi.AAVE:161
..NDC 'JA- AVE,.
RfVE (SIDE C. 92 V4
UVE;Fi:S:iDE CA, 92.5111
C.B[A 5357
USE OF PERMIT -
S��iC»�,F'
L0 TJ..PZ 2C - S1~`D - P0VkV 1T DU9S 'NOT INC°i.U?79 Di..shM WALL Get
POOL:
Cijai
C AtiiiOti4t :.alttf+CSEt'1.' 635:00 SES
�.1CcA[pl!'P.dII b!.����3J LV8,7.YA.t4 d'A�
.
CcJN8'i`RLX rf'f N -P $993,00
-
t�;1't,Tc ss�crs; htMGA 43Y -13
1011-10100-42140
i;�,EG 16CAL, V lir&., . 1 I�0{�ti-42r?-11017 S153AT
.PLU-MBitdt3'FEE 101-000-419-000 S 162.59
NTOT ON RIF RF -KO 1101-000-1241-00
QTZAJDfr1i' rr 1,01,,.000-42.3-000
A111' IN PiIBLIC ?J.,AC1.F3 -.t<ezSJf':: 701-01)0-2155-)00 $251,74
xFb r>rpca:5'.f ±0e-ti!N>"4QR31R 4250.0�s
M_TCfTON A>>DPWkNC'NECK
$6,954.60
LESS PRI.E.-PAIDREES
4250.1100
r •.
,
.. , E,/Ti%Iw ,C .F..&%l,Y7 E•4,�`a.H..aT DUE NOW
% iri AQ;
RECEIPT}
fes'-"�'l�-
DATE c�
Ely
DATE FINALED
INSPECTOR
�
�.�•\ =� 1�.�.•.•"""'_!^'yi
'°
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade /
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing ACompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
`
Drywall -.Int. Lath
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
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 A IF
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:
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
September 7, 1999
(760) 777-7000
(TDD) (760) 777-1227
Steven Walker Homes
7161 Indiana Ave.
Riverside, CA., 92504
(909) 784-0840
Dear .Mr. Walker,
As requested; a special re 'inspection was performed at .79-980 Merion this afternoon for.
Certificate of Occupancy and City Final. The following corrections -were not addressed.
r
1. Complete'firiish grade and,landscaping:
2. Provide self illuminated *address.
3. Provide required atticventilation.
4. Engineering Department approval:
A Temporary Certificate of Occupancy will be granted provided a self illuminated address is
installed and operational by close of business September 8' , 1999. The balance of corrections
shall be completed and must be re -inspected within 30 days.
Sincerely,
aniel P. Crawford J �.
.Building Inspector II .
dpc
T
r
icat.6....,of
City,of,,.LaQuinta..
Ouilding' and 'Safet= ®ep argent F���
- ,� . O F TN
This Certificate issued pursuant, to •the requirements of Section :709 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in comp/lance with the various ordinances
of the City regulating building construction or use.. For the following.-
BUILDING
ollowing:BUILDING ADDRESS: 79-980 Merion (30 DAY TEMPORARY)
Use Classification: Single Family Dwelling Bldg. Permit No.: 9901-078
Occupancy Group: R-3 Type,of Construction: VN Land Use Zone: RL
Owner of Building: Steven Walker Homes Address: 7161 Indiana Ave.
City: Riverside,,CA., 92504
By: Daniel P. Crawford Jr.
Date: September 7. 1999
Building Official
POST IN A CONSPICUOUS .P,LACE :I
i
;
.•OWEN$-CORNING
Fiberglas}s
.Building Insulation
The contractor named below certifies that the Owens-Corning Fiberglas Building
Lt =.Insulation used carries the NAHB Research Foundation, Inc. label for assured
thermal performance and -that the Building Insulation is installed in comformance
`k_.. with the. current energy conservation regulations, California Administrative Code,
_ Title 24, State. of California, in the building located, at:
X79-984 MERIOIV LA QUiNTA 28340-3 LOT 1
Address City Tract Number
Exterior Walls BATT` 3112 R-1 5U
3> .Owens-Corning Fiberglas Type Insulation
Thickness R -Value
i�.�'.Ceilings-
Owens -Coming Fiberglas Type BLOW Insulation 1A R-38
z.
Thickness R -Value
Floors
Owens -Coming Fiberglas Type Insulation
Thickness R -Value
Foundation. Walls
Manufacturer Type Thickness R -Value
n -
x _ :General Contractor
License No.
Date
Insulation Contractor Paragon Insulation License No. 832072
By lam/ 'lam 1L. Title
SEC
Date -- aTui�a
OVYIENS CORNING
OWENS-CORNING FIBERGLAS CORP.
a .Pub: No. 15 -BL -14725 i
Insulation Operating Division -
3: ;Litho in U.S.A Sept. 1987 Copyright 0 1987 Owens -Coming Fiberglas Corp.
Fiberglas Tower, Toledo, Ohio 43859