9901-079 (SFD)LICENSED CONTRACTOR DECLARATION
711 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
Professionals Code, and my License is in full for a and effect.
License # Lic. Class Eix .Date
/e'
7 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: t:
( ) 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
• i
WORKER'S COMPENSATION DECLARATION
I hereby affirm 'under penalty of perjury, one of`the following declarations:
O 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.
( 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 9y rytY ryry Policy No. //i� �Mtt n
4J l9A S f:AI' ,!•1IK.CAL' lir.. f 7 WM S.b VV A2017x96-00
(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 int ny� neer so.as to become subject to the
Workers'•com ensation laws of(C liforhia, an a ree that if I should become
f? � 9
subject t q •the workers' compens cion p rovs} ns of Section 3700 of the Labor
CAde, II at o �/with comply wTWthos, Islon
ate: i ! •r 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 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, a�d State laws relating to the building
C
ons
correct
and hereby authorize J�,, ep/relsen'tatives of this City to enter upon
bove-mentioned property for inrspe�t'on purposes.
rf �
(Owner/Agent) Date
BUILDING PERMIT PERMIT #
Zt Jaiv*.r
s74
DATE VALUATION LOTj ,, TRACT
- . 99.
JOB SITE- - - ,
ADDRESS L;0066 IYAL?,tJIQ� t
APN
76,1480-030
OWNER
CONTRACTOR / DESIGNER / ENGINEER
f°o'17NIElltat'13/Af il4~'!) T, �eAot►ti7
,- ;.6y ¢ • re•.rae,c.19a .i G .Elf
�7' �I rty�/a�..r�lry�y Hl a c
� tv v r t a,. � e. 01'. , S
7`161 INn"7�ii�e.�'�,11V ,
7i61 NCi1.A:1~1t�fiV:3�.
HIVE S[ E CA 9:L504
RI VIER` 10E CA 92._5(14
(90)A784-0840 0130 5357
USE OF PERMIT
SNOLl::k?Ai FAMILY DVEZ L1,NG
1.0'.t' 2, PLAN .t/k - SP'D - PERMi"T 13O -ES NOF .EXCL E BLOCK WALL
OR PDX1111
CUSs0114:+;;�JA,', i 'rv.'��57iti+t d,tt►I:GJ at.
0ARA4?&LARPOTtT 580.00 SF
EnatC11113Tf_3y �.aii.�t•i. iii L,.�.i'.s
a��'•,va.�'i. avis.
CONST ROC'"!.'1ON1..7116 101-00041&000 59k°.Ctt?
~?ai ( ;1 LSF , 1X11-t1dll -4 39-3 tS &75 ,.f ►
WI C:iW4(CAL FEE 101-000-421.0100 ;5,w
t LPIC` RICAL, FEZ, 10.1-000-420-00
PLUMiaM(a s+1 101-000419-01Y) $lira 4�j
?'1"1�('►?v'cxA?(�'T.1�Nt�';"r;a:�,'�StA ?�?1.-•�Ii3�1_?,�i.-C%0() �17.R%S
G£eeiWN(I FU 101.-OW4223-GW
1N.I'- ASURUC7`t1RE F1`b3S . 22:5-000.443.342 S19-18131
AFt.•i 1•N' Pt SLIC, PLASS -: ESID 701.000-255-000 S397.03
> s EPOSt:'I' .l f 1-000-439-318
RMI-TOTA-1, C.O. NFr_10X,11.0N AND PLAN CHECK
LESS PRE-P.,k- I FES
4250.100
t67T:31.PEtkM.IT FIi.. DIIJIF NC!w
$5,932.46
j'4J �l/l:ti�f
RCEIPTfr:'y�.%�4
DATE.y
BY ,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade //
Return Air
Steel X,
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap /
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath s
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROV LS
POOLS - SPAS
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
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
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring. ..
Low Vottage Wiring
Flxtures
Main Service
Sub Panels
Ext 'or Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final q 44
Utility Notice (Perm)
COMMENTS:
OWENS-CORNING
!berglas Lµ
13011din'g Insulation
jhe.contractor named below certifies that the Owens-Corning Fiberglas Building !
z'in
sulation used carries, the NAHB Research Foundation, Inc. label for assured
thermal performance and that the Building' Insulation is installed in comformance
"u- ., with the current energy.conservation regulations, California_ Administrative Code, "
Title 24; State of California, in the, building located at:
8¢000 MERIQN LA QUINTA 28340-3 LOT 2 -'
Address City Tract Number
Exterior Walls-.
BATT
3112
R -15U
;Owens -Coming Fiberglas Type.
Insulation
General Contractor'
License No.
Thickness
R -Value '
Vic•
Title Date
Ceilings.
BLOW
.151/4
R-38
* Owens -Coming Fiberglas Type
�._ .
Insulation
InsulationContractor-
_
License No.
Thickness
R -Value
:Floors
z :`• Owens-Corning Fiberglas Type
Insulation .
Thickness
R -Value
`r Foundation Walls
tri ; • ,, Manufacturer ..
«,
Type
Thickness
R -Value
?e Pub. No. 15•BL-14725 -
; Sr'. tho in U.S.-A. Sept. 1987-Copyhpht ® 1987 Owens -Coming Fiberglas Corp
MIM
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Fiberglas Tower, Toledo, Ohio 43659
General Contractor'
License No.
='=By-
Title Date
Peragon insulation t>32072
InsulationContractor-
_
License No.
gY
09 -Title
r` 9 Title Date 8/9ig9
?e Pub. No. 15•BL-14725 -
; Sr'. tho in U.S.-A. Sept. 1987-Copyhpht ® 1987 Owens -Coming Fiberglas Corp
MIM
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Fiberglas Tower, Toledo, Ohio 43659
eCertificate'of O.
City ®fLa;--Quinta _x
Building and Safety Department OF
This Certificate issued pursuant -to.-the requirements of Section: -109 of the .Uniform Building Code,
certifying that, at the time of issuance,- this structure was in compliance'. with the various ordinances
of the City regulating building construction or use. For the following: �
BUILDING ADDRESS: - 80-000 MERION
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:. 9901-079
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.
r Date: 9127/99
• -`. i .
- . Building Official
POST IN A CONSPICUOUS PLACE, k
a,
i