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9901-080 (SFD)LICENSED CONTRACTOR DECLARATION r 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 Professionals Code, and my License is in full force and effect. License,# Lia Class Exp. Date 7�5�tu ate � 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: 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). r () 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. ( I I have and will maintain workers' compensation insurance; as required by Se tion 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. i)i+31` Z.0 PAC07 4C } NS N W AV i?S?5-00 (This section need not be completed if the permit valuation is for $100.00 or less). (°) I certify that in theperformance 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 Caflfornia, and agree that if I should become subject to the workers' compensatid,.n ptovisio s ofr ec on 3700 of the Labor ;?te e I `II fo ith comply witlU�lios oviiffon:%�� Applicant r fff�jj /V 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, and State laws relating to the building construction, and hereby authorize repre�stentatives of this City to enter upon the a�bove-mentioned property for inspection purposes. vSfg' nature (Owner/Agent) Date l/q BUILDING PERMIT PERMIT# DATE VALUATION ; LOT TRACT JOB SITE. ADDRESS �a�liP"D�dr1A'6JJ�1 APN OWNER CONTRACTOR/DESIGNER/ENGINEER Io4 :rt�I%�t\t�%i A.V.Q. t161 INDIANA AVE. 4V, f St�J i CA 92,504 Rl.VERS10. CA 92504 ' M9)784-0840 USE OF PERMIT LOT 3, Pf-0. JR. - $ -PER-Mt f DaJES 140`f mi;o'D11 W Ott Wtom: vl 12,4.J00 3F �(,1U't;170 +L4y/tkV�JTrRUli.1.1t1N j}., C;A1tAJQVCJV0-;10Xf 339-4,*SF EN MA6ED CGINyFb. NY' �.:.•YI.d ISTRUTC-41,710N 204,6 77,90. l .9 PERWfff r, RE, SUMNURS, Lt)I*i i; ti 4'EE 101 -000 -X4:18 -00l0 $i.t3t37.4t+J 'LAN4OffF` ,'uf1:,Cy4RXt.0 a�L f"E',3 Ef 4M00t1- "'-�Jt)t? SS5, 0 UEc;'.4WCtai, F -EE 01-000 -420-00 Pli 4aW31NC4 fW 101 -OW -4,14-000 $162.50 S rRf °iF QA K)Ti.O4Y FES - ,RE,1 )0 Mt -000-74k%10 20.47 ?; RADINCf FfM? !.11J Ixm.,123-000 =14.00 tNFRiVMR0*CTLW;.ME 225.000413^342 &031. 4 AXI' fid 1'(l}}3IJC LA.0"k-a-R.MSI-701-C)CtM545-40 3 $261:69 :0t_000.-1439_1 18 4001)0 St D -'?"MAL + ON,;rMIX:' ON AND '?t,AN' C,�JF';(�'.5r . $7$7,063,04A, c� Ct•� �:C'e�l'r.''.'8'.t Y.iL _['�a�.'.47,J -1$500.00 RECEIPT DATE q BY ^ f DATE FINALED INSPECTOR .d•.y INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs A Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing 3p Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath S/ Final Final BLOCKWALCAPPROVAILS 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 17 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 760 777-7000 `Ln QUINTA, CALIFORNIA 92253 (TDD) (760) 777-1227 September 13, 1999 Y Steven Walker Homes. 7161 Indiana Ave. Riverside, CA., 92504 (909) 784-0840 Dear Mr. Walker, A Temporary Certificate of Occupancy is issued for 80-016 Menon. A re-inspection is required for City Final The following corrections were not addregsed 1,.Complete finish grade and landscapirig. a:2. Provide required attic ventilation: Sincerely, ianiel P. Crawfo Jr. Building Inspector II dpc + .. _ •. r+ .4 � ..'. '.. , .. .. _ 1. ta; yI 't}".•« D >, N � 0 y" The contractor named below certifies that the Owens-Corning Fiberglas Building Insulation used carries the NAHB Research Foundation, Inc. label for assured thermal performance and that the Building Insulation is installed in. comformance 'With the the current energy conservation regulations, California Administrative Code, `,'Title 24,.State of.California, in the building located at: 80=0.16 Nl.ER1ON LA QUINTA 28340-3 LOT 3 Address City Tract Number �- insulation contractor 'Paragon Insulation 0"32072 _ License No. gy:.. - : c.. A ruT%C;.� Title nrn Date A;Ci;C19 �'.•♦-�'t F Exterior Walls . BAT 3112 R -15U Owens -Coming Fiberglas Type Insulation OWENS-CORNING FIBERGLAS CORP. Pub. No. 15 -BL -14725' - Insulation Operating Division Litho In U.S.A. Sept. 1987 Copyright © 1987 Owens -Coming Fiberglas Corp. Thickness R -Value Y�'f Ceilings Owens -Coming Fiberglas Type BLOW Insulation ' 1.51/4 R-38 Thickness R -Value ,(floors Owens -Coming Fiberglas Type Insulation K ; ' Thickness R -Value. :-Foundation Walls cL� $ y` Manufacturer Type Thickness R -Value , General Contractor License No. ` - By Title Date �- insulation contractor 'Paragon Insulation 0"32072 _ License No. gy:.. - : c.. A ruT%C;.� Title nrn Date A;Ci;C19 �'.•♦-�'t • OWENS-CORNING FIBERGLAS CORP. Pub. No. 15 -BL -14725' - Insulation Operating Division Litho In U.S.A. Sept. 1987 Copyright © 1987 Owens -Coming Fiberglas Corp. Fiberglas Tower, Toledo, Ohio 43659 Y�'f ert�fica.ie of.®ccupancy�. -1 Cify.LaOQuinta. ,, pGw Building and Safety -De aitment� OF This Certificate issued pursuant to the requirements of Section 109 of the Uniform BuiIding 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 - 80-016 Merion '(30'DAY.TEMPORARY) Use Classification: Single Family Dwelling Bldg., Permit No.: 9901-080 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 13, 1999 Building Official POST IN A CONSPICUOUS PLACE