9901-082 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
/ate I 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:
( ) 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). r;
( ) I am exempt under Section B&P.C: for this reason
Date ' Signature of Owner
WORKER'S COMPENSATION DECLARATION
i
I hereby affirmfunder, 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, f6ir the
performance of the work for which this permit is issued.
( J, 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 ' T/ v Policy No. ppqq�} �a �C �(�
. UNId.L,.L P��1>""i.If; 10 I 13 ' wvelo 1711%40
(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 Cd'lifornia, and ree that if I should become
subject,to the workers' compensa ori rovisi n f Se Ion 3700 of the Labor
Codd shill fo 'hwith comply wi{ o e pro si' s �,
. Date: F Applicant
Warning. Failure to secure WorLCers' 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 represe tatives of this City to enter upon
the above=mentioned property for inspectio p roses.
% A
)i nature (Owner/Agent) P _Date
BUILDING PERMIT PERMIT#f
DATE VALUATION r, LOT•tri. �— s TRACT
N3t1-
a -
JOB SIE _p..,
ADDRESSf �➢[W (A.,rWaV1
APN f.
'!Qt@-�'a363^�,YcY
OWNER .
CONTRACTOR/ DESIGNER/ ENGINEER
5"fI V A: kr k'. `.I1O3t1".t3S
71d'1 fNDIANA.AVE. "
7101 INDIANA AVE.
itdV'11Z Ifs CA 92�"J4
1iJWCSJ.D:G CA. 92504
3
�`?i►� idi44'+4#!F,O1 53;517
USE OF
pPERMIT
471;AYL.F�R.dk'r A'J:V.vb1A.l l� 7,J VY &rl.. [e\,lV�,:7
LOT 3. RLAN 39A - SF0-- P T DOES NO T 1NCLi)rs R BLOCK WALL
Oft I100,11.. PLAN ti^'HE.CK Mi. 1tEE,tr10ED 7.5% FOR XAULITPLE ISSUANCE, OF,
SAME',17LA1J 'I—YV ^w
i,Cpaiaiicti3C:"1'sON 2 450;00
POR01K)ATIO 245.04) SP
f: iAib.tA61WLAf2:1 OR`!' S l.t J SIP
.d.ci9TUNIATE..0 ST Qb? ��i�v'aS i.�Ii`��C�l�t
��r,�. r.'1.90
CONS J'k2U(77:':tfrll`T FEE .101.4x.10.418-0) $1.007.00 .
PLAN $7W 13
AiA11;CALFF-C:. 101-000-42'-00 '�35.5fl
ETUC "I RIC NL 10.1-000-4201-000 $154;03
PLUNJI$1NG F0 101-000-419-U00 $1162. S0
`J'FWNG MOTIO11i k'TX. ,. RUM 101-000-2414 $20,47
GRAW N0 FW 101-000-42,-000 $20.00
lNMA.STRiJOTTiRE VEE, 22-5-000-dW31-342 %4,531,94
AR.'1 rNPOOL ICPLACZ-S<.iceSfl:701-'000-255-000 $1261 a()9
RECEIPT
DATE
BY 1�, .�^r� -""
DATEFINALED
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
Combustion Air
Roof Deck Q
Exhaust Fans
OX 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
Drywall - Int. Lath
Final
Final
BLOCKWALL A- PPROVAL_g
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 7
Encapsulation
Gas Piping
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:
:.
erdicate;af�Occu anc - T .
s .. r ..
y a�.
L/ '
City
of La0
..Quinta s
,.
Building and $a.fetk-Departmen' t 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 fol/owing:
BUILDING ADDRESS: 80-050 Merion (30 DAY -TEMPORARY)
Use Classification: Single Family Dwelling: Bldg.. Permit No.: 9901-082
Occupancy Group: R-3'- ~ Type- of. Construction: VN Land Use Zone: RL
4'.
Owner of, Building: Steven Walker Homes Address: 7161 Indiana Ave
City: Riverside, CA-., 92504
By: Daniel P. Crawford Jr.
Date: 9/16/99
Building Official
POST IN A CONSPICUOUS PLACE
• I
OWENS-CORNING
Fiberglas
r`::Riii:lr n* n .1nci i1n♦io%n
' The contractor named below.certifies that the Owens-Corning Fiberglas Building
.?x : Insulation used carries the NAHB Research Foundation, Inc. label for assured
thermal performance and that the Building Insulation is installed in comformance
-with-the current energy conservation regulations, California Administrative Code,
'= :Title 24, State of California, in.the building located at:
`,Z�80-050 KERION LA QUINTA 28340-3 LOT 5
qA , 'Address City Tract Number
t Exterior Walls
',
BATT
3112
R -15U
Owens -Coming. Fiberglas Type
Insulation
=' BY
•Date
`x•'
Title .
Thickness
R -Value
Paragon Insulation. 632072
Insulation Contractor.
License No.
a .Ceilings:
BLOW
Title OM_ Date RtCaf�9 .
Owens -Coming Fiberglas Type
Insulation
151/4
R-38
Thickness
R -Value
-Pub. No. 15 -BL 14725
Insulation Operating Division
Litho in U:S.A Sept. 1987 Copyright O 1987 Owens Coming. Fiberglas Corp. Fiberglas Tower, Toledo, Ohio 43659
Floors
,- Owens -Coming Fiberglas Type
Insulation
Thickness
R -Value
r
Foundation Walls
Manufacturer
Type
Thickness
R -Value
General Contractor
License No.
=' BY
•Date
Title .
Paragon Insulation. 632072
Insulation Contractor.
License No.
03(
.
Title OM_ Date RtCaf�9 .
_"o
r'
OWENS-CORNING FIBERGLAS CORP.
-Pub. No. 15 -BL 14725
Insulation Operating Division
Litho in U:S.A Sept. 1987 Copyright O 1987 Owens Coming. Fiberglas Corp. Fiberglas Tower, Toledo, Ohio 43659