9901-083 (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
avD to 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). 4
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;
(XI 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.
(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/a� y manner spas toPecome subject to the
w6Pkers' compensation laws of tCa ifornia, ani p ree that if I should become
subj�ect.tQ the �orkers' compensa on rovis 4 Sed ion 3700 of the Labor
C9de, I h f¢h' ith comply wit se proisiorits�,J
t,Date: Applicant !V
' r -
Warning: Failulre 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 v�AR all City, and, State laws relating to the building
construction, and hereby auth rize rep�resent 'ves of this City to enter u on
the above mentioned prop/rty fir insp fid poses.
IS-gnature (Owner/Agent) 'Date
BUILDING PERMIT PERMT#
9tit#1'�1)is;i
DATE VALUATION �+qqy pp�{{ ee yy LOT /, TRACT
,7r
JOB SITE �` Ea - y
ADDRESS ao614.1<DJ�
APN `
1d/:�i1�91I-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
c�'r•1:\�'t�T1'xO,A;Y�1;T�i i�n�arFr.
.. l • IwL ,t.['MJl ,},'e. \ I. f.�J1'I. .. fi
�`r��,rwnr��rA.�,'�'' �i.E�.°�,%��5
V F' ).. L't r. ,{. i.i��
71 61 1N'b Aies',fi A-V .
71611N1)[ANA AVE.
RIV1r1MIM QN 92504
RIVE1LS1DE CA 42504
" ►4,784-094:x_57
'
USE OF PERMIT
tiIIVi`LE FANHL`S' MELLIN
L 0 T 6, PLA N 16 Ft - IS -F0 -P ERMI D(YE8 NOT 1NCLMlk,- BL0CK WA1.:L
OR P 0L.. PLAN c~HECK.FIXREDUC-0) 75°ro FOB. MuLf'rRIJ11-13SUANCi3 01
SA -ME 'PLAN 'TYPE
� Ca t'? iwT r,:i):�lu'1'RiJG I It :iti 2,101.00 51.
PORC.R(PA 10 2P4.00 SC'
GA-F{.71(r&CARPDXF 580.00 SP
E+-'S-�'���.� E C.`,'. T O�' <;CR'8'.�:.�tC�:1�?f3'^.r
:f ;fs;�`3�3,'.rd';
xx: 7p. 77 77��,���,yyqq+�+ 3, i� 7 A,�'
tI'PitIILOJI6 FEE.7 SJMJWi,I�.✓i{.,!4�
C*NST kU 110N .FF—E 301 -NO -419-000 1916.00
PLAIN C 1TM,FRE 10i -000-439-31S
nriLtlCkTt',NiC.tLf. MEG, 1011-000.421.000 585.50
CL'13L'1'.itlf;�t� f: C;fs 1.Ot-Otlt3 21J-tilOt) $142.64
PLtM31NO FEE 101-000-4.19-000 S146150.
PROW :Mi?TIOISFEE -U5a) .I01-000-2.41-000 si7.m
ORA>.ING 17W 's 10;1.000-423-000 $20.00
)t rRAS!'R C"2`CK8i133 .225-00-443-342, S19:33.31
ART .I.N PIMLIC; PLACES - ItESIE 70.1-000-255-000 $ 197.03
LESS a 'XE -fie ID F)a.GS
so,fy0
UffAL 3'T+,RM.T.T. C,F.1.IYTJ 11f,W P$lr'
s'5, m)1
f�� r
RESP',
DATE f `
BY r ' J
DATE FINALED
INSPECTOR
x
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
ALI,
Ducts
Slab Grade
/
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
s
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z
Drywall - Int. Lath
f 9
Final
Final
BLOCKWAL 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
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles.
G.F.I.
Smoke Detectors
Temp. Use of Power
Final / 7/' c,? ,-
Utility Notice (Perm)
COMMENTS:
rte V
v. -.OWENS-CORNING -�
Fiberglas
ftildi'ng�. Insulation
The contractor named below certifies that the Owens-Corning Fiberglas Building
'Insulation used" carries the NAH6 Research Foundation, Inc. label for assured
thermal performance,and.that the Building -.Insulation is installed in comformance
- r with the current energy conservation regulations, California Administrative Code,
Title 24, State of California, in the building located at:
,Y 80-068 MERION LA QUINTA 28340-3 LOT 6
y Address City Tract Number
Y Exteriors Walls
BATT
t'`w,�Owens Coming;Fitierglas Type Insulation
BLOW
Owens -Coming Fiberglas Type Insulation
Floors
y, Owens -Coming Fiberglas Type
foundation Walls
31/2
R -15U,
Thickness
R -Value
151/4
R-38
Thickness
R -Value
Insulation
% Thickness
R -Value
Manufacturer Type Thickness R•Value
' General Contractor "�., • ,.v
License No. ,
"
By. Title
Date
Paragon insulation 632072
Insulation Contra or
�.,License No.
�.i1
'°y' .
V B:
Y \' / Title SF[ Date $fig
' Ali
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
of OCfte ccupancy.�-
�.
City of La Quinta
Law,
cFM
Buildin g and Safety Dep artment of
This Certificate issued pursuant -tothe requirements of Section 109 of the. Uniform Building Code,
certifying that, at the time of issuance, this structure was in corrnp/iance with the various ordinances
of the City regulating building construction or use. For the fo%%inning: -
.BUILDING ADDRESS: 80-068 MERIO.N
Use Classification: SINGLE FAMILY DWELLING ." - Bldg. Permit No.: 9901-083
Occupancy Group: R3 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: 9/21/99
Building Official r
" " POST IN A CONSPICUOUS PLACE. "