SFD (9901-084)LICENSED CONTRACTOR DECLARATION
,J 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
1 -!Professionals Code, andl-my License is in full force and effect.
1 License # Lic Class Eq& Date
t
�t �e S 0,
,D Signature of1C ntrac or
OWNER -BU ILDER'DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( -) 1, 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).
1, as owner of the
1property,-,am exclusively contracting with licensed
contractors to construct the project, (Sec. 7044, Business & Professionals
Code).
I am exempt under Section B&P.C. for this reason
Date Signature.of Owner
WORKER'S COMPENSATION DECLARATION
Thereby affirm under penalty,.qf 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 pe'rmit is issued.
1, have and Will: maintain workers' compensation insurance, as required by.
X
Set: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 liVaC+ Policy No.
'�rf, Jr4 TO, t, 114muo U -P-9111140
A.,
CL -1 1W.. 4. 1.,
(This section need not be completed if the permit valuation is for $100.00 or less).
1, certify that in the perforriiance 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, and agree that if I should become
su .ject'to the orkers' corripensat tons(of S ctibn 3700 of the Labor
Co 41s all hw th comply with p( si!�,prrvisiorIs
J9 , Applicant
Warnin . g,: Failure to secure Workers' Compensation coverage is unlawful and
ghall: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 t . o 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 agree's 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 fromdate 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 vjith all City, and State laws relating to the building
construction, -,and hereby d, re is
Thorize City to enter upon
for s
the above-mentioned prop9ly 1.. r in Tecti
Sig4re (Owner/Agent) Date
PERMIT #
BUILDIN, PERMIT - i4� �i)
., Nis 84r�
DATE VALUATION LOT'*?,41 TRACT
S204,677." 28_140,3
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
SMArf"N' U'A.41' 'I' _10V 11',
AVE
7i6 11913.UxN1+.AVE,
RNERSIDE CA. 92504
RIVERSIDE CA 97.504
(90q)7$4_0
USE OF PERMIT
SINGLE FAMILY DWELLTNZ
LOO T 77, MAN 3CA - 81,D - PMMIT M)ES NOT 114CLUDEBLOCKIINALL
QR P"_PLAN Ci; ECKFM REDUCR) 79.1/6 F0R MULI`111L HIMSUANCE 40F
SAME PLAN TYPS r.
WSTOXI CONSTRUC1,11TON21 .2,450.00 irior
245.005F
C 539.00 3F
1R1,,. OF CIONINSTFIR.111C TH ON
2104,0577.1"U
CONSTRUCVONFEE 101.-000-415-t OO $1,007.00!
$85.50
ELECITMAL FEW A.01—OW-420-000
PLUN413)WO FFE 101-000,419-M S162.LV
i 0 1 900 -?4't-000
QRAI)ING FES iO3--00(1-423.000
INFRASMUCTUM F -all 225-0.00-44' .042 SOHN
MMI -14 PUBUC PLACES - RESIC 70 1-000-25.5-00
UA Y! Nf DI .P HA2
4T, AL CO -M,
$
LESS PU.-PAID FRIES
$0.00
VY ALVERWITIFE 'NOVV'
A
F
DeT\��\ 4
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
Combustion Air
Roof Deck 3 y
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
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
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 i 57 49
Utility Notice (Perm)
COMMENTS:
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ert icatea-Gf.-Occu p .anc �-
t_ y
a�
.- Cot • :of �La•• Q��nta �._- � [� • .. �:
u�l+�n and Safety Dqpartment. MOF
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This Certificate issued pursuant to: ttie;,requirements of Section*409 of the Uniform Building Code,
certifying that, at the time of issuace,: this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:80-080 Mesion.
Use Classification: Single Family Dwelling Bldg.` Permit No.: 9901-084
Occupancy Group: R-3 Type"of Construction: VN Land Use Zone: RL
Owner of Building: Steven Walker Homes . Address: 7161 Indiana Ave
F. City: Riverside, CA:, 92504
By: Daniel P. Crawford Jr.
Date: 9/16/99
Building Official
�0W A;
POST 1N A CONSPICUOUS PLACE
.OWENS-CORNING.
�- Fiberglas:
4B� ilding insulation
"-4 -The'contractor;'naimed below certifies that the Owens-Corning Fiberglas Building
N Viz. Insulation used carries the NAHB Research Foundation, Inc. label for assured
y<r.:
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:
80-080 MERION�' LA QUINTA 283401;3 LOT -7
Address City Tract Number
r.� .
Y3 _ -
�� Exterior -Walls BATT 3112 R -15U
Owens Coming Fiberglas Type Insulation
Thickness R -Value
>` Ceilings SLOW 151/4 R-38
{� Owens Coming Fiberglag Type Insulation
" Thickness R -Value
Floors
Owens -Coming Fiberglas Type Insulation
Thickness. R-Value.
Foundation Walls
Manufacturer Type'. Thickness R -Value
Cc` �
'.:•'General Contractor License No.
BY Title Date.
Paragon insu4ation 6321372
h Insulation Contractor„ License No.
i
Title !:ZF=r Date 8491S9
FIBERGLAS
,y
. OWENS-CORNING FlBERGLAS CORP.
15 -BL -14725 Insulation Operating Division
kti ; Litho in U.S.A Sept. 1987 Copyright 0, 1987 Owens -Conning Fiberglas Corp. Fiberglas Tower, Toledo, Ohio 43659