SFD (9902-162)LICENSED CONTRACTOR DECLARATION
1. 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
Prof6ssionals Code, and my License is in full force and effect..
Lic. Class
License # -.,..,Exp. Date
7- rf ;, ,
E'
velflat� Signature of Contractor vf, MA
OWNER -BUILDER DECLARATION Z
i:hdreby, affirm under penalty, of perjury that I am exempt f rom the Contractor's
License Law for.the following.reasoh:'
i;!as owner of, the. property, or -my employees with wagesas theirtsole
compensation, will do the work, and the structure. is not intended or offered for
;s , ale (Sec. �b144, Business & Profe ssionals Code).
as *owh6r of,the property, am exc"liusively' contracting with licensed
coriiractors�to construct the project -(Sec., 7044,',Business & Professionals
l.arn exempt under Section, B&P.C: f6r this reason
Date, Signature re of Owner
WORKER'S COMPENSATION DECLARATION
ride
I;h'ere6y aff irm `6� r pepalt ' y, oI perjury one of -the following declairaitions:
.1 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 66 work for which this permit is issued.
I have and will. , maintain workers' compensation insurance, as required by
S6ction,370.0 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.
QN-IT K-) P IF] C INS
(This section need not 6 completed if the permit valuationis
E Nislor $100.00 or less).
I'c ' 6 ' rtify*tha'i in the performance of the work for whi6h this permit is issued,
I shall,not employ any pepon in any manner so as tolbecome subject to the
workers' compensation laws. of ,California, and, gre!(that if kshould become
subject to the workers' compensation' provisions of SectN 3700 of the Labor
- I It, . & i
C6d&;.l sh 11 f A Vthwith Comply with,,those14 provisiF ons.
A
Date;Applicant
Wain i ng:;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 is provided for in Section 3706
of.1the Labor Code; interest and attorney's fees. .
IMPORTANT Application is hereby made to the Director of Building and, Safety
for`,a� permit subject -to conditions and restrictions set f6rth on his
application,
pli6ation.
1. Each person upon whose behalf this application is made & each person at
Wh6se
.!equest 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
peemit, 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
'
SignatureOwnei.....-, Date;,.
BUILDING -PERMIT PEPIMIT#
DATE VALUATION LOT s902_ 1 6-d TRACT
-)R%An_1
JOB SITE
APN
ADDRESS A.
4110 IWIRRI
OWNER
CONTRACTOR DESIGNER ENGINEER
MVEN NVALKER IOME�'
STEVEN WALKER 14( MES
7 161 - INDLANA Ate.
716'1 'INDIANA AVE..
RIVERSIDE CA 92504
MVERSIDE. CA 02504 -
('909)784-0840 CK11 5357
USE OF PERMIT
J
&I PC -!.AA Hv ONNIPWRIO
L0,T $, 'PLAN 2B -SED- POWiT DOH'S NOT INa"u-DEBLOCK OR
POOL.
CU3TQM'0'_)N.STP.UC11014 2,379,00 SF
'PORCHIPATIO 220.00 SF
GARAGE/CARPCIRT 508.00 SF
ESTIMATED COST OF CONSTRUCTION
198,206."
PERMIT FEE SUMMARY
CONSTRUCTION �_EE 101-000-4.18-000 S-9,86.00J
PLA14 0413'11r_"K FrX. 11-01-000.439-318 $806,35
pill.iNJOING FRE, loi-000-41940
,i 2iL - 000 8 2,
ilCi iJl14G V 'E'
1, 4 kA S1.KU'CTt0k_8.I•`J,'k 25-000-443-342
AR'r IN PLMLfC PLACES -'RESEC-701-000-25..5-000
f. AND PLAN C -HP -CK
S6,87 6. 9 4
11S'PRE-PAJDFL
$0.00
TOTAL PERINIff FEES DUE N(AV
S6;876.94
6QATE,•BY
DATE,FINALED
INSPECTOR
4e
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
Exhaust Fans
O.K. to Wrap /
Framing
F.A.U.
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 APPROV41LS
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 0691
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
Utility Notice (Perm)
COMMENTS:
71
x
k
S
WES'TERY INSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760 F
(909) 686-8786 Fax �-
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, .TITLE 24, STATE OF
CALIFORNIA, IN THE BUILOING'LOCATED AT:
TRACT/ PHASE: PGA WEST -PHASE 2 TRACT #:28340-3
LOT#: 8.
SITE ADDRESS: 80-090 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
N
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 3.1/2" R -VALUE: -R-15
CEILINGS :BAITS BLOW
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13 R -VALUE: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER: ,
BY:
TITLE: ,
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: Prod uctio A ager
DATE: OCTOBE 27,1999
N.Cortificate of Olccupanc'y
Cit of La Quanta R
R- y
Building and. Safety Department,c�MOFj�"°
This Certificate issued pursuant .to the requirements of Section 109 of the Uniform Building Code,,•
certifying. that,, --at the timeofissuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:', '
BUILDING ADDRESS: 80-090, MERION '
Use Classification: SINGLE FAMILY DWELLING -Bldg.. Permit -No.:-',9902-162
Occupancy Group`. R-3 TYOe of Construction: VN Land U.se Zone:, RL ,.
Owner of Building: STEVEN WALKER HOMES, Address: 7161 INDIANA AVE ;
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR
..Date: 11/22/99
Building Official L -
POST IN A CONSPICUOUS PLACE '