SFD (9902-165)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
Professidials Code, and my License is in full force and effect.
License.# LiL Class` 1 Exp. Date
emf00
i.11Date/`1 % 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:
(r) , 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).
( ) . I, as owner of the property, am exclusively .contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 's
() 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.
j .01. 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.
UNITF0PiVAN �IC,'INSN'V�`A21117i34 -0(t'
(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 California, and agree that if I should become
subject to the workers' compensation provislons.of Section 3700 of the- bor
Code .1 shall forthwith comply withi4h'ose provisions.%�t
Date�� r/si t' Applicant--�"
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject, an.employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fors a permit subject to the conditions and restrictions set. forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
s any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and. employees.
-1 Any permit issued as a result of this application becomes null and void if
Work is• not commenced within 180 days from date of issuance of such
permit, or cessation of work for_180 days will subject permit to cancellation.
I ceiMfy that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby autrhorize representatives of this City to enter upor
the above-mentioned property,for inrspection purposes.
ig lure. (Owner/Agent)/�" % .�r�r Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT " TRACT
&UN,677.90 [1'I1.t+31i6-
J013 SITE 1
APN -
ADDRESS
OWNER
CONTRACTOR/ DESIGNER /ENGINEER
STEVEN WALKEP, t-tOPvtES
STE'VEN WA1 KER Fifa! ES
7.161.%NDWNA AVE,
1161 WD ANAs VE,
RIVERSIDE CA 92504
RiVERSfDF CA (02501
;S�J9)784.0840 CBLA 5351
USE OF PERMIT
LOQ' '11, PLAN 3C -SFD- PENN : !' I iURS NOT INCUDE BLOCK NVAUAS OR.
PCiUT_, PI t11+I CF-II:CK FBF RMUC`,ED 7.50/ FOR. MLILTIPLE ISSUANCE OF
SAW- PLAN T�?E
CUSTOM CC)iL`S`GUXTION 2,4Sp.d0 SF
PORCHIPATT()45.00 Sr-
GARAGE/CARPORT :539.00 SF
ESTIMAI I it t"4 'ST OF COINST1•iJGTION
:�tlw�r7 �1a3
P ERi U T FEE SUMMARY
CONSTRUC` ION.FLE 101-000-4I.1$-060 $1,007.00
.AN CF WC.")< PEE 1:01-000-4139.31$ 13
"L ECHAMCAL FSM 101-000-421-000
EWC`.TRfCA1 .F'K 10'1. -000-420-400 $154.03
PLUN113l.NCf FELT, 10401W419-000 $152.50
T%'1fiO OM01'1014 FEE- - F-ESID 101-000-241-000 $20.47
GRADING NEE .101.000-423-000 $'2ttM
Wf`RA.S'1R !C"I[UREkEE 2 -000-443-1,42 34,:531.:4
AR!r IN PUBLIC PLACE: - RESIr 701.-000-':.55-000 $261,69
SC13,`f0IY\L CONSTRUCTION AND PLAN C 3:R:ECK;tl6
¢J82
0,01 0
Tl`.DTAL PERMIT FEES L111?E'N01"r
$6,443,26
ECEIP r `
DA E .,
BY { O
DATE FINALED
INSPECTOR
4,1'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 2
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck S
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P .
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Pa irewall
Ext "or Lath
Drywall - '
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 .001
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:
y
. ' WES'TERNINSULATION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760 '
(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 BUILDING LOCATED AT:
TRACT/ PHASE: PGA WEST-PHASE 2 TRACT #:28340-3
LOT#:
SITE ADDRESS: 80-150 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS-MANVILLE THICKNESS: 31/2':• R-VALUE: R-15
CEILINGS: 'BATTSBLOW
MANUFACTURER: GREENSTONE THICKNESS: "10.3": R-VALUE: R-38
�.
GENERAL -CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:. WESTERN INSULATION, INC. .
LICENSE NUMBER: 481278
BY:PO
TITLE: Products Ma ager
DATE:. OCTOBER 27,1999
g
WCertifecate o'f
City of La
�11 If
I€
wuinLd
Building and.Safely Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the timeotissuance. this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS. 80-150 MERTON
Use Classification: SINGLE-FAMILY DWELLING. Bldg. Permit No.: 9902-165
Occupancy Group: R-3 Type; of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER H'OMES'. 4ddreiss: 7161 INDIANA -AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 11/18/99
Building Official
POST IN A CONSPICUOUS PLACE