SFD (9902-166)tr 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
�Da'��+ �fJ� Signature of Contractor "�#frtttt4 f ✓I'i•`' �'�" '"
OWNER -BUILDER DECLARATION t'
I. tiereby.affirm underpenalty 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
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.
( )� 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 isissued.' My. workers' compensation insurance carrier & policy no. are:
Carrier ,.. - Policy No.
UtaREO PAC.IVIC :NS I^•fWA2t:1 if.,
(This section need not be completed if the permit valuation is for $100.00 or less).
( )' I certify'that in the per 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 pro 'Islors of Section 3700 of the Labor
v� i Fl t
Code(1,shall forthwith comply with those provislonsY 1___.�---�-
Date (�s ks`! Applicants ✓iti, t' /lfi'
Y 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
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
j 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.iAnypermit 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, 6r 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.
Signature (Owner/Agent) A, 4 � � �,"A, Date J/,(
i/
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$200.696.1.0 t2 1$340-3
JOB SITtff
APN
_
ADDRESS �-
,pp'71--d1` - El R"i`ONitN A -
76.14-9041"
• •OWNER
CONTRACTOR./ DESIGNER / ENGINEER
S'MMVEN %"ALKER ROMPS
S"fEVEN WALKER. HOMES
71011NDFJ1.NA.:AVU,
7161. INDfAb1A..AVE.
R1taRSIL4:E CA 92504
RIVERSIDE CA 92504'
2504-
(909)794-0840
(909)794.0840 10EL# 5357
USE OF PERMIT
Gtr zt ry r r thir.
LOT 12, PLAN 2C-S1`D-, PfR-& IT DOES NOT INCiMF +31,0(k. WALLS OR
POOL,-
CU,S'I'OM C01NSTRU4CTICYJhf 2,37S►.f0 '��r.F
POR.CI•iLPATIO 220,00 SF
GARAQVCAR'POR T 635.00 SF
vs rrm "r.r1n cost' Ov cow.mucr. m
X01,1 1x..14
PERIW1 FEE SUl1(.iMAM(
C 014STC€UCTION FCS;.101-000-418-000 9�+x.00
P,1 . [q. {"IMCK Ff E 101-000.439-318 -$i 11.99
1411 HAMICAL Fick i.fl1.-{itlti-X 2,1-f1(.?t7 >;9 :Oti
ELIECTRICAL, H:t F io1-00()420.000 115:3.47
PJ'JJ'tL1 MNCi 'Ft2T. lot -000-"09-o00 $162.50
STROz G )MOTION FRE, • RE -SIT) 101-000-241-000 $20.07
OR,WNIG :1 EC 101-000-423-ooa 120,00
1NC•'.R��:,'fM. JC"CU]RHE 225-0W-443.342 $4,449,83
ART.INC.11LIALIC: PLACES .-RESIC'701.-000-255.1100 $251.,74
SUB -TOTAL CON5'��lUC1'IfJtV.AAtO P1.t1N CHECK
s%,9S�t.60
I'ESS PIK -PAID 1'1~`ES
$0,01)
.. TOTAL PEIt.MIT FEES DUE NOW
$6,954.60
EC-EIPT• ` %
[ATE✓„
BY�
DATE FINALED
INSPECTOR
Z
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
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 APP_ ROVA S
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 3
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.1.
Smoke Detectors
Temp. Use of Power
Final 44 6 424 4Z
Utility Notice (Perm)
COMMENTS:
N'1
• i
WESTERN -INSULA'TION, 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#: 12
SITE ADDRESS:' 80-166 MERION, LA QUINTA,_CA.
EXTERIOR WALLS:
. t
.
MANUFACTURER: JOHNS -MANVILLE
THICKNESS: 31/2"- R -VALUE: R-15
CEILINGS: BATTS
MANUFACTURER: GREENSTONE
THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR:
STEVEN WALKER HOMES;'
LICENSE NUMBER: i
BY:
TITLE:
DATE:
INSULATION CONTRACTOR:
WESTERN INSULATION-, INC.
LICENSE NUMBER: 481278
BY:
TITLE: Oroductiq M
nager
DATE: OCTOBER 27,1999
r
rtificatebf -Occu anc
p .Y
Ci(y of La Qdinta,
Building and Safot Departm'ent 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 following:
BUILDING ADDRESS: 80-166 MERION
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-166
Occupancy Group:.R-3 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: 11 /22/99
Building Official
POST IN A CONSPICUOUS PLACE J
Amo