SFD (9902-168)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 • -
Date j j
Signature of Contractor s } f1
OWNER -BUILDER DECLARATION -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law• for the following reason:
( ) :l; as owner of the property, or my employees with wages as their sole
coriipensation, 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)... .
O Iam'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
Ston 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.
s ='.tl?1) a.r1GIF':TC.:1`;+i�i NWA2t)T 7oP964i ?.
(Thos section need. not be completed if the permit valuation Is for 100.00 or less).
() !•certify that in the performance of the work for which this permit is issued,
l shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, andyagree' that if I should become
n' p
Subject to -the workers' compensation' bf Section 3700 of the Labor
Codej Lshall forthwith comply wit!those provisio �s.
D .
ate 5 Applicant ��� r �-
/ 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
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 with all City, and State laws relating to the,building
construction, and hereby authorize representatives of this City to enter upon
the dbove-mentioned property for inspectionrpurposes.
he
VBignature (Owner/Agent)- r�' ^ -' I f "t �� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9"2468 TRACT
, rIR $178,813.10 14 28340-3
JOB SITE '
APN
ADDRESS — - r
00,202- AW--RION
7'(;1-x.40-Qt99
OWNER CONTRACTOR / DESIGNER / ENGINEER
STEWNWALKER HOMES ' S17EVENNV,1kL'KER HOMES
7161 MDiAN1A AVE. 7161 (N>�.tA•1 AAV&
RIVEWDE, CA, 02504 RIVERSIDE CA 92:504
(909)784.0840 C3L# 5357
USE OF PERMIT
LOT 14, :PLANIB -SF D.,1'f 72iV[ T W S NOT lWs~"f A)E BLOCK WALLS OR. '
POOL, PLAIN CHECK :k.EE RMUC`.ED 750/4FOR T1dMTTPLK,1SSUANC1 OF
R
CUST01\4 CONSTRUCTION«_ lt)1.00 SF
,
FCIR(HPA'1TTO 28F1-pfi '
GARt1GE/C. ORT 580.0031F
CS' IMATED COST OP CO[ S I`RUCTION
178,813.;3.0
PERMIT FEE SUMMARY
CON5TRIXTION FE, 101-000-418-000 $9.16.00
PLAM HECK" EE .101-000-439.318 80.15
NftrCHAN1CAL 'FE 101-000-42.1-000 $35.53
Ef EC TRICAL FE 101.000420-000 $142.614
PLUMB.M0 FEE. toi-CM-419-000 $14'2.50
STROI10 MOTION REE - RESI.) 101-001,24..1-000 $17.88
GRATING FW, 101 -000 -42:3 -ON $20.00
Wl-RM'1RUCIfURE FU. 225-000-441-342 53.958.31
ART I1,T.P1JRL1C P14ACI»S - R SW 701.-000-255-000 $197.0
SUB21'C, rAL CO.NSTR:UCrION AND PLAID CHECK
$5,668.01
LW K(L—PA1:13FEES
$0,00
TOL M, 3'EMl1 IT FEE, S DUE 1`1t)W
Sr3,668.01
ti
ECE;PT ` DATE BY r 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
A
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 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 LinesL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
. O.K for Finish Plaster
Sewer LateralPool
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) IIIA -VI 7 -7
COMMENTS:
41.1
.}!` y.. ,,+ a *.. ' � f � �eJ r �} X� _ r f • y " - ',., f�
WESTERN :INSULATION, . INC. ,
4211 Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Fax
r
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#: 14
SITE ADDRESS: 80-202 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 31/2 R -VALUE: R-15
CEILINGS:- BATTS BLOW
MANUFACTURER: .GREENSTONE THICKNESS: -10.3" R -VALUE: .R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE: J
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481.278.
BY:
TITLE: Producti n Ma ager
DATE: OCTOBE 27,1999
te' ncy C
C)Ccu
LA&rthrica ..,o
Pa.,
LO.
Ct Quinti Y
«• . ..' ..•.' _ .. �� % Ira ��`����'
Buildinaand'-Safety Department OF�ti°
This 'Certificate issued pursuantto: 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.builging construction or use. For the following:
BUILDING ADDRESS: 80=202 MERION
Use Classification: SINGLE FAMILY DWELLING _ Bldg. Permit No.: 9902-168
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
y By: DANIEL P. CRAWFORD JR.
,, /, Zv ; Date: 12/2/99
Building Official
POST IN A CONSPICUOUS PLACE
:.. A .