SFD (9902-169)LICENSED CONTRACTOR DECLARATION
),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
f". tai O,t3� A YL D +� F f Signature of Contractor #
OWNER -BUILDER DECLARATION
Thereby affirm under penalty 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 them 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)'.:
I am .exempt under Section B&P.C. for this reason
bate '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.
(>)/l have -and will maintain workers' compensation insurance, as required by
Secf on 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.
UNI'f,'Ei7 PA IFIC INS NAY 200 1596-00
(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 toEbecome subject to the
workers' compensation laws of California, and agree` thafl ifjl should, become
subject to the compensation provislonsrof Section 3700 of the Labor
Codee!-shall forthwith comply witfi�those provlswns. / ✓#/
Date`. ' ` /` r Applicant
j/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, andbState laws relating to the building
const/ruction, and hereby authorize representatives of this City to enter upon
the above-mentioned' property for inspect1 f purposes.
bS g ature (Owner/Agent)' �•.>tit ' 4 Date.
BUILDINGAAMIT PERMIT Y °
DATE VALUATION LOT 9007'-1.Ps9 TRACT
C 1.9204,677.901S 2h.3diq=�
JOB SITE I
APN
��;Yy�sep��•ya�
ADDRESS ��-��QT 1�P.+103V1:3
nI�DI-�i3o-r1�9
OWNER
CONTRACTOR/DESIGNER/ENGINEER
STEVEN NVA:LKER HOMES
ST EVEN IVA.T KKR HOMES
7161 .f14D.IANA AVE.
7161 LN.DIANA..AiiE,
RIVER,q,IDE CA 91504
RIVERSIDE CA 92504
(909Y7844)840 C.BL # 5347
USE OF PERMIT
�IYV('°1 `' " lU1'1 :1' i•1\Si. �''t.'�.t1niC`
'
LOT 0, PLJW'MB-SrD-PrRN i DOFS'NOT UNCI TIDE RLOCK W.AY LS Off.
POOL. "P.i .ASI CRECK FEE REDUCED 75%0 FFR NR.1 rfP.I,.E TSSUANC% OF
SAME PIAN TYPE.
CUSTOM CON. STRI)CTION 1,450.00 SF
P4' RC}3/PAY10 ST
GARAGWAR!'OWr 5:39.0.0 SF
U STIAIATED COST OF C-ON81RUC•i"I N
PERMIT FEE Sl(3MAMRY
CONTI'I3LiG'.t'dON .PF 101-000-418.000 $ 1,007.00
PLAN CHECK FEE 101-000-439-3.18 $203.13
MRCHKNICAL F.FE 101-000-4121-000 535,50
ELFC:TRICA1. VEE 101-000-4110-000 $154,03
.PLC._tMBINGCI+E 10.1-000419-000 5162 5di
�: ;x
STRONG .MOTION ;1 - - R&SII., 101. 101-0 24-1-000 S2,0.47
GRAOTNGFEE 101-000.123-000 uki o0
1•NIFI.tA.STltUCTUR!_ 0. 225-000-443-.342 &153..1.94
ART 1N PUBLIC PLACES - RISSIC 701.goO-?.5 4-000 V26b.59
SCr.E3-`f*Cr A.i.. CONS`.1 F UC'IIO v' h -ND PL, :N' CHEtC-K
$6,4418.'2A
IISS PU-.PAID 1 UIS
,, $0.00
TOTAL PERMIT FEESi DUE NOW
$6,448426
.y •
SECEIPT
DATE �' /
BY - ;
rDATE 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
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 CIA
Drywall - Int. Lath
Final '
Final 0, 0aPOOLS
BLOCKWALL APPROVA S
- SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 323
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral ZQ4
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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
'440 Ua
Utility Notice (Perm)
. -
WESTERN INSULATION, 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:
i
TRACT/ PHASE: PGA WEST=PHASE 2 TRACT #:28340-3
LOT#: 15
SITE ADDRESS: 80-218 MERTON, LA QUINTA, CA. `
EXTERIOR WALLS:
MANUFACTURER: JOHNS-MANVILLETHICKNESS: 31/2" R -VALUE: R-15
1 •
CEILINGS: BATTS
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOLIES
LICENSE NUMBER: -
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278 ,
BY:
TITLE: Iroduction banaker
DATE: OCTOBER 27,1999
IN.rc
Certincate:iof-Accuarc - �-
p
Y a.
CitaoLinta.,
Buildina .and .Safety Department OF��°
This Certificate issued pursuant to;.Ae 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 Cityregulating building construction or use. For the following:
BUILDING ADDRESS: - M 80-216 MERION
Use Classification: SINGLE FAMILY DWELLING Bldg,.Permit No.: 9902-169
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
B DANIEL P CRAWFORD JR
Building Official
Y.
Date: 12/2/99
POST IN A CONSPICUOUS PLACE . �.