SFD (9902-170)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 •• f__�_ Signature of Contractor
OWNER -BUILDER DECLARATION
I he-reby'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 their sole
compensation, will do the work, and the structure is not intended or offered for
Sale (Sec. 7044, Business & Professionals Code).
( .) 1, as owner, of the property, am exclusively contracting with licensed
contractors. to construct the project (Sec. 7044, Business & Professionals
Code). r ` ,. -
() I am exempt under Section B&P.ClAor 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
p'ermit.is issued. My'workers' compensation insurance carrier & policy no. are:
Carver Policy No.
UNITED:P,ACIFIC fNS NVv '.0117896-00
(This section need not be completed if the permit valuation is for $100.00 or less):
O 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 provisions of Section 3700 of the Labor
Code, I -shall forthwith comply with" provisions.
bate ..:� N E ``i Applicant r 'z& - �� A�
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
i.. 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 cessati6h 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 propertyy fo inspection {pu`r'poses.
Sig
nature (Owner/)Ngent) t 51r -+' 11tvj Datef�? `
BUILDING PERMIT PERMIT #
f.99W,
DATE VALUATION LOT �70 TRACT
-
7161.
• Qc( $204,677SO 28340x.3
JOB SITE--
APN
ADDRESS -
s_fi-2a01Mmud
- -
OWNER —' -
CONTRACTOR / DESIGNER / ENGINEER
STEVEN WALKER HOMES
STEVEN WALKER, H•(3Nt1•ES
7.161 INDIANA AVE.
7161. IIvMAN.A.AVN.
RIVERSIDE CA 92504
RIVERSIDE CA 92504
(9()9)784-0510 C1.L# 5357
USE OF PERMIT
�, 'r e e • v� �•� ri • •rax t
LOT 16, JK AN 3.0 -S. � PPJ? IRT DOES NOT IMCLTZ-2 BLd7t"' WALLS OR
P001., PLAN CEI!' 7%- rES RIDTJCED 750,6 FOR.MULTIPIX ISSUANCE: Of,
.a ; P1,Aw TYPF
CUSTf„ M C"•ONST;RUC'140N 2A50.00 SF
PoRcippAT~IO 245,000
0A:R,ACFF.WCARPOR 5;3.9.00 SIT
'& ST ni IXT ED COS' ' OF' CONMUC'TION
6'77:91?
.114,
PERMIT FEE SUMMARY
C0NS,.1`kiJCT.1ONMi 101.000-418-000 $1,t1�37.tm
PLAN MECK FEE 101-000-439"318 S203, ,
NI:E HANICALFF 101-000-421-000 &'15•
t-LEC'CRWAI,FFX 101-W0420-000 S15a.UI
PLTli AINGhEE 10:1-000-h.19.000.
..S1*.R0N0 _ 0T10N FEE - RE3.fD 10.1-0010-241-000 &ZOA7
GRADIl+tc3'.FE1 101-000-4LI-000 $20.00
'JWFRA,'VVRL'C1`U9R t:E..(~ 225-00-443-341 $41S311.94
.ART N FUSLI4 .PLACE:S.:RESW 701.000255-000 � $261.69
SUB-TOTiLl CDM,"MI 1M ION iND PLAN CHECK
K-JI418.26
1..1sSS PRE -PAID FETA S
Si0.0o
TOLILL'PE.RMIT :FEES DUE NOW
%%448.26'
r,
VFtEt%P
T ,< cn_�
�`7 i�
BNr
DATE FINALED
INSPECTOR
" d�
•
i
4'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
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 APPRO LS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 A 1,1A
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
WESTERN INSULA'T'ION-; 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#: 16
SITE ADDRESS: 80-230 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 31/2" R -VALUE: R-15
CEILINGS: BATTS BLO
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE:' R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE: T
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: P duction 46nagt
DATE: OCTOBER 27,1999
f 0ccu rtica to opanc
Y N.,
AN
o
�0f.La ulnta
City C�
.
uiidinBg.sand'Sa'fety.,Department C�`y O F TNS.
This Certificate issued pursuantt-to the requirements of Section 109 of the Uniform Bui/ding Code, f
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: = _= -807230 MERION
Use Classification: SINGLE FAMILY,*DWELLING Bldg. Permit No.: 9902-170
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: 12/2/99
Building-d'fficial '
POST IN A,; ONSPICUOUS PLACE
j