SFD (9902-171)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
l r r
13 i .,4� f Q13o100
VDa-ste/ r Signature of Contractor . S
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) ; 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).
( ) -1,as owner of the property, am exclusively contracting. with licensed
contractors to construct the project (Sec. 7044•,. Business &: Professionals
Code).
( )' Lam 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:
(,) 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 is issued. My workers' compensation' insurance carrier & policy no. are:
Carrier Policy No.
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17f3<r P C'( C i;t s"�n.y7Qq�s-1 t
(This section need no a omp a ed if the permit valuation Is foi 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 provisions%of S tion f 3700 of the Labor
Cod e,'I st`iall forthwith comply. with4ho'le provisions. ' `{ `
spate:= `? (1 i`1 APPlicant?� / 1' �_
` 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. Iagree to comply with all City, and; State laws relating to the building
construction, and hereby authofize representatives of this City to enter upon
11 i 1 i h if
the/above mentioned grope,�v for inspection; purposes.
3k
Signature (Owner/Agent)- Date
BUILDING PERMIT PERMIT" -
DATE VALUATION LOT`9ta1�&�7Y r TRACT
S200,696.10 17 7_ 28340.3
JOB SITE ••
APN
ADDRESS _
196:240_ IMMON
761480-099
OWNER• CONTRACTOR/DESIGNER/ENGINEER
M14FEN NVALR;ER HOMES STEVEN WALKER HO11I S
716.1 INDIANA AVE,, -7161 1NOL NA.AVE:
RIVERSIDE CA. ?504 RIVERSIDE CA 92501
60091784.0840 CBL# 535'
USE OF PERMIT
'LOT i7, PL NN 2AR -SV-D- PTA-(AlDOES NOT €N-01.UDE,BLOCK WAUS
OR POOL. PLAN CHECK FFE RF.,DIICUJ 750% FORMAXPLE, issuAmm OT
qAh,IP Of AN In'PP
C S`!'OM CQNS Rf lCTION ?.179.00 SAF
POi2c.t PA -10 X2{3.00 SF
C:ARAMCARPORT 635-00 SF
ESTIMMEM COST Orli' CONISTRUMIGN
200,696.10
PERMIT FEE SIi'fOWAR
CONSTRUC..riON FI -M, 101-000-4.19-000 $993.00
PLAN CHECK FEE 10.1••000-439-318 $203.00
MECHANIC::AL F'EA 101-000-421-000 $92:00
UEC=!'11ICAL Fa 1031.000-420-00'10 $153.47
4%l7MBING FEE 101.000--14 i 41-000 ;x162.50
S'i,'RONGAiOT1ONFEI -.REM 101-000-241-000 $20.07
GRADYNG FEE 101-000-4.23-000 $20.00
iNMA.S'19 UCTURE FEE 225-000-443-342 !A,449.83
ART IN PUB1,1CPLACES, 1 ESIC 701-t300••255.000 $2$1.74
SUB -TOTAL CON-TrRUM ION -AND PL V4 CHECK
6,3QS.61
€ ESS PRE -PAID FEES
10.0101
TOTi-VL PERJbt.i3' l! EES DUE NOW
$6,3455.61
RECEIPli �� '• ( K,
. y�. �.
ATE/'j
'
BY` IVI �r "N
�(.J
DA�NACED
INSPECTOR
, �;„
� - �. rye• -''
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 14 F
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 I
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
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:
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:
TRACT/ PHASE: PGA WEST -PHASE 2 TRACT #:28340-3
LOT#: 17
SITE ADDRESS: 80-240 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 31/2" R -VALUE: R-15
CEILINGS: =BATTS BLOW.
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 13" R -VALUE: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NU ER: 481278
BY:
TITLE: lProductiMi Manager
DATE: OCTOBER 27,1999
WrCer'dficate
of ccu ar c
City of L.a Quinta
� le.y,ura+`4
Building' and Safety Department 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: 80-240 MERION '
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-171
Occupancy. Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES
Building Official
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
1("4 , -
By: DANIEL P.'CRAWFORD JR
Date: 12/28/99
t •
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