SFD (9902-172)LICENSED CONTRACTOR DECLARATION
ere 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.
Li6ense Lic. Class Exp. Date
It A
/'f149004 13 - �) !.,) 11 00
D. Signature of Contractor
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
pale (Sec. 7044, Business & Professionals Codd).,,
1, as,owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.* 7044, Business & Professionals
I *am exempt under Section s .B&P.C.'for this reason
Da te LSignature of Owner
'-WORKER'S COMPENSATION DECLARATION
1 -hereby affirm under penalty,6f perjury one of the following declarations:
I haveand will.mainta'in a certificate of consent to self -insure for workers'
c6nipe nsation, as provided for by Sectio , n 3700 of the Labor Code, for the
06rformance.of the work for which this p ermit is issued.'
have and Will maintain'wo'rkers' compensation insurance, as required by
Sbction 3700 of the Labor Code, for the performance of the work.for which this
ple . rmit is'issued. My.workers' compensation insurance carrier & policy no. are:
r Policy No.
CaMe
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 agr6i�i that, if I should become
Subje6t to the workers' compensation provisidhs of Section a700 of the Labor
Code I shall forthwith comply with1t e provisions,,
Warni ' ng: Failu re to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fi.nes up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the1aborCode, interest and attorney's fees.
IMPORTANT Appli6aiion is hereby made to the Director of Building and Safety
for..'a permit subject' to the conditions and restrictions. set forth on his
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
anynnit issued as aresult cdthis oppicamnagrees to, & shall, indemnify
& xom,xamn|mmmo City of u,Quinta. its officers, agents and employees.
2. Any permit issued asaresult o,this application becomes null and void if
wb,xio not commenced within 180 muvs from date o, issuance o, such
�permit, orcessation oxwork for 18Odays will subject permit tocancellation.
| certify that | have read this application and state that the above information io
c6imot.|agree tocomply with all City, and State laws relating tothe building
construction, d hereby authorize representativesof this City to enter upon
,y for inspectio"npu?poses.
ignature' (Owner/Agent) Date—
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
Qr4 $2.04,677.,90 Ig 128.3110-3
ADDRESS
80--254 ANNUON
761.484-099
OWNER CONTRACTOR DESIGNER ENGINEER
STEVEN WALKER HOMES STEVEN IWALKE R HOME S
710-1 INDIANA AVE. 71611NMANAAVE.
RIVERSIDE CA, 92504 RIVERSIDE CA 92504
(909 784-0840 CBL# 5357
USE OF PERMIT
POOL. PLAN CHECK FEE PFDUCFZ 750A F OR MULTEPLE ISSUANCE OF
CO3TOMCONV'RUCTION 7,450.00 SF
ESTIMATEM COST Off CONSTRUCrION
Oil
'41,114.6 0 t.,
CON' STRUCTION M, 101u00041"00 $1,00T00_
PLAN CHECK FEEE 101-000-439-318
MECHANICAL FEE 101-000-421-000
EIXC'1'R1CAL'VEE 101-000-420-000
PLUMBING FEE .101-000-419-000
STRONOMOTION FEE' -.11RE-SID 101-000-241-000 $20.47
GRADINO FEE 101-000-423-000 S20.00
1NF'RASTP,UCrLq18FFX 225-000-443-342 $4,531.94
LESS PRE -PAID ITTS
TOTAL PERN117 FEES DUE NOW
$6,448-26
RECEIPT.
DATE.
BY
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
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
POOLS - SPAS
BLOCKWALL APPROV LS
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
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 ,
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
Utility Notice (Perm)
IV
WES'TERN.INSULA'T'ION, 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#: 18
SITE ADDRESS: 80-254 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: -
DATE:
.INSULATION CONTRACTOR: .WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: qroductiorWaner
DATE: OCTOBER 27,1999
- r - s F e.:.kyt, •.rte
. f .®ecupanc �Tfi_cate :''0C_a.
� , `GAG •
fCrtQVinta,.
•
c�`� �F
Buildiha and':SafetY Department
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: 80-254 MERION
.. Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-172
;Occupancy Group:. R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES Address: 7161 INDIAN AVE RIVERSIDE
- Citya RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Building Official
Date: 12-9-99
POST IN A CONSPICUOUS PLACE