SFD (9902-173)I LICENSED CONTRACTOR DECLARATION
1`hereby affirm.under penalty of perjurythat 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
I
ate r,:.✓D i SContractornature of
�—_
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 their 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).
( )`11 am 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
perf?Jmance of the work for which this permit is issued. `
(� 1. 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.
M- 1I `1e.D I) cwtc -Igs NWA1110I"196-W
(THis section need note completed if the permit valuation Is for $100.00 or less):
.(.J. ('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 ifrl should become
subtect to, the workers' compensatfon'provisions of Secti 3700 of the Labor
Code; I shlall forthwith comply with/t ose provisions. • _
Date.. Vit,, Appli-'
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 autlPorize representatives of this City to enter upon
the bove-mentioned property for inspection purposJes.
� 11
1
ignature (Owner/Agent), Date ..•.
t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 17 TRACT
S17 ,8131.10 19
JOB SITE
APN
ADDRESS
X96 460" R ON
761-48&.099
OWNER
CONTRACTOR / DESIGNER / ENGINEER
STEVEN WALKER. HOMIEs
STEVEN WALKER HOMFS
'71.61 I ITiIt1NA .
1161 R4DIANA AVE. '
RIVERSIDE CA 92504
RIVF_II.SI.DE CA 92504
(;.909)784-0840 Cf3 #' . 5357
USE OF PERMIT
i sl / 'A k0l 'IV nwrr i /.,,o
LOPt 19, PLAN 1AR -ZNF D- PEREbiWT DOS --S NOT R40LUDE BLOt,.t+ 'tb`A.LLS
Oi21POOL. PLAN CHECK. FEE REDUCED1.1 1X4 FOP, MIJII.TMLE.ISSUANCT OF
51AME PLAN TYPE.
CUSTOM CONSTRUC:'1''!ON4 4,.101..00 `,a'F
PORCHMATIO 284.00 ,S1:
GAR.F+G1.s1CARPORT 5214.0) .9F
f STMA'iTED9 COST t"►:V CONSMt1t,'E' L1N
17I. 13.110
PE1it'MIT 11' i E .VVN NJARY
CON511"RUC ION116.'s 101-000-419-000 $9.16:00
PLAN C}tf:Cls FEE 101-000-430-31S $188.1.5
MECHA ICALFEE 101-000-42.1-000 ."5,54
hLECTIttCAL F14�p, 101-000.420-000 $142.64
PLUrii111NG FIT. 10.1-000-41.9.001) $162,50
STRONO MOTION FEE - RE•SM :10I.0i3C) MI -000 17.436
GRADI[NO FEE 101-000-423-000 $2Cl.a?0
t
fmmASTRIJMYRE FEE 225-000-1143-3642 $3,9148.:4•1
A,Wr W PIMAC - ilii.SEC 701-000-15-5. 00 $197.0.1
S[JB-TOTAL CONI.�MU(frIQN AND PLAN C.116 CK
$5,668.01
LME PRE -PAID AID F131 -ES
� 0,00
TOTAL PERMIT FEES DUE TiC1W
SS,GdiSM
FjEgEEIIP,TT.1�`
DATE
"J
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/G
Drywall - Int. Lath
r
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_
{
WES'T'ERN INSULA'T'ION, INC.
4211 Latham Street, Riverside, California 92501
(909) 686-8760
(909) 686-8786 Fax ,
INSULATION' CERTIFICATE -
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: PGA WEST -PHASE 2 TRACT#:28340-3
LOT#: 19
SITE•ADDRESS: 80`-280 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS -MANVILLE THICKNESS: 31/2 R-VALUE�R-15
CEILINGS: BATT$
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R-VALUE:.R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
I NSLJ LATION -CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMB R: 481278
BY:
'TITLE:duction ana er
DATE: OCTOBER 27,1999
yii/qyw"S'Y't":"^-rf+.^rn^y"'-+....... +-w+'.r'T" '+r sl'�M•. w�..-. . ?R%�..�w.--.......r... ..y-,. w.
III
x OWN
,..A;e1rtjricate.-'.0
Occupancy.
- a/
Cityof--La Quinta y
Bu'flding and .Sa•rety Department of do
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:. 80-260 MERION
Use .Classification: SINGLE FAMILY -DWELLING
Occupancy Group: R3 Type'of Construction:
Owner of Building: STEVEN WALKER -HOME S
Building Official
Bldg. Permit No.:
VN Land :Use Zone;
9902-173
RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 12-10-99
•t
POST IN A CONSPICUOUS PLACE