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` 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
Dai {'+' Signature of Contractors'
T `OWNER -BUILDER DECLARATION
I hereby.affirm under.penalty of perjury that I -am exempt from the Contractor's
License:Lawfor 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):
( ).. I; as owner of the" property,' am exclusively contracting with licensed
contractors to .construct the project (Sec: 7044;,'Business & Professionals
am ezempt.under Sectlorr'- B&P.C.'for this reason
Date .'" Signature of Owner
i 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.
(' have and will maintain workerscompensation insurance, as required by
Section 3.700 of the Labor Code, for the performance of the work for which this
permit is issued.. My Workers', compensation insurance carrier & policy no. are:
Cartier Policy No.
l " rk.3%-vr t! 6u• C1flC If4S t7 W�.^4 i7A�V'V+l .
(Thin§ection need not be completed if the`permit valuation is for $100.00 or, less).
I certify thaflin 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' compensati0ri provisions"of Section 3700 of the Labor
Code ',hs�iall,forthwlth comply with those provisions.
Applicant
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
ofthe tabor Code; interest and attorney's fees::'
u
IMPORTANT Application is -hereby made to the Director of Building and Safety
fora-; permit subject- to 'the* conditions • and restrictions set forth on his
application. .
:• 1' Ekh'.person upon whose behalf this application is made & eachperson at
wI bseyeguest 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 1 -have read this application and state that the above information is.
correct:;l 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 property for,inspection purpdsesIt ,.
Signature` (Owner/Agent): �'"1� Date 3 {,"t j
PERMIT #
BUILDING: PERMIT
99. 17;
���DATE
VALUATION LOT M . TRACT
'29,140-3
qQ0,696J0
JOB SITE _
APN
ADDRESS? _
761-480-493
OWNER — — _ CONTRACTOR/DESIGNER/ENGINEER
STIEVEN YvALKER HON:f.E.S '� $T-EV?3N WALKEK :HOMES
716.1 INDIANAkVE. 716.1 IN0LANA, AVE.
RIV'ER:SIDF CA .92M4 R1'VEiISIDE Cts 92504
f909j784-0840 CBI.* 53.57
USE:OF PERMIT {
LAW 20, PJAN 20 -3rD- PERAOT DOES 'NOT iNCl•.'U E BLOCK N,VAI.LS OR.
POOL. PLOT CV.WK F]M R.EDUr; ED 5% FORMULTIPLE. 1SS'11ANC-F a.F .
fw , T AIA ,E
y
CUSTOM. C0NR171tU(., ri0N' 3'70.6f; SF ,
PORG'# PATT.0 MAO )s
G' rt4il.r3.L0C,ARPORT 635.00 SF
. EST 1� IAT,E.1: COSH ;:V L0N T>eb1Ca'MINI'
R•r4�,��;�.:y
PERMIT FEE $UNI GARY
CON1rfR. I TION FELE 101-000418-000
ft.�LX C31E-CK FSE 0.1-00044393:18 S.203.00.--.
INIECHAN'IC A1: i±Er,- $92.00
'ELECrRICA:L•:F :fk.. 101.-000-4204W $153:47
PLTTtdf:I31Rt0t 1.01.(340�dt11-GOD . $162,54
,
S'C' 2.(3I+fQ A10TION FEE, ., MhD 10-000-74.1-000,520.u7
GRAMNO FEh 1131 OiID-42.3-OOb �2!1:�7ti
ixFkA,,rrRtJC' wkvam 2.25`•00.0.413-342 $4,449.83
AWr 1NPf3t IC PLACES - REM., 701-000-253-000
A4'fl3_"Wrl`r� COM5M CITION, lND PLAN CHECK.
$6+,3=45 F i
LESS :PRE -PAID rk S
1+(1.tZU
TOTAL PERMIT FEk:S DUE NOW
$6,345,61
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,
R CEIPT t .
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 91, tllf#
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 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 I
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection Q
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:
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Building. end ,.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 regulatingbui/ding construction or use. For the following'
BUILDING ADDRESS:. .80-268 MERION
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-174
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: 12/16/99
Building Official
` POST IN A CONSPICUOUS PLACE
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