SFD (9902-175)LICENSED CONTRACTOR DECLARATION
1 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
li48a > ; ` �� 4130100
Date 7 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:
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, contractingwith licensed
contractors to construct'the project (Sec. 7044, Business & Professionals
Code).
( )..I`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'
e.:
compensation, as . provided forby Section 3700 of the Labor Code, for. the
p@rforma;ce of the work for which this permit is issued.
)' I have and will maintain workers' compensation insurance, as required by
S,ettior 3700 of the Labor Code, for the performance of the work for which this
peh-Ait,is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
' ilrrl7l}nPAoC1ta7C" S NWa$I)d 806-0D
(This section need not a compe ed if the permit valuation Is for�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 Section 3700 of the Labor
Code, I„stiall forthwith comply withetho'se provisions. 1
Date , „ f ; • , 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
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 authorize representatives of this City to .enter upon
the, above-mentioned property for inspection purposes.
,
Signature (Owner/Agent)}�•�V `4 1' _. Date
BUILDING PERMIT PERMIT#
ft
DATE VALUATION LOT 990:2175 TRACT
? 5178.813.10 , 21 28340-3
JOB SITE - ' " '
APN
ADDRESS
80-782ti' ERION
7514WO"
OWNER ;F CONTRACTOR/DESIGNER/ENGINEER
S'IT, 4"E N1 WALKER HOMES ST I EN WALKER HOMES
-1161 TNmANA AVE. 7161 INDIANA ,AVE:
RIVERSIDE CA 92504 RIVERSIDE CA. 92504
(909)784-0840 CBL# .5357
USE OF PERMIT
L(7'F 21, PLAN 1AR -SF0-.PEi2MI DOES NOT INCLUDE 'BLOCK WALLS.
OR ,POOL, PLAN E. lr-Z`f,;..i~ tis REDUCED T CED 7.`s°✓n FOR MULTIPLE ISSUANCE OF
-Q A Tuty 01 4,NT
CUSTOM CONSTRUCUON 2,. OLOO SI'
PORCY3tPATIO 284.00 8F
G RAGf•.7CARPOW1' W.00 SF
EnIMAT:t+,[D COST OF CONS'1`R11LMON
178,813.10
PER Mff FEN SUM A- ARY
CONSTRUCTION FEE 101-000-1.18-000 $916.00
!PLAN CH ECIC F'ElE? 101•-W0439-318 �1r1�.1S
NIECHANICAL FE,.,E .I0t-000-421-000 $85.50
E1,Fc'FRdC-n mi., 101-000-420-000 $14244
. PLt.XMSWO FEF 10.1-000-41.9-000 $.161.50
ST.RONO.MOTION FU. - RCSID 1,01-000-241-M. 31-88
C1RAD NO FEE 101-000-423-0017
INFRASfRUCY'URE W. 125 -NO -443-342 $3,938.31
ART'1N PUBLIC PLACES - RFSIC 701-000455-000 $'197.03
SOB -TOTAL CONErFIVJCT1ON AND PLAN CHECK
$5,668.0!
LESS P1U.,-PA[D FEES
$0.00
TOTAL PEWIT FEES DUE NOW
$54668.01
AECEIPT.- *i'
Iljj"�,�
DATE ` r"�
l
BY
...� ",
DATE FINALED
i a
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel j
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap 6
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 I Iw2AZ j4POOLS
BLOCKWALL APPROVALS
- 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 Z
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
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 417 V11,717 TW_
COMMENTS:
IJ
�s+.,.w ,tam "w:'^'�. :V, s`,'"F.'•+i.'_TS?`. _
_WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
)909),686-8760
3 (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#: 21
SITE ADDRESS: 80-282 MERTON, LA QUINTA, CA.
EXTERIOR WALLS:
MANUFACTURER: JOHNS-MANVILLE THICKNESS: 3 1/2" 'R-VALUE:' R-15
CEILINGS: BATTS O
-MANUFACTURER: GREENSTONE THICKNESS: .10.3" R-VALUE: R-38
S
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: -WESTERN INSULATION, INC. '
LICENSE NUMBER: 481278
BY: ,
TITLE: roducti Man ger
DATE: OCTOBER 27,1999 r
rt;n;ruricate or . vucupancy
Building 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 fo/lowing:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: STEVEN WALKER HOMES
Building Official
80-282 MERION
Bldg. Permit No.: 9902-175
n
VN 'Land Pse,;Zone: RL
Address: 7161 ANDIANA AVE.
City: -RIVERSIDE, CA., 92504
By: DANIEL P., CRAWFORD JR.
Date: 12/23/99
POST IN A CONSPICUOUS PLACE