SFD (9902-176)LICENSED CONTRACTOR DECLARATION
a 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 o Ekp. Date
p �� 11111 B f f .,lis f} f f��Q4
bate '' `1 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:
(. p. 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`I'icensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code. r,
(
);,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'
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 per of the work for which this
permit •is* -issued. My workers' compensation insurance: carrier & -policy no. are:
Carrier'' Policy No.
UNITE A
(This section need notbe e e
compld if the permit valuation is or 100. 010r ess).
() I certify that in the performance of the work for which this permit is issued,
!.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'shlall forthwith comply witmhose proivlsions? }./d'
Date:. X1.1 7 " 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
W
hose 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 representativeslof this City to enter upon
thii4bove-mentioned prope rty,for inspection purposes. J
r j
Signature (Owner/Agent)' Vii} Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT "990jJ76 TRACT
• ' ( $204.677:90 2'2--` 283A0-3
JOB SITE
APN
ADDRESS
843% K FMON
61-480-099
OWNER `�'`"'l CONTRACTOR / DESIGNER / ENGINEER
STEVEN WALKED. HOMES STEVEN %VAUKFR 140MES
7161 ffiDIANA AVE. 7161 ENDIANA AVE.
12.1VERSIDE CA 92504 RRTRSIDE CA 92504
(909)7"0840 C L# 5357
USE OF PERMIT
wa a� .tom.:: .'.[Il.YJ. J! VY, 'y.. .+ •V
].OT 2?, PLAN 3A -SF D- PERMT DOES NOT INCLUDE BLOCK WALLS OR'
POOL,. PLAN 0AECK i•Tsl:`.�.�i' UCED 75% FOR. MULTIPLE ISSIJANCE O
C 0,T9 P-1 AMTi
COSTOM C iNS:TE2UMIr1C?N 2, • 50,00 6F
PORCHPATTO 245,00 SF
;
{iAI AQWCARPOR;T 539.00 SF
ESTIMATED COST OF iC NS7f"RUC CION
204,67-7..90'
PERMIT 1('ie E'.9UMMARY
CONSTRUCTION FEE 10.1-000-418.000 $1,07.00
PLAN CHECK FEE 101-004-439418
NIECi•ir?u�iICA€ F E 101-C3W421-000 533:50
ELECTRICAL "LF 101-000-420-000 $154,03
PI:I.1N CNG F'F.,E 1.01 -000419 -OW. $ i 62.. io
S"I'ICO.NG IVic uofr�t FEE - :RE&D 16t-000-241,•040 V.0.47
GRAWNG rC-9 101: -000-423- 00 $2lI:t�O
INFR.A.ST UC:.1'(,lEt>~ klffi' 225-000-143-342 S4,91.04
AWr IN PUBLIC PLACEi;S-1 ESII. 701-000-2554000 S26I.d r
SUB:FOT)1.I., CONS'T`RUC710N AND .PLAN CHECK
$6,448.26
LEgs 1'RF'-PAt1 FEES
$01M
TOTAL PERMIT FEES DUE NOW
56,44826
E_ II2T`'\ \;,
DqT C�C�\
BY / %I'
DATE INALED
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 /d
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA4S
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
/
WESTERN INSULATION, INC.
4.211 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#: 22 _
SITE ADDRESS: 80-298 MERION, LA QUINTA, CA.
EXTERIOR WALLS:
'MANUFACTURER: • JOHNS -MANVILLE THICKNESS: 3 1/2" R -VALUE: R-15
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" RWALU.E: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER: -
BY:
TITLE:
DATE: ,
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
1
BY: -
TITLE: Pr duction ana er
DATE: OCTOBER 27,1999
10(1-
A04
VC r®ffc
y. ffPYd cupan--r-:
Od
City
of.La- _ uinta
b B uilding.and" Safety Department F
4
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: 80-296 MERION:
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-176
Occupancy Group: R-3 Typ6 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: 12-20-99
Building Official
POST IN A CONSPICUOUS PLACE