SFD (9902-177)0
LL
LICENSED CONTRACTOR DECLARATION
h ' bz6by affirm.under penalty of perjury that I am licensed under provisions of
b - hap'ter 9'(c'ommencing With Section 7000) of Division 3 of the Business and
proi6ssionals Code, and my License is in full force'and effect.
License # Lic: Class. Exp. Date
�30100
Date 1
Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perju'ry that I am exempt from the Contractor's
License Law. for theJollowing 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).
1, as..owner of the property, am exclusively contracting with licensed
contractors. to Construct the project (Sec. 7044, Business & Professionals
C6de).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under p6nalty of perjury one of 'the following declarations:
I hav6.and Will maintain a certificate of consent to self -insure for workers'
compensation,- as provided. f6r 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 performance of the work for which this
pe6it is iSiued.,My work6rs' compensation insurance carrier & policy no. are:
Carrier , P
Policy NO.
R) Ptme rgs N.�Vpq 9640
ffh..is:!�ection need no etompleted if the permit valuation is or or 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' compensa on1provisions of'Section MO of the Labor
Code; I shall forthwith comply with those provisiongA
i5atb': 'Applicant ZC_7. ,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall.Subj?dt 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 LaborCode, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fors a permit subject to the conditions and restrictions set forth on his
application.
-A. 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, r& 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.
certify. that I have read this application and state that the above information is
correct. I.Bgree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the a,bov.e-mentioned property for inspection purposes.
gature (Owner/ ent) 7 Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
< $2-00,69630. T33-- 28340-.3
JOB SITE
APN
ADDRESS
761-4",M
OWNER
a
CONTRACTOR DESIGNER ENGINEER
STEVENT WALKER' HOMES
STEVE NVALKER HOME S
-7161 INDIANA AVE,
7161 INDIANA AVE.
RIVTERSIDE CA 92504
RIVERNSME CA 92504.
0)784-0840 CBL# 5357
USE OF PERMIT
I is 94 A:1 i L y &1111"`1 f fh1c.
Ph f G
_1!
-L,
LOT` 23, PLAN 2A -W-D- PERMT DOES NOT INCLME-BLOCK WALLS OR
FOOT.. PLAN CMICK FFiFFTEDUC WE Mo FOR MJLTIP[,F TS$UANCF OF
SAME, PT.AW, Myrt
CUSTOM CONS TRUCTtON 2,379.00 SP
PORCION110 2210.00 SF
GARAOWCARPORT SF
ESTINIXECDCOSTor, COMTRUC1,10IN
2(1411,696.10
-PUM11T 'r, EE SUMMARY
CONYFRUCTION FEE 101 -OW -418'-000 $993100
ft AN' rclMOK TFEE, 1.01-00-439-318 1 S2,01W
mEcHANicAL'Fu, 101••000-;421,-000 s9l*
ax-crRic.m. -FEE 101-000-420-(M $153.47
PLU?V1.BT.NGFFAi 101-000-419-00)7 $1.62.50
-
STRONOMOTION FEE - RESID 101-000-241=000 $20.07
ORADING FPX 101-000-423-000 $2lt.00
INMA81"RUCTURE VEF. 22.-9flO-443-342 $4,449.91
ART 114 PUBI, MPLACT35 - RAM. 701-M-`2 5;1-000 $251.74
SUB -TOTAL CONSTRUCTIONAND PLAN CHECK
$6,34.5.61
WSS PRE -PAID FEES
$0.00
TOTAL PERMIT FFES DUE NOW
$6,345.61
t1REGEIBY DATE FINALED ]INSPECTOR
,uk.T,,�
I -�JT)
1.%
INSPECTION RECORD
OPERATION T776ATE
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
0. 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 do
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 0,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) f 17
COMMENTS:
WESTERN INSULATION ' 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#: 23 r
SITE ADDRESS: 80-310 MERTON, LA QUINTA, CA:
EXTERIOR WALLS:
MANUFACTURER: JOHNS-MANVILLE THICKNESS: • 3 1/2" R-VALUE: R-15
CEILINGS: =BATTS:)BLOW
MANUFACTURER: JOHNS-MANVILLE THICKNESS: 13" R-VALUE: R-38
'GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
r -
y
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM :481278
BY:
TITLE: roduction ana er,• Y
DATE: OCTOBER 27,1999
. t -
AWN
e of
ce'-'tl:;cat ancy. C.
a.
of �La - �ntaCit
pBuildin'and Safet Depar�tr ent�'
s.
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: 8.0-31.0 MERION
use. Classification:. SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-177
Occupancy Group: R-3 Type of-Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES
Building Official
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL -P. CRAWFORD JR.
Date: 1-3-2000
POST IN A CONSPICUOUS. PLACE