0006-292 (SFD)�=LICENSED CONTRACTOR DECLARATION
I hereby, affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04
w Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
LLJ
/�
0413012(
o Z r` /Date c Signature of Contractor
CD_0
Zo
0 OWNER -BUILDER DECLARATION
J
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
Z_ ( ) 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).
M() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
O CSI
Z WORKER'S'COMPENSATION DECLARATION
oZ
FI hereby affirm under penalty of perjury one of the following declarations:
LO Q- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X Lu ILL compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
CE
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carrier Policy No.
Cb --iIJN1TED PACIFIC 1140 NWAJ1W45-D0
r` O
J (This section need not be completed 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
�?ect �heworkers' compensatlon,provisionsofSecon 3700of the Labor
ehal6fort wi. complywitsthosepfoisions: 7 / r I?! Applicant l'
r 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
i/theove-mentioned property forin p ction pur • oses�y�ure (Owner/Agent) . a. ' Date`''. Z_J(.C/
C� 6 BUILDING PERMIT PEErRMMIT#
DATE VALUATION LOT CZWOQOW= 1jW%,TRACT
29347
JOB SITE
ADDRESS 'WIM Cr W�TiDIM8-TIAR1 K-1
APN
767 *10-+M
OWNER
CONTRACTOR /DESIGNER / EN INFER
91TV 4 WALKhR ,110 IE.9
SMVEN WALIC M HOMES
7]61 LRDIAN.AAV&
7361 INDIMAA'l L-
RIMI>Dl± CA 92SO4
WERSIDE, CA 92SO4
(909)784.0840 C.U* 3337
i
USE OF PERMIT
MOIX FAIv1ILYOWEIKLINQ
..vim
SK,,)- I.,C IT 2 PLAN 2 PERMIT DOES NOT INC,'I UDZ E1WCK WAILS OR
POOL
CUSTOM CONSTRUCTIO14 3,590.00 SP
PORCIVPATIO 371.00 SY
IAkAOGC.°ARPORT (211) 17,444,00
KS'I'.! !tAiKD COST OP C 0N,1rRUCTY0N
a,c>di�ks]Ol
ItF+20vilf'Ch"EE SIUM.'I14A,RY
CONSIRUCTiON FEE" 7®i-000-4ia-000 $1,3.0:00
PLAN CHECK 1'1;E 101-000-439-37.8 $1,104.03
ME'.CIiANICAL FEE 101.000.421-000 $124,00
;?LLG' RIC:A1, FEE 101-000-420-000 $227.45
PLUMBING PEE '101-000-417-000 $203,75
STRAND MOTION TALI; - USID 101-000-241-000 $30.20
ORAOING F? 101.000.423.000 520.00
DLrVE OPEI7.IMPAC!' PEE $1,907.00
ART IN PUBLIC PLACES. RKSIC 701-000.255.000 $255,10
S"UB iii SAT. CONMRITCMORAND PL.l+.W CHFOC
X5,221.55
I= PRE•PAU) VERS
$0.00
�r4;3'I'�, 1, MEW DTI,NOW
$52 k-:'-7
"~}
r
RECEIPT
DATE BY/
DATE FINALED
INSPECTOR
d
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
0. K. to Wrap b 0
F.A.U.
Framing tW Jb
ZCompressor
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping f
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole A
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)
INSULATION CERTIFICATE [C-1
,81 -655 -BROWN DEER PARK] LA QUINTA
-� Number and Street City
Riverside
29347
County Tract No LOT
Description of Installation
1 ROOF
Material Brand Name
Thickness (inches) Termal Resistance (R -Value)
2 CEILING
Batt or Blanket Type BATT Brand Name CERTAINTEED
Thickness (inches) 12 Thermal Resistance (R -Value) R-38
Loose Fill Type BLOWN INSULATION Brand CERTAINTEED
Contractor's min installed weight square ft 0.615 Ib Minimum thickness 14 3/4 inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) R-38
3 EXTERIOR WALL,', Z;r
Frame Tvoe '
A. Cavity Insulation
Material BATT
Thickness (inches) 61/4
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 FLOOR OVER GARAGE AREA
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL
Material
Thickness (inches)
Declaration
Brand Name CERTAINTEED
Thermal Resistance (R -Value) R-19
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Complianc • where applicable.
2,3A 2/20/01
Item #s ignature, to
Item #s
Item #s
Signature, Date
Signature, Date
PARAGON INSULATION
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
i
Certificate of Occupancy
City of La Quinta
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 following:
BUILDING ADDRESS: 81-655 BROWN DEER PARK
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0006-292
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: 9/6/02
POST IN A CONSPICUOUS PLACE