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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
48004 B � �/�7 04130/2(
D to+ 0r sSignature of Contracto .�L,
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).
( ) I, as owner of the property, am exclusively contracting with 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'
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 performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier U?NITRD PACIFIC WS, Policy No. NWAIJOIS4540
(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
's bJect to he workers' compensation\rov sions of tion 3700 of the Labor
ode, II sill fo hwith comply wit,,dhos rOVi ions.
Date: /� lC^ /}(� Applicant V/
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 bove-mentioned property for inspection pur6oses.
7 � : ,' 6 k& An
Vignature (Owner/Agent) Date
A BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$315,240.W C3—r,. - 2.9347
JOB SITE
APN
ADDRESS S1:—FJ"'RIP
�I %-3 O^S O
OWNER
CONTRACTOR/DESIGNER/EN (NEER
S'IEVW WALKER 1-I0MES
$'i'EVW WALKFR HOAR
7161 INDIA14A AVE
7161 1ND1 1'A AVE
RIMSWET CA 92SO4
litMSIDE CA 92SO
(909)7840&40 CBL# $357
USE OF PERMIT
S�A1•C31::1:1'A1Il.,i° i?Yi7JE2LI�NC�
F
311017r LOT 3 PLAN 3 PERMIT DOES N09' INCLUDE 61DC1C'WAI,IZ OR
POOT,.
CUSTOM CONSTRUCTION 3,829.00 SF
PO1;L'I- PATIO 341.00 SF
O.ARAOWC.ARPORT (8F) 12,426.40
E51CMA-11'0 COSH' OF C0 N'9XkT1Cd 0-W
3151,240.00
P + tI9r $`irT ST7A&K&RY
CONSTRUCTION FEE? 101-000,418.000 suc' ,50
PLAN CHECK FIW, 101-000-439^318 $1,133-96
MECHANICAL FEE 101.000-421.000 $10i 50
I(I.,LCTR1CaAAL NA'E 101-000-420-000 $1:;0.70
PLUMAINO FEE '101.000-419-000 S146.50
STROMA MOTION FEE - RESITS 101-000-241-000 $31.59
CM ADINO .FEE 1.01.0010-423-000 520.00
DEVIZ1.0P R. IMPACT FL8 $1,907.00
ART IAT PU.BLiC PLACES - RESIT 701.000.155.000 5538.10- ,
BOB- COX811=110W AND PLAN C5 WIC
$5,570.18
LESS PRIIPA03FM
50100
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3--1 1,vo,.flti�J���+,�
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RECEIPT
DATE
BY J'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION j
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"I_- - In Lath
3a
er ! b
Final
Final
BLOCKWALL APPROVA S
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 G,
Neater 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
COMMENTS:
X62 ��`rarrL Qj( �l ��i
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)
♦
Certificate of Occupancy
City of La QU'inta
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: 81-665 BROWN DEER PARK
Use Classification: SINGLE FAMILY DWELLING Bldg.- Permit No.: 0006-293
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