9907-486 (SFD)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 #.a Lic. Class Exp. Dat44 e
'
ateSignature 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).
( ) ' 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' corrlpensation insurance. carrier & policy no. are:
Carrier iIMMID. MC,tFiC INS Policy No.: 1NWAW17t196-00
(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
works" compensation laws of California, and agree that if I should become
su l�ect to the workers' compensation provisions of Section 3700 of Jhe Labor
de, I shall forthwith comply with those provisions: --%o
r
COate: � r.? Applicant—/-"- =�' .►��. r .
Warning: Failure to secure, o kers' Compensation coverage is unlawful and
shall subject an"employer to criminal penalties and civil fines up to $100,000, iri
addition -to the cost of compensation, damages as provided for in Sec tion'3706
of the Labor Code, interest. and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is,performed under,or pursuant to
any.permit issued as.a result of this applicaton agrees to, & shall,- indemnify
& hold harmless the City of La Quinta,.its officers, agents and employees.
2. Any permit issued as a result of this application becomes. null and void if
work is not commenced within 180 days from date of issuance of. such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter'upon
the above-mentioned property for inspection purposes. -
,rSignature (Owner/Agent)Date
PERMIT N
BUILDING PERMIT -07-496n- ,
DATE VALUATION �2�1),?S�b,�i'. * LOT t TRACT
JOB SITE 57t,7_47 SAS ANDREWSAPN
=
761-09&-078ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
9MVEN WALk: M HOM ES
STEVE [ 1WA1,KF.R HOMES
7161 KMANA AkS •
7�if��l�+']p'rt`NA1 INA AVE,
RIVERSWE CA M�J.R
A� qp�}
E C 92
(W9) -,%4-W,40 CBL# 53.57
`
USE OF PERMIT
s�NrJ�,� 4�.A�1'I9��1'la��'±r~1:LV�+I�i
. •
SY4U-L(t 19"PLAN i'EtdA.3•!.'J . 13 ',4 r,4V'T.fNC;LUJ_.EHL()VA• WALL QX
POOL. ?'P/o REDIJc'"noN To PLA2s .iS6UANcF,':
OF SAME PLAN TYPE
M' XI'001 C'ONS't R7UC TICIPT 2,.379.00 SY
PCSR.MPATIO 220.003F
C&AYtAO JCA�R11iZ X35,.00 3F
1!:SI'i'.UM AITM COST OF QWS?,C$B:CiMON.
290,69C10
PERMIT FE E SUMMARY
C0N11?X1C`910N FRE $993.00
PLAN QiECK FES 10,9-f1t30-,t 39-3t�+ 3.i?Q
ASFC`HANICr' , FEE 10'@ t34? 1-Af111 � :
'fi LEc, M iCAI,. F.0ty x 31- <�20�Oiasi � 5't.4
PL A IJBI NG FEF 101-000-419-0100 $ L&1.50
GRADING m" .$20100
A31' f IN PUBLIC N ACES - REwlD $«5'1."7'4
DEVELOPER IMPACT Mis" ;Sf,9D7.430
suB-Tor� . , c oms rRuC, r 100 AND PLAN C 14E(K
LESS ,`r':R,E-RAID r ,SSS
$0,00
T£►Wg: PROTCDUENOW
$3,9f4.2.7lV
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
_
Slab Grade
Return Air
Steel
7
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
_ -
F.A.U.
Framing —
-
Compressor
Insulation
7l
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath A
g6
D II - Lath
_
Final �(�3�
BLOCKWALL APPROV LS
Final
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
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:
AIG -3072000 1556 WESTERN INSULATION 909 686 8796 'P.10
WEP'STERNINS ULATiC) , INC.
4211 Latham Sty, Riverside, CalJorc4q 92501
1a1, (909) 686-8760 Fax (909) 686-8786
INSULATIO*yam 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 1 PHASE: RYDER HERMITAGE SERIES — 28603-1 PHASE:
LOT # 1 ol
SITE ADDRESS: 67-237 SAINT ANDREWS, LA QUINTA,CA ,
............................ "__`.=-----�-- -- ..................... ,
EXTERIOR WALL
MANUFACTURER: JOHNS MANVILLE THICKNESS: .3 Y, R -VALUE R-15
CEILIN S: BATT6 SLOW
MANUFACTURER: JOHNS MANVILLE , THICKNESS: 13" ' R-VALUE:,R-38
- ---------------------------------...--
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY: -
TITLE:
DATE: '
INSULATION CONTRACTOR: WESTERN INSULATION,' INC.
LICENSE NUM 78
BY:
TITLE: OFFICE'MA010WER
DATE August 30, 2000
Certificate,of Occupancy
Cityof LaQuinta
Building- ' and Safety Department �oF
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: 57-237 SAINT ANDREWS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-486
Occupancy Group: R-3 Type 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: 11/3/2000
Building Official
POST IN A CONSPICUOUS PLACE ,