9907-484 (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.
Licensef Lic. Class Exp. Date
48004
Signature of C
I
ate Contractorz
OWNER:BUILDER DECLARATI'ON.
I hereby affirm under penalty of perjuiry,that I am exempt from the Contractor's
License Law for the following reason:
1, as owner of the property, or. my employees with wages as their. sole '
compensation, will do the work, and the structure is notintended 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
Code).'
O I am exempt under Section B&P.C. for this reason
Date Signature of own-er
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 ta .ion 3700- of the Lbor Code, ,for .the
performance of the work for which this permit is issued.
I have and will maintain workers' compensation' insurance, as re , quired'by
Section 3700 of the Labor Code, for the performance of the' work foi which this;
permit is,issued. My workers' compensation insurance Carrier & p6lic,
y no. are:
Carrier Policy No. I . I ..
Ut,UTEDPALCEnC TNS NWA201,7896-00
(This section heed 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;
11 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
ect to the workers' compensation.,provisions of Section 3700 of the Labor
del I shall forthwith'comply with th 96 provisions:
ateApplicant—,',
Warning: Failure to secure'W/rke*r's' Com . pensation 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 personuponwhose behalf this application is made & each person at
whose request and for whose benefit work is,performed und6r.or pursuant to
any permit is:sued, 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 clays 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 a6ove-mentioned property/for inspection
/Signature (Owner/Agent)
BUILDING PERMIT
DATE VALUATION, S199206Q7PERMIT
",
7
LOT. TRACT
5013 SITE
ADDRESS
OWNER CONTRACTOR/DESIGNER/ENGINEER
6MVFN'WAJ,KKR HOMES- 917EVEN WALKER HQMES
7161'fUDIANA AVE. 7161 INDIANA AVE.,
RIVEMIDt CA' 92504: RIVERSIDE CA 92504
i,9&9) /'64.0W CHU 3357
USE OF PERMIT
SINGLE FAMILY DWEULING
or ll' L.%J a
OR POOL.
CLI 3TOM CONS'I'Rual 1014 2.379.00 3F
PORCRMT10 SP
GARACIEMWORT 508.00 SF
ismATEo COn OF CQN&-n4U(_-f10N
-of
j.#0
PERMIT FEE Wh%VkRY
CONsTRuarION FM
1014WO-418-M
$914.00
PLAN C'WCX FES
590635
WXUANICAL FR
101-00344SA -WO
592.04)
uLF.c,rkf,bAY. FEW'
-1014W-420-000
'PLUMIM40 FEE
$162.50
STRONG'MOTION FEF - RESID .
101-00-241-000,
$19,82
O R AD ING F BE
3�000
AftT IN 1'U8J,1CPUkC*ES - MsW:701-OW-155-00.
DEVE10PER'"'APACT fTW,.
&1*90700
SUP,-MTAL,CONgMtl(MI�)N-ANDP,L,ANC§iECK
LESS PRE -PRT FEES
TOT. U. PERIMIT FEES DUE NOW
RECEIPT DATE BY' DATE FINALED INSPECTOR
$4,3QO,12
$0.00
$4,390.12
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
Insulation
_
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
56
Drywall - Int. Lath
71
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/ 9
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
AUG -30-2000 15:55 WESTERN INSULATION 909 686 8786 10.09
WEAIS ERN INSULATI0` 9 INC O
4211 Latham Stmot, RivmWe, California 92501
Tel.' (909) 035-8760 Fax (909) 686-5786
INSOtA`T`ION 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: RYDER HERMITAGE SERIES - 29603.1 PHASE:
LOT # 17 _
SITE ADDRESS: il57.26 S9 AINT A DREWS-, LA QUINTA,CA
EXTERI08 MALL
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 Ys° R -VALUE; R-15
CEIUNQS: BATTS BLOW
MANUFACTURER: JO VILLE THICKNESS: 13" R -VALUE: R-38 '
GENERAL CONTRAC108: STEVEN WALKER HOMES
LICENSE NUMBER:
• BY: _ ..
TITLE:
DATE:
ISISULATI ®N TRAC : WESTERN INSULATION, INC.*
LICENSE NUMBER: ,
BY: ,
TITLE: OFFICE AGER
DATE August 30, 2000 '
k
I 1
I
M
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: 57-269 SAINT ANDREWS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-484
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES
Tem
Building Official
Address: 7161 INDIANA AVE
City: RIVERSIDE, 'CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 10/5/2000
POST IN A CONSPICUOUS PLACE