9907-483 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty Of perjury that I am licensed under provisions' of
Chapter9 (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
-77480W04
ate S igna'ture of C6htract0`r
OWNER -BUILDER dECLARATION
I hereby.affirm under piRnaliy of perjury 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 not intended or offered for
sale.($p6. 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).
I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby .affirm
m 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.whi6h this
permit is issued. My workers'' compensation insurance Carrier & Policy fio. are:
Carrier Policy No.
UNITED PACIFIC INS NWA2017789&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.
5r ,
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
subj6ct to. the Workers' compensation provisions'of Section, 3700 of the Lab6r
CAB, I shall forthwith comply with those provisions? Z,
116ate:
Applicant
Warning: Failure to secure Wbkers' 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.compensaiioh, 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 requestand 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 l"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.
4;
Signature '(Owner/Agent)' Dite//
a
BUILDING PERMIT PERMIT#
DATE 1 VALUATION $178 LOT. TRACT 28W
_6 3.1
JOB SITI! C457 --M.,
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MVF.N WALKER HOMES.
SIMVENWALKER HOMES
161 [�QIA14AWT,'
7161 INDIANAAVE,
'RIVER -SIDE CA 92504
RIVE SIDE C' A 92504
(909)?8"840 CBL# 51517
USE OF PERMIT
SINGLE FAMILY 113INVELLING
SYD - LOT 16, PLAN 1B. PERMIT DO U-. OT WCLUDE ULOCK WAU, OR
POOL, 7.50/a P&MUCTfON TO PLAN CHECK FEE FOR .fait, LTI]PLE ISSU.ANCH
OF SMIE PLAN 3 T.F1
CUSTOM CONaRUCTION x,10 t oo SP
PORCH/P,ATIO 284.00 Sr
GA KAGOCARPORT sso0 IV
118,813.1,41
PERMIT ri CE SUAIMARY
CONSTRAJCt'10N F MT S9160)
PLJklq CHECK Flau 101-000-439,418 SIS&IS
ME01ANICAL Fiffi. S851io
klECTRICAL 101 -MG -420-000 $142,64
.PLIM. ING 101 -000 -4.1.9 -OW $10.50
STRONG NJOT ION Frl`- R8W $17.88
.101-000-3414)0
GRADTNG FEE 1120.00
ART IN PUBIJC PI ACES - RE'S Ta 701-000 255 -OW SfV.03
DMIRLOPER IMPAZ r FJM $1,907,00
WB-TMAL CONSMUCTIONAND PLVI CHECK
LS SS P" -PAID FEES,
$0.00
TOTAL PERAUT I5TX3.*DU E NOW
$3,636.70
RECEIPT
DATEBY!
DATE FINALED.
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings]
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_
dd
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing v`
Compressor
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
POOLS - SPAS
BLOCKWALL
A PROV S
steel
Set Hacks
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
_
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
3�
Appliances
Final
COMMENTS:
'
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)
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This Certificate issued pursuant, -!o--, the requirements,of Section' 109 of the Uniform Building Code,
certifying that, at the time of-issgance;=this structure was in, compliance with the various ordinances
of the City,'regulating building` construction or use. For the -fdl% wing:
'BUILDING ADDRESS:% �;. —57'285. SAINT ANDREWS
Use Classification: SINGLE FAMILY DWELLING Bldg -'Permit No.: 9907-483
aay� of' colwiruc'tion: VN Lan4� Use Zone: RL
�.....� �._ ...f _ r..: , .
Owner of Building: STEVEN WALKER HOMES Address: • 7161' INDIANA AVE
City: RIVERSIDE, CA., 92504
By: ' bANIEL P. CRAWFORD JR.
2 'L Date:. 9128!2000
f.
Building Official
POST IN A CONSPICUOUS PLACE -
t:
SEF-21-2000 1602 WESTERN INSULATION 969 686 8786 P;.05i13
WE'SaTEOR'lal' INSUL T1 o. INC.
4a11 Latbnm Street, Riverside, California 42501
` Tel. (909) 686-V60 Fax (909) 6868766 -
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 — 28603-1 PHASE:
LOT # ; 16
SITE ADDRESS: 57-285 SAINT ANDREWS, LA QUINTA,CA
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N
EXTERIOR WALL
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 'A R-VALUE: R-15
,
CEILINGS: CATTS.." BLOW
MANUFACTURER; JOHNS MANVILLE THICKNESS: 13" R-VALUE: R-38
CEILINGS: BATTS BLOW'
MANUFACTURER; GREENSTONE THICKNESS: 10.3" R-VALUE:"R-38
GENERAL CONTRACTOR: STEVEN WALKER HOME_ S
LICENSE NUMBER:
BY:
TITLE;
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION,- INC.
LICENSE NUMBER:
BY: 1
TITLE: OFFICE MANAGER
DATE August 30, 2000
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