9907-479 (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 # Lic. Class Exp. Date
�,,/as' %4(Ji14 �3 3Q/2tlf
te , Signature of Contrac
D
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 isnot 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).
O 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:
Carver Policy No..
;x
UNITED PACMC.1N3 NWA2011895-00
(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
workers''compensation laws of California, and agree that if I should become
subci to the workers' compensation provisions of Sectioh 3700 ofthe Labor
Cotle, I shall forthwith comply with those provisions%"'' ,r
bate: %* APPlicanf`
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up fo $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. 4
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
th • above-mentioned propertyforinspection purposes: ,
Signature (Owner/Agent)"%/ Date����
BUILDING PERMIT PERMIT#
DATE i VALUATION y LOT gF� TRACT
t t 31 $204A77.94 C"! t > - 2r&43-1
JOB SITE
ADDRESS f-469 SPANIS11 W1��n� rF1 I
l '�
�il -0904)78
OWNER -
CONTRACTOR / DESIGNER / ENGINEER
STEVEN WALKER HOMES
S'C'E`.'9N'VIVA1.10EWH0MF.S
J
716:1 INDIANA .AVE..
7161 INDIANA AVE,
RIVER SIDE, CA 92,504
CA 250
UD.14, &
(R{jlI�t'E^Ir`
5351
USE OF PERMIT
C IAiP-a D I f V DA rr 1 . A7'1
,`I D -LOT -13, P Ati 3C; PER3�II`T E 'Naf INCLUDE 1,3LOCi� MILL GAP. `
PCK)L,
0J,151'C3.M CON S`.TRiICf ON 2,456.00 SF
1aii12C's!• PATIO X35.00 $F
GARAQ3AJClL[' PO`RS 539.0 ! W' '
M UNIA'1'1 D LX*T OF CONSTR1i'C'g ON
204,,' 77.90
CDNSYRUC'1'ION T'Fii 101.4=4184M $1,007.00
PLAN CHECK FEE .10.1,-000-439-318 $820.51
PMCHAN1CA.i:.'I+M 101 -000.421 -OW ; S -m
Mt:T'71�1C 4L ,� 101' 000-4220-000 $154.03
.PLi,.TMWID FERt�1�t1Q0-aIE)11i1�? $t62.gt1
S9'RUI>i(3 i4 arION FEE - RE31D 40.1-000'•24,1.000 520.4'
0RAIN O Fhb Mt10
Akr il` PL031.:IC PLa.CES RESID 701.•f 955-WID. x»fil.,rj9
177EL' CYI?LE 1i4il�.flCT' S 1.,907.00
SUB-'.FDTt% Gi'MS' Rtft✓" ION AND PLAMCHEC:K
S4,4M Iii
'LESS PRE -PMD ES
WAD
TOTAL1'ERt11C.8T r, US DUE NOW
$4,438.70
RECEIPT
DATE
BY -
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ��
�e _
Ducts
Slab Grade
G pD
Return Air
Steel
_
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap x
FramingCompressor
Insulation .4,Ry __" p
_
/
F.A.U.
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/
-� �—
Final ��2 _o_t�
BLOCKWALL A PROVALS
Final
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBIN
APPROVALS
Gas Test
Electric Final
Waste Lines
/d
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Z
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICALL
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)
APPROVALS
10000,
al tic,
COMMENTS:
ruertlef7sucar"ye
of Occupancy
0j
City ®f La Quinta`. . . . . . . .
Building and Safety Department Of
.1
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 o,r use. For the following:
BUILDING ADDRESS: 57-365 SPANISH HILLS LANE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-479
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: GARY H'ARTMAN
Date: 9/22/2000
POST IN A CONSPICUOUS PLACE