9907-478 (SFD)LICENSED CONTRACTOR DECLARATION
�1 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
/A ..
Date Signature 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.
(yr 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 Policy_ No.
UN TFD PACIFIC"I NS 9WA20178%-Q9
(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
subject to the workers' compensation provisions of Secti6n-3700 of the°Labor
Cdide,)I sh II forthwith comply with �h,�ose provisions.. f�''
Kate: l�' � `1 APPlicant
Warning: Failure to secure Workers Compensation coverage Is unlawful"an..d
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
th2above-mentioned property for inspection.purposes. i~
nature (Owner/AyDate"Sig
.PERMIT#
BUILDING PERMIT.• �,
DATE VALUATION $;061696..10 LOT R14 - - TRACT 2W)3.3
JOB SITE ,....APN
ADDRESS 76141"79
OWNER CONTRACTOR / DESIGNER / ENGINEER
MES
) 61 INDIANA Ate: _ 7161 lMIANA AVS:. .
RIVERSIDE CA 92504 R VEK41DE CA 92504
��b9)78d�0 4U QBQ 535?
USE OF PERMIT
SF13 - LOQ' I2,. PLAN 2Q, P"ERWT :D01,7s3 NOT Q;�1b)DV'ItI MK WAII OR,
POOL.
CUSTOM CONSTRUC''CION 2,379.00 Si
POIICV/PA'TIO 420.00 SF
0AtiAQFJ ARPO.'KT Qs3S.00 SF
F'.S3'M.rtTUD COIST TJX+" C+rMMUG°li') ON
PERWHY FEE SUNIM4RY
t`amrrRUC'TION.F
►()I-Ogl1- YIRw(?IDi1
$910.00
PLAN '0ffiCX FK
$111.99
a a't'?'.rt's�I1V41CAL FEE
.Q�i
ELECTRICAL Fri:.
Itl.l,-1300-Q 0-tiet3
1 3.47
HI.IJ 'iAtGk
,10.14M41:9.000
s'rRoNa m( t" oW i'EE - RES,w
..101-(iJO-241.000
sm.07
GR.ADR-101l+EE
.101-000-42.3-000
t4Wr IN "LAC F LA.CIE5 - RrISW •701.-rtM- 715-000
T2! i,'+'4
SUB -TOTAL C. oNsmuG°nON AND .PLAN CR ECK
i.ESS PRE-PAWFEES
RECEIPT I DATE
DATE FINALED I INSPECTOR
$4,411.17
V-00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel f
Combustion Air
Roof Deck
xhaust Fans
O.K. to Wrap A
F.A.U.
Framing /j
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
_
FinalPOOLS
BLOCKWALL APPROVA S
-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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection V
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring g
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
SEP -21-2000 16:03 vJESTERN INSULATION 909 686 8786 P.707i13
4
mmi°° TIN, I
42 t 1 iAtrem S[rftt Riverside, CaMerriia 92501 "
Tel, (909) 686-8750 Fax (909) W-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS 13EEN 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 # 12
SITE ADDRESS:' 57-381 SPANISH HILLS LANE, LA QUINTA,CA
............... .-----•-,--
EXTERIOR .WALL
MANUFACTURER: JOHNS MALLY&LE THICKNESS: 3 1A R -VALUE: R-15
BLOW.
MANUFACTURER; JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
GENERAL CONTRACTOR; STEVEN WALKER HOMES"
LICENSE NUMBER:
BY:
TITLE:
DATE:
TRACTOR: WESTERN INSULATION, INC.
LICENSE NU • 81 78
BY:
TITLE: OFFICE AGER
DATE August 30, 2000 .
hr#
(L.ert
to bf v C cup'anc�-�-
'
}tyl f1 ta a
of.L"'r%uw
S. Widing ands fety Department OF
This Certificate issued pursuant to, the requirements of Section X09 of the Uniform Building Code,
certifying that, at the time of issuance, `this structure was in comp/lance with the various ordinances
of the City regulating building construction or,use. For the following:
BUILDING ADDRESS: 57-381 SPANISH HILLS LANE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-478
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER.HOMES Address: 7161 INDIANA AVE
'City: 0 RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 9/26/2000
Building Official
POST IN A CONSPICUOUS PLACE