9907-469 (SFD)LICENSED CONTRACTOR DECLARATION,
I here. . by affirm under penalty of perjury t - hat I am. licensed under provisions of
Chapter
pter 9 (commencing with Section 7000) of Division 3 of the Business and
.Professionals Code, and my License is in full force and effect.
License.# 6ic. ClasA Exp. Dat,%/
W W4
bate Signature of Contractorli""
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that .1 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 (Sec. 7044, Business & Professionals Code).
1, as.owner of the property, . a ' m exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & - Prof ession,61s
Code).
I am exempt under Section B&P.C. f6r this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION—
I hereby affirm under penalty of perjury one of the i6llowirfq declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided
ed for, by Section 3700 of4he 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:
Carrier tMTW PACIFIC INS Policy No. NW A201"9"o- -
(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 iniany manner so as to become subject to the
workers' compensation laws of Ca'lifornias andpgree that if I should become
subject e workers' compenslatfidn pt,�V'isioy, '+f Section , '3 " 7' 00 of the L , abor
I's 1J S�e si
code 6,�,with comply wit�,,�V, PPA
Kate: — Applir.Ant-
Warning: Failure to secure' Workers' *Compensation coverage is.. Linlawfu i I and
shall subject an emplo . yer to criminal'penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a. permit subject. to the conditions, and restrictions set forth on his
application.L.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this-api5licaton agree§.to,'& shall, indemnify
& hold harmless the City of La Quinta, its .officers, agents. and employees.
2. Any permit issued as a result -of this application becomes null and Void if
work is not commenced. within 180 days from date of iissuance of such
permit,'or cessation of work for ,180 - days . will subject*perrnit.to cancellation.
I certify that I have read this application and state th at the above information is
correct. I agree to comply with all,Ci ity,'and State laws relating to the building
construction, and hereby abihori�e representatives of this City to enter upon
0 inspection .. , . N
the mentioned property for inspAtion purposes:
,,above-mentic
AJ C
Signature (Owner/Agent) Date
PERM'T
BUILDING #9 07- 469
P
k,�
,.ITDATE
VALUATION LO, TRACT
JOB SITE' -%`1-440 Mrk%1NT.1nn1_1Joi:Y §,ANZ
APN 761-4111311"'Id
ADDRESS
OWNER
CONTRACTOR DESIGNER I ENGINEER
SI'EVEN WALKrk HOMES
WEVEN WALKER HOMES
7161'M..1ANA AVE,
7161 IN-WANA. AVE. ,
PJVERME CA,
RIVE4101DE CA rW04
(9W`9)`784-0 40 CBL# 5.357
USE OF PERMIT
SWOLF. FAN91ILY DWELLING
P1,7W,4 3m 0071m� —11M M- L'U13F. . W WI: VK
51• o - tu 1, i ,1. su- Moupi7
POOL 75%* REDUCTION TO PLAN CHECK FFE FORMULT IKE ISSUAWS
OF SANlE PLAN TYTIE
Cuslrolwl (110NSTRMI-V1011i SF
PCKCHPATTO N-5.00 V
0ARAGWCARPORT SF
9.13TWAINFEED COST OF C0N$TRUCT(YN.
204477.90
PERMIT FEE SUMMARY
CaNnRUCM, ON nZ
PLAN (1MCK FU to
WC9ANITCALF96 0 1 1 M10
$1,54.03
P110h4BING FEM 4034K*4194W
MoNri !MU rION FPX, - 1I1�6 W 101-000441-000
-GRAPING FEFI vue
Awr fm msuc PLActm, .'Rusir 701'-000-? r`+-000
TCS CILECK
M__AJ, CON'TRUCTION AND PLAN
$3,823.32
LESS PRE -PAID FEES
$0.00
TGTIUi PE Nl_ 17.$Ek UR, VOW_ ;'A
1
S3.823.32
, 4.<
Nlo
733:�
RECEIPT
DATE
BY a
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION 7f7776ATE
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
Framing A
_ ��
F.A.U.
Compressor
Insulation ,� _14&_
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
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out +i +
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)
on
, A t�,;erffricate -of..-Occup'ancy
L01
•
City
pf'La.-Quinta
`l •�
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: 57-445- SPANISH HILLS. LANE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-469
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: DANIEL P. CRAWFORD JR
Date: 6/15/2000
POST IN A CONSPICUOUS PLACE