0006-301 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions
Chapter 9 (commencing with Section 7000) of Division 3 of the Busines
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
748004 B r (541.30/2(
Vate !�+�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.
( ) 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 lI nTM PACIFIC INS Policy No. NWA119130.60
(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.
subs� ct to the workers' compensation provisions of Sectio 3700 of the Labor
CcI e, I 's' all rt with with comply wit�.,tf 11 o�se p�o�vi ions. /
{[`ate: ���%� �/1V_)Applicant `K
Warning: Failure to secure Workers' 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 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
the above-mentioned propertyfor ii
Ispection pur uses.
IS g ature (Owner/Agent�•�" �^t .. Date
LL/
t✓}n '0 BUILDING PERMIT PERMIT#
4
DATE VALUATION LOT '�+► TRACT
$31S NO.S(1 29347
JOB SITE
ADDRESS
1 �73�1`�F;1.�12YWAY
1
APN
767=3304HO
OWNER -'
CONTRACTOR/DESIGNER/EN INFER
8T'EVW WALTCM 1101Y=
S'17EVM WALKIM KOWA
7161 INDIAXA AVR
71 G1 T13DL&NA AVS
RIV.ERSME CA 92504
RXV90ME CA 92504
(909)784-0840 G1314 5357
USE OF PERMIT
SINGLE FAI A LY D)VAUL MID
SFD- LOT 37 PLAN 3C PERMIT DOES NOT INCLUDE BLOCK WALLS OR
POOL, iS % PIAN CHECK, FEE I2.EDiICTIOW FOR IS.91JAAiCE, OI, SAME
PLAN TSE
CUSTOM COIISTRUCTIO14 3<$39100 SF
PORCH/PATIO 341.00 SF
0A1tAC}i?,dC'ARPORT (RIS) IZ424,40
ISII iZ3) COS' OF C011IUCITON
31-5,240M
PEIMM 'EE 9i711 MARY
CONSTRUCTION PEE 101-000-418-000 $1,395,50
PLAN CHECK .FFZ 101-000-439-318 $743.49
MECHANICAL FEE 101.000.42140150 $113,30
ELECTRICAL FEE 101-000-420-000. $330.70
PLUMBB40 FEY. 101.000.419.000 $196."30
STROWO MOTION ",9 - RLSID 101-00044 I -000 $31.52
ORAD11 O WE 101-000.423.000 (20.00
0.',il,1.,OPZR IMPACT FEE $1,907.00
ART tN PUBLIC PLACES - RE81I 701.000.255.000 1iM.10
:1L113 -TOTAL CO2+TMLICIIOR AND PLAN CFFCK
S4,120.31
1.1I;3S PM -PAID Fas
S0700
S I}VE NOW
�4,720ri31
RECEIPT
DATE
syn,DATE
FINALED
INSPECTOR
1/ f e.1--•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
M-
ReturnAir
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
6
Drywall - Int. Lath42
Final
Final /
BLOCKWALL APPROVALS
POOLS - 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
Encapsulation
Gas
as Test
Appi
Final
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)
COMMENTS:
INSULATION CERTIFICATE IC -1
55-855 TUMBERRY WAY LA QUINTA'
Number and Street City
Riverside 29347 37
County Tract No Lot Number
Description of Installation
1 ROOF
Material
Brand Name
Thickness (inches) Termal Resistance (R -Value)
2 CEILING
Batt or Blanket Type BATT Brand Name CERTAINTEED
Thickness (inches) 12 Thermal Resistance (R -Value) R-38
Loose Fill Type BLOWN INSULATION Brand CERTAINTEED
Contractor's min installed weight square ft 0.615 Ib Minimum thickness 14 3/4 inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) R-38
3 EXTERIOR WALL
Frame Type
A. Cavity Insulation
Material BATT
Thickness (inches) 61/4
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 -FLOOR OVER GARAGE -AREA
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL
Material
Thickness (inches)
Brand Name CERTAINTEED
Thermal Resistance (R -Value) R-19
Brand Name
Thermal Resistance (R -Value)
Brand Name -
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Declaration.
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Complianc , where applicable.
2,3A �/ 2/20/01 PARAGON INSULATION
Item #s gnature, Datt Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s
Item #s
Signature, Date
Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
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: 55-855 TURNBERRY WAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0006-301
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES
*`-'-t
Building Official `
Address: 7161 INDIANA AVE.
City: RIVERSIDE, CA., 92504
By: GARY HARTMAN
Date: 11/14/01
POST IN A CONSPICUOUS PLACE