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9907-463 (SFD)LICENSED CONTRACTOR DECLARATION In I heveby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C14 W Professionals Code, and my License is in full force and effect. License # Lic. Class � Exp. Date r- O � 148004 B 04/30/201 ' W oZ ;,Date`( c Signature of Contractor �� O� (-) C OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1n License Law for the following reason: Z ( ) 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). CY) () I am exempt under Section B&P.C. for this reason. . N Date Signature of Owner Orn . CL z WORKER'S COMPENSATION DECLARATION 'It CD Cc I hereby affirm under penalty of perjury one of the following declarations: U') � O () 1 have and will maintain a certificate of consent to self -insure for workers' X u1 LL compensation, as provided for by Section 3700 of the Labor Code, for.the O � Q performance of the work for which this permit is issued. m QU ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this d rn H permit is issued. My workers' compensation insurance carrier & policy no: are: 19t z Cartier Y Policy No. n Co —)U141:TEDPA.CIFICINS r".0 J (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 ofiCalifornia, and agree that if I should become subject to the'workers' compensation pr8visions of Section 3700 of the Labor 3 1Code, 1A (,fofrthwith comply with fhose•�rowis sr~ Date: i / Applicant 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` r➢epresTntatives of this City to enter upon the above-mentioned property for Inspection purposes. 17 i S gnature (Owner/Agent) ��� �' ° L� Date PERMIT # BUILDING PERMIT g7A DATE/f ! . 7 VALUATION Z�=� S+10 LOT �L TRACT 2�-�-1 JOB SITE ,l)'IA�ir`��' APN 761-090-073ADDRESS �— OWNER CONTRACTOR / DESIGNER / ENGINEER STEVEN WALKER. I40NILu S'II"I;WN %V,AI. KFA HOMES 7161 INDIANA. AVE. 7.161 INDIA`NAAVE, PdVERSIDE CA 92504 RIVERSIDE CA 92504 (909)784-0840 C81,# 5357 USE OF PERMIT S.II< GLE FAMILY .IDWELLYI O SF D - LOT y, a? AN 2AR,DOES :N0T ;~ NCLUDE 13LCWK WA11 OR POOL. C'•USTON4 CONS1'itdJC'.I`ION 21373-00 STY PORCHIIsR'I'£O 220.00 SF GARAK?OCARPORT 633.00 W TA,1°' TIt'411AXE+.ID C(Wf OF CONSTRIUMON 2i` 0,69t>.10 PERiWHY F-Ef E.SI AIM Y r *NS rRUCTION FRE 101 -000 -419 -WO '$993.00 PLAN CEFECfiK,IF4E 101.0,00-439-318 $811.99 MECHANICAL FE I. U I.0fIi1-1d^ 1 >t3ii1'v �>�.t30 ELFLfRIC IC M, $153.47 &'Li mBING 1'- 1; $162.50 STRON(r lvl YFIO'N FEE, - RESID 101-000-241.000 S"1410,07 GR A1D.1140 FE S 101-=-423-000 MOO AWf 1N PURLIC IN.A.C",]ES - RESIC 701-000-25-1-wo $2x1. A 9DI"VHi.(3FM DMIP >LC"1 FFE 81,007.0. SUB-`C'iY`I't\L C°,C).NS'iRUCI'!r' N AND PLAN C1IEG.K S4,41.1.77 LESS PRE -PAID HES $12.W D'OIAL"T'E3tMIT 1 EX: DUE NOW S4,411.77 RECEIPT DATE BY i ;�j DATE FINALEDy INSPECTOR k- , — INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade _ d S Return Air Steel Combustion Air Roof Deck // Exhaust Fans O.K. to Wrap _ �� F.A.U. Framing _ �a Compressor Insulation Fireplace P.L. _ 3 Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath /�If 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' 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 7Pool Cover Sewer Connection /Z Encapsulation Gas Piping Gas Test 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) i. WESTERN INSULATION, INC. 4211 Latham Street, Riverside, California 92501 Tel. (909) 686-8760 Fax (909) 686-8786 INSULATION CERTIFICATE 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 COLLECTION - TRACT # LOT# 2 SITE ADDRESS: 80510 HERMITAGE ------------------------------------------------------------------ EXTERIOR WALLS: MANUFACTURER: Johns -Manville THICKNESS: 3 1/2" R -VALUE: R-15 CEILINGS: BATTS BLOW MANUFACTURER: Johns Manville THICKNESS: 13" R -VALUE: R-38 CEILINGS: BATTS BLOW MANUFACTURER: Greenstone THICKNESS: 3" R -VALUE: R-38 ---------------------------------------------------------------- GENERAL CONTRACTOR: STEVEN WALKER HOMES LICENSE NUMBER: BY: TITLE: DATE: INSULATION CONTRACTOR: LICENSE NUMBER: 481278 BY: TITLE: PROD C ION MANA DATE May 9, 000 ESTERN INSULATION, INC. 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, cartifying that, at the time of issuance, this structure was in compliance with the various ordinances Df the City regulating building construction or use. For the following: BUILDING ADDRESS: 80-510 HERMITAGE Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: Owner of Building: STEVEN WALKER HOMES Building Official VN Bldg. Permit No.: 9907-463 Land Use Zone: RL Address: 7161 INDIANA AVE City: RIVERSIDE, CA., 92504 By: DANIEL P. CRAWFORD JR. Date: 5/18/2000 POST IN A CONSPICUOUS PLACE