9907-464 (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.
License14M4 �31c. Class Exp. Date
741W. 0
,Date Signature of Contractor f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
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:
Carver " UNr=.PAC1iIC 1;?f��" Policy No. NA?Ol Ip,9S-(EO
(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/a^ny manner'so as. to become subject to the
workers' compensation laws of C91if6rniWand ree that if I should become
subject to the workers' compensation pro Isio sof Section 3700 of the.Labor
Code, I shall f�grthwjth comply wit ose p oyaslonst"
r y / �
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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)ik
L— Date
BUILDING PERMIT
PERMIT 7
DATE �% / VALUATION 51.78,813.10 LOT
3 r
TRACT 28603.1
JOB SITE '804522 HEit1V1ITAG#J
APN
7G 1-d3"-D?Fj
ADDRESS •, ,-__ - - - - - _ -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
S'TEVEAI WALKER HOMES
S rEVEN WALKER
140MES
7161 INDIANA AVE.
1161 INDIANA AVE.
RIVERSIDE CA 92.504
RI V'ERSIDE
CA 97-504
(903)78,,10840
CB:L# 5357
USE OF PERMIT
S1NGL.E .lit\ ILY DWELLING
1�L1C'aL.
CUS f(.W 4:ONS CRU SC:'1i7.018
'',,, W 1.0 k
PO RCHf1'ATIO
284.00 SI
t;' 3ARAGEfCt>,PWORT
.54W.00 S)+
E-STIMAXED ("M—OF
C 01+i8"1'RUCTION
17013.10
PERMIT FEE SUMMARY
CON'SIMUC111014.FEM 10 •O0i')-108.000
5916.00
PLAN CHECK M 3.01-(100-X39-3.15
$752,60
'hfFl.; HANICA1; E,F:E 101 U{)Ii-421-000
&'33•y0
EI:XCIRI AL RE, 10`1-0011420-000
S142.64
PLUNfAffiG'FEE '10-M'419-000
$162.50
&fR;NQ M TIO -IN FEF - RESID 101-000-241.-000
$17.8$
GRAD114G FEE
:lKY IN PUBLIC PLACES R E;S7iIC 01-Ck��;t••25.5-000
{-
�7
DE1�iV.140PC1.C� I1!✓trS � ..
di 1y7+/7.V.J
F- ry
SUB-'1"Ol'AI C -:ONS` RUC.'t`1IU
AND LAN C.REC1,'.
LESS P.K -PAI.D f'`L,L�
r� f,�da2i11.15
1a $0.00
TOTAL, PCfdj4UT
irN
FEES DUE NOW
�0;2d11.1�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings /�/y`
Ducts
Slab Grade
_
(
Return Air
Steel
Roof Deck
O.K. to Wrap�3
Framing
Insulation
// _
0, – —
�� '
Combustion Air
Exhaust'Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ 40
Drywall - Int. Lath
/4(1QD
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
Water Piping
_
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�/
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)
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# 3
SITE ADDRESS: 80522 HERMITAGE
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 1/2" R -VALUE: R-15
CEILINGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 1" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
----------------------------------------------------------------
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUC
DATE May 9, 2000
Certificate of Occupancy
City of La Quinta
.�:-9,'Uilding 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:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
R-3
80-522 HERMITAGE
Type of Construction: VN
Owner of Building: STEVEN WALKER HOMES
I/
Building Official
Bldg. Permit No.: 9907-464
Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 6/14/2000
POST IN A CONSPICUOUS PLACE