9907-474 (SFD)LICENSED CONTRACTOR DECLARATION
-1I hereby affirm under penalty of perjury that I am licensed under provisions of
r . Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W to Professionals Code, and my License -is in full force and effect.
ry License. Lac. Class ° ExpA. Date
1 LLJV
oZ r -hate Signature of Contractor. t "
o, O.
JI.—
C:) OWNER -BUILDER DECLARATION
W WD_ r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
a- 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).
c'i)() I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O N
M
d Q WORKER'S COMPENSATION DECLARATION -
p z I hereby affirm under penalty of perjury one of the following. declarations:
Lo tr
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor_ Code, for the
O J Q performance of the work for which this permit is issued.
Cal Q U ( ) I have and will maintain workers' compensation insurance, as required by
id 'C)- Section 3700 of the Labor Code, for the performance of the work for which this
d LZ permit is issued..'My workers' compensation insurance carrier & policy no. are:
oo Carrier ilrrrr D 3y.t�Cl '[C Il!dS Policy No: N'` A201170%% • .
r` O
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, of, (�alifom al and agree that if I should become
subject to'he workers' compensation p�o�isions of Section 3700 of the Labor
C99d'e, I sha�l/fo�thw,th comply wifh.those rovlsns_
;kYate:°� l / Applicant u�'
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.
1 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 ins n purposes.t
Signature (Owner/Agent) ! �� Date / f
BUILDING, PE MIT PERMIT,
�o mb3tlCf{
���t�fy� ,�
VALUATION LOT TRACT
DATE r//0
JOBSITE F`bg'+`�74tf%Kt"1111A p
APN t9. �9T-IY
ADDRESS +e - -- --'`-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
j CEVEN WALKER HOMES
S FVI' N WALKER HOMES.
7161 INDIANA AVE,
7161rN1r DANA NNit. '
RIVERSIDE CA' 92,,50.4
RtVEit.SfUE CEI. 92504
t9)?d�Jfldd E:If # J357
USE OF PERMIT
SINGLE FAMILY OW.Er,I..ING
~
Zrll - .v+ Jd. -t.ASV ^i .va a LK .Pz y al*J_.._�t
POCfL„ 75°!o Rhrutfi7r.10N' TO PLAN CHECK FIX F 0, R, IVAI.i,TR4.L tSSIJANC
OF SAME I?L ANI TYPE
CUSTOM CO.Z -vfRU17CI N 2, 301.00 5T'
'PORC-WATIO M_ift SF
G,ri RA.O'i?,lCriMaf,7RT 580 )o S:.
csTIMATcu:con or, Cowrmcnorl
178,813,10
L"ON,1E1RUC'9"tON FEE 104-000418-0-00
PLAN t, BECK FEE ltJl-1M.439-31I3 198.15
M�YAx+I1'C„1..
I;1XX;rTUCALT .33- $1421.M
PI,1NBING �"E:a?- 116150
STRONG MOT(OIN V69 - RESID 101.000-241-000 $17,88
c,IZADWO F86 i.0k .000-423-00 $1211:00
wr w fir. ej tc.m,A4;' s - RES1C 7o t 0 $197,03
OEVCLOPER 1.NdP,ACT FUE. 11,9V7,00
SUB -TOTAL C{:?PJWRUCii ION AND.CPI...�iN CHECK
S.i,,636.70
LESS RRE,-PAID.. FEES,
P1).00
:,T(Yi
t?kll.`S4pEN111t'ffT .]1E.LS DUE NOW
S.I: 636.70
RECEIPT
DATE
By '; f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings O�L`�
Slab GradeIM
Steel
Roof Deck
_
/�� - _
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Insulation .6�1./�
Compressor
Vents
Fireplace P.L. /
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2�
Drywall -Int. Lath
Final
Final
_
/ _6
POOLS - SPAS
BLOCKWALL
APPROVA S
steel
Set Backs
Electric Bond
Footings
Main Drain
nd Beam
Approval to Corer
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
110 _
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Finat
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
/
Encapsulation
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)
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:
R-3
80-574 HERMITAGE
Type of Construction: VN
Owner of Building: STEVEN WALKER HOMES
Tem
Building Official
Bldg. Permit No.: 9907-474
Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 10/6/2000
POST IN A CONSPICUOUS PLACE
OCT -06-2000 13:13 WESTERN INSULATION 909 686 8786 P.04iO4
TERN IN uLATT N, TNS.
4211 Latham 9tseet, Riverside, Celiforaia 92501
TeL (909) 685-8760 Fax (909) 686.8786
INSULATION CE=MCAT
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: PGA WEST RIDER COLLECTION - 28603.1 PHASE 1
LOT # : 52
SITE ADDRESS 80574 HERMITAGE, LA QUINTA, CA
EXTERIOR WALL.
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2 " R -VALUE: R-15
C i ATTS BLOW
MANUFACTURER: JOHNS MANVIME THICKNESS: 13" R -VALUE: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES _
LICENSE NUMBER:
BY:
TITLE:
DATE:
lbiSULATION Q0NTRAQ1[QR-: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: OFFICE MANAGER
2)
DATE OCTOBER 8, 2000
TOTAL P.04