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9907-473 (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. License•11 4 Bc. Class Exp. Date��� U7ate r Signature of Contractor v� 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 UNITED PAC.'IFIC INS Policy No. tdWA20I706­00 (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,r�nd agree that if I should become subject _ the workers' compensation provisionslof Section 3700 of'the Labor C de, L"shall,forthWith comply with those prov�i'sions— r t! f t rt ti.,. Bate: 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 reoresentatives of this City to enter upon the above-mentioned property for inspection purposes.- §'ignature (Owner/Agent) Date PERMIT # BUILDING PERMIT' �J� DATE VALUATION $204,677.90 LOT S1 , TRACT 28603-1 JOB SITE WSW 1HERMI lla`nl1E APN 761-9"-078 ADDRESS f OWNER CONTRACTOR/DESIGNER/ENGINEER Sn, VEN WALI:.EK H-D_NtE£3 S'I'BVR-N WAI,IEFR.-s•IbMFS 7161 INDIANA A VE. 7161 INDlkiivtt, Q.V.E. RIVERSIDE C.E . 92504 RI"VE.RSIDE CA 92504 g!+�iKJ 78�•Ot$�19 CBLY .5357 USE OF PERMIT SINCILE EAMILif ONVEL 1NC.. Nk.t).- VYII- Si, VLALN'.3ux I ywi,Nt3'i' I. [;f.itJlm Ismicr. WF.m -R K*L.. 51,11,111MATUrIG1N'i O PLAN diECK FEE FOR MIME [SSUANCE Or SAN4F. PLAT.4 TYPE POP-0,11/7Vr}►TIO 245.00,91F 43-ARAG&C`'Al21F`ORT SF fl+ leiTIMATEI3.tAMT av9F C3.N.&FRIVIC110N. 204,677.90 FERMI' FEE SUKA'IARY MNSTRUC0111014 ME, -101-M0418.000 PLAN Cf K' C1H l.fld.-000439-31;5 '62195.13 MECHANICAL HE 1.01-OCti-41 0,00 $85.50 .ELEC1'WAl. Eid. 1iJi ©t1~�1ZtD dOil 1154.93 PL.U&IRINC.I ..M. , tfl.k -t1I30 X319 -0&I4 g 1.6'�..5c► S'I'iiONOMOTICjNFEE. -RE,31D 101-000-24I-{D(iIJ 170.47 GRAI3iY fSF $:24.00 ART iN FdI dC PLACES. - R E9.11.. 701-000-` 55 -WD 5um1'.'Y1' . CONSi'It.0 1 ION AND PLM CHECK�. $3A23.32 .'S9 PRE -MID FEES st),I:.1fI ► �� q T\yT%aOJ PERMIT �.TJ)JbY L1W Y��180W,53.623,32 RECEIPT DATE BY '� DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 4 Ducts Slab Grade Return Air Steel Roof Deck 9Q Combustion Air Exhaust Fans O.K. to Wrap /�� F.A.U. Framing Q/!�D ifcSa_—���� Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 7,1 Final.01 Final POOLS - SPAS BLOCKWALL APPROViLS ` 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 I 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 rflfj Utility Notice (Perm) OCT -06-2000 13:12 WESTERN INSULATION 909 686 8736 P.23%04 W TE [ IN LATI "� IqkqpC 4211 Latham Strut, RiveIsidc, CalSorrila 92591 TeL (909) 686-8760 Fax W9) 686.8786 - ULS . CERTEPICATE 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 SUILDING LOCATED AT: TRACT ! PHASE: PGA WEST RIDER COLLECTION — 26603-1 PHASE 1 LOT # : 51 ` SITE ADDRESS 80586 HERMITAGE, LA QUINTA, CA EXTERIOR YffiLLS' MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 712 " R -VALUE: R-15 IL N SATTS.-,. BLOW MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38 ----------- * . ­--------­--- GENERAL CONTRACTOR: -STEVEN WALKER HOMES _ LICENSE NUMBER: BY: TITLE: DATE: INSULATION CONTRACTAIR: WESTERN INSULATION, INC. LICENSE NUMBER: 4131278 BY: TITLE: OFFICE MANAGER DATE OCTOBER 6, 2000 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: 80-586 HERMITAGE R-3 Type of Construction Owner of Building: STEVEN WALKER HOMES --I -.,t, /4--w Building Official VN Bldg. Permit No.: 9907-473 Land Use Zone: RL Address: 7161 INDIANA AVE. City: RIVERSIDE, CA., 92504 By: DANIEL P. CRAWFORD JR. Date: 1/26/01 POST IN A CONSPICUOUS PLACE