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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, anis my License is in full force and effect.
License # Lic. Class.,,! t Exp. Date
ef d R f jjf t w /04/30I2C�f
Date l', f '1 �1 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 Policy No.
UNITED TED PACIFIC INS NWA201789"O
(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 alifornia,/'and agree that if I should become
subject to )he workers' compensation proAions (of Section 3700 of the Labor
Code, I s l �I f'oprtfiwith comply with those previsions,_-_-- '
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose•behalf this application is made & each person at
whose request and for whose benefit work is performed under or -pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all ;City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propefor insp`eciion purposes.
s�[,i�
+Signature (Owner.Agent) +.f�" J Date !
BUILDING PERMIT PERMIT#
DATE VALUATION _ LOT TRACT
l� -
SI1913.�Q��911 U56 2>�fti�i-1
�
JOB SITE
ADDRESS "
APN
'20, 98.�IEKi�4i �AGE�
ib1-00-075
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IMEVEN WAMER T -TOMES
STEVEN WtOMER. HOMES
:%
iR.I TMSIDE SCA 191Y2504
(90)784d)M C$L# 5357
USE OF PERMIT
00 - Lar 50, PLAN 213, Pff"T DOES NOT INCLUDE BLOCK CK WALL OR
Ia001, acP.la cTanora ro PLAN, c:T:fRX FF FOR N1L( �1T1 LF, ISSUANCE
OF SAAAF PLAN fkWs
CUSTOM C ON.3,1'}t(Jt TIO N2,9,00.4.E
Ik:7R,C'11CCP�,'ri tCD "2G.C�1 �`�
GARAGE/CARPORT 503.00 SI°
'EST IMAT EW e:O&r OF CONSTRUCTION
19SAW"
PERI CITEE E SdINA'iARY
CONSTRUCTION FEE 101 -000 -418 -MO W86.00
PLAN CHECK FE
PsIECHANIC.AL, FM, 101-000-421.000 592.0tf
H-LEC'TRICAL F7F 101.000-420-6,k?f) 1:�t➢.J3
PI,"rIMBI GFid 1,01-009-119-tiM $1162.54
TMO NG h10TIO'N IKU - REM 101 -000 -241 -WO $19.82
GRAI:DINO FM 101-000-42 V -+D(?() $20.00
All r 1N PUBLIC ;f' ,4XFS - RESX701-000-255.040 $20.52
DEVE-1.0PT R IMPACT VHS 11'"T00
SUB -TOTAL CONST[i.L.(MIO.N AND ELA;:gN CHECK
$3,785.30
} � t�
LESS PRE-PAIDMIS IS
S(Mw
f t -
TOTAL PERAMITYEES DUE N6W:
RECEIPT
DATE
BY f
DATE FINALED
INSPECTOR
/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms Footings
Ducts
r f
Slab Grade
�d � �
Return Air
Steel
Roof Deck�j
�99
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-� _
Compressor
Insulation
Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath I
_
d
Drywall - Int. Lath
Final
Final
_
o
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
Pool 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
t
FbQurgs "- '.
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility NoticePerm)
OCT -06-2000 1312 WESTERN INSULATION 909 6868786 P.02iO4
WEDWOUTERN IN D"ULATION 9 INC*
4211 Lanham Street, Rivcrsidr, QWomia 92501
TeL (9N) 686.8760 .FaK X309) 6868786
I11 SULATION CERTEFICA`Y'E
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 J PHASE: PGA WEST RIDER COLLECTION — 28603-1 PHASE 1
LOT #50
SITE ADDRESS 80598 HERMITAGE, LA QUINTA,`CA
EXTERIOR {MALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2 R -VALUE: R-15
CEILI S: BATT BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS; 13" R -VALUE: R-38
---------------------------------------
GENERAL CON_ RACT®R:_ STEVEN WALKER HOMES _
LICENSE NUMBER:
BY:
TITLE:
DATE;
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
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 Gro.up: R-3 Type of Construction
Owner of Building: STEVEN WALKER HOMES
Building Official.
80-598 HERMITAGE
vn1
Bldg. Permit No.: 9907-472
Land Use Zone: RL
Address: 7161 INDIANA AVE.
City: RIVERSIDE, CA., 92504
By: RICHARD K. KIRKLAND
Date: 6/28/01
1 - 0IIS POST IN A CONSPICUOUS PLACE