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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, and my License is in full force and effect.
LicenseLic. Class Exp. Date.
1148004 B t:4� 0 (x
/ate'2'� Signature of Contractor ✓�'�" ��°y"
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
curilractors 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:
( ) .1 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-.
Carrieri1N1'i.'�7 I�r1C,i.FIC k% Policy No.' NkVA20178t6.00
(This section need not be completed if the permit valuation is for $100.00 or less).
() 1 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, and agree that if I should become
slect to the workers' compensation provisions of Section 3700•of theLabor
roC • de, I shall forthwith comply. with those pro4isions.� '
te://.. ?y'.�" Applicant :
Warning: Failure to secure , orkers' 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
Zignature
bove-mentioned property/for inspection purposes:
(Owner/Agent) A +/-• '-� Date
lr"' . .
BUILDING PERMIT
,-PERMIT-44W�
DATE r VALUATION %.` LOT �.1tf TRACT
ilf A -
� �GZi11 :iRrl�X _A _L5
APN %��-tz!►i1+-Ilii
ADDRESS
,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
STEVEN WALKER. HOMES
STEVEN WALKER HO&I.ES
7161 NMANA AVE.
7161 INDIANAAVE
RIVERSIDE CA 9? -%4
RIVE:R.SDE CA 32504.
(909)TU-0-840 CCL;? 5357
USE OF PERMIT
SINGLE FAMILY EINVEL1 ING
Sdf' LOT 49, PLA�NI --.i P, :P-' flT ,000- S WI' 1NICLil1;M 81.00 Wtel..l..
017..POOC.. 150A R WUCTION TO Pl..AN (NECK rEE FOR NIM.:1'.tPLE
ISSUA24IC"is'• OF SAOQ P.T. iW TYPE
CUVOI A CEJ' NJ'I'RUCT'1'ON '2 450.00 SF
PCDP1.CHIPA.` 1.0 243.00 SF
GA_RA0PJC.ARY-'0RT . S39.00 SF
�;�r�MArra�,:s� C��a�r a:��..Ca�•;v�•�':�s5t•1t��
2r�;s�ry.��
PERMIT FEE SUMMARY
COAf.,11R.UCTIONF'E.8• 101 -11(10.411.8 -OW $1,007AAi
11. AN CH CK l+.i"M 101-000-439-319 $265.13
1VIECHANICAL F.FF 1(16.-004 q21=1100 $85.50
%W1'f? JCAL h` 1 " :101.000-420-Ot:t1 154.03
PLUM RING FE ::. 1tii>�Yri
57"RONG MOTION F.8E - RE310 10.1 -OW -241-000
GRAWNG FbF 10t-00@•42"3-000 • $2Q3,C y
A;dt`t i�1":PI;1'B.Q.'dt: PI..ACi�S-1Z�SfL .7{31-011(3-�55- $2+5i.bls'
'Ir'I.:)PER INI.i?A1: T JWT
SLI&�TCYI'A . CONSTItUCTt0N AND PLAN CHECK
x,025.32
LESS 'PRE-PAIDC, is
- M(h)
T(Yf AL PED2NIff r, EELS VV Ej: NOW
33,823.32
RECEIPT
I DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z,
Underground Ducts
Forms & Footings L
( d
Ducts
Slab Grade
QO
Return Air
Steel
_
Combustion Air
Roof Deck
_
��'
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing_
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
_
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
�Q�-T
�-'7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Seaver Lateral
�y
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)
AUG -30-2000 15:51 WESTERN INSULATION 909 686 8786 P.01
,,rdsTERN I1 SULAT10"q lwc.
4211 L&Uu= su*8t, lUnrslde, CaUkrr a 92501
'Cel. (909) 6$6-8760 Fax (909) 6WS785
INS ATION CZERTIFICATE
THIS 19 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 HERMITAGE SERIES — 28603-1 PHASE:
LOT # 48
SITE ADDRESS: -8041-0-HERMITAGE-1-LA QUINTA,CA
- ----------•_-_.-.-.-:.------------------------------------------ -
.0 TERIOR WALL
MANUFACTURER:
C U :
MANUFACTURER:
JOHNS MANVILLE
THICKNESS:
BLOW
JOHNS MANVILLE
THICKNESS:
FERAL CONTRACTOR; STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
3 'A" R -VALUE: R-15
INSULATION COATRACI[OR: WESTERN INSULATION,, INC.
LICENSE NUM 278
BY:
TITLE: OFFICE MANAGER
DATE August 30, 2000
13" R -VALUE; R-38
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 fol/owing:
BUILDING ADDRESS: 80-610 HERMITAGE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-490.
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES
Building Official
Address: 7161 INDIANA AVE.-
City:
VE:City: RIVERSIDE, CA., 92504
By: RICHARD K. KIRKLAND
Date: 6/28/01
POST IN A CONSPICUOUS PLACE