9907-488 (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.f Lic. Class Exp. Date
ate ��� °' .r 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:
Carrieri. rrblo 1;'".a1,.CT FC ENS Policy No: _ . NW t7,8 �0
(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 S�of employ any person in any manner so as to become subject to the
workp(s' compensation laws of California, and agree that if I should become
Pa
ject to the workers'compensation provisions of•Section 3700 of the Labor
de, I shall forthwith comply with t bse:provisions./ � e: � �''-ai!' Applicant .4/ fes, a•'»,`�Psr^-.
Warning: Failure to secure Valorkers 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
constyuction, and hereby authorize representatives of this City to enter upon
th/e above-mentioned property for inspection purposes.
r/Agent) ZZlSignature (Owne,x�
O
F/,=40-
QY01T {� PERMIT[�z-,_7ADATE BUILDING, P1ERVALUATION
~—� �i��
DT TRACT
�11L:,jA
JOB SITE x48111!04 4"RMITE GJEK'
ADDRESS "•
APN 761-090-078
OWNER
CONTRACTOR/DESIGNER/ENGINEER
STEM WALKER 110DAES
SYEVEN"W.i LKER .HOMES
7161 11N1 �'tiN VF_
7161 MDl.A��.A AVE.
IUVER.SME CA 92:504
RWERSIDE CA St V4
(9"78440 O CBLM 5357
USE OF PERMIT
SINCILE' FAMILY 1JiifFL1. NQ
tiEll LLYI'41, Yt.AN t(, t• EKMI l' 01JUS tW_Yi' :iPd(,f,1A& t%L)C& WALL Qa
POOL, 79D16 RED'C30TI'(:+tV TO PLAN i."JF fKCK FFO11.Altlrl;MPi.E YSSUTA,N(=;
OF SAME PLAN MT-
POIZCAVATIt'1 N4.00 ST'
GA'RAQ.E'A 7, A''RRO.E'1' ii0;ft0 SF
ES'T,IiVlAYU9 (UST OF CONS'i' ICTION
171;5.,913. 0
PERWIf FT E. SUMMARY
CONSTRUCTION :T17EF 101-000418-000 $1.1.6.00
PLAN CW.CK Fid 101-000.4:3. 315 $198.15
.MECHANICAL M9 1ts.i-Uiitl» 1=t1Q(i $95.50
UiEC"1`Iii;C",AL$142.64
PLUn481•n1C fl:E M. 101-000419-000
STRONG +'v OTlrh'!11 F9E ...fM :101 OM441-000
MAD NG FFA t 01-000-423-1`"
.ART IN PilIVAC PLACES -'t Il, 701-000.255-000
DTIV pLOPIM 1T PACd' Fu.x3,'i0".flt)
, LTl3- ru ,\, L con {`3'i.LJL' nc N AN1'i P AN C.a:1 Cx
LESS FRE -PAID FEES
$0.00
TOTAI, PFPuVrr 1rUS DUENOW
$3,636.70
l%]�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings /
Slab Grade ,�
Ducts
Return Air
Steel
Combustion Air
Roof Deck &/14V
Exhaust Fans
O.K. to Wrap
F.A.U.
_
Framing It_ �� _
Compressor -
Insulation
Vents
Fireplace P.C.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath '1
Drywall -Int. Lath �
Final
Final / _
POOLS - SPAS
BLOCKWALL APPROV . S
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
'r PLUMBING APPROVALS
Gas Test
Electric Final
WasW,tines -
Heater Final
Watej�Piping ZPlumbing
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test /
Appliances
Final
COMMENTS:
i
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
AUG -30-2000 15:52-' WESTERN INSULATION 909 686 8786 P,02
Wwt
'AERN INSULATIO11T, I C o
42 L L Latham StMt, Rlversidc, C WO'Taa 92501
Tel. 1909) 684-6760 FtX (909) 686-8786
IidTMJI,AMN QRTIF'lC1�7��
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 HERMITAGE SERIES - 28603-1 PHASE:
LOT # ; 47
SITE ADDRESS: 80-634 HERMITAGE, LA QUINTA,CA
---------------------------------------------------------
EXT OR WALL
• , MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 %" R -VALUE: R-15
C I ATTS BLOW
MANUFACTURER; JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS cQsOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOMES
LICENSE NUMBER:
BY:
R
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUM 1278
IS Y:
TITLE:* OFFICE GER
DATE August 30, 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
80-634 HERMITAGE
Occupancy Group: R-3 Type of Construction:
Owner of Building: STEVEN WALKER HOMES
Building Official
vnl
Bldg. Permit No.: 9907-488
Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 1/25/01
POST IN A CONSPICUOUS PLACE