0006-333 (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 # Lic. Class Exp. Date
t
s B' (7/30/2(
LDatet `` f" Signature of Contractor; s 12[?, e
ti .+I
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 PACIFIC INS Policy No. 11YA1191945- 0 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 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
subject to the workers' compensation, prov lions of Secti6n'3700 of the Labor
Code, I sshatll-f ok�iwith comply with/ hose, provlsio;&,,,
(Date: C ',� '•- Applicant Z
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 property for inspection purposes. ,
'Signature (Owner/Agent) A, Date
�! BUILDING PERMIT PERMIT#
'Z333
DAT VALUATION LOT TRACT
$204,677.90 28603.11 �c
JO ITE
ADDRESS �Nwa• A.
APN
761-0'07 r
OWNER
CONTRACTOR /DESIGNER / EN INFER
8TI±.'VE9 VJAL1C R HONM
S'T'EVEN' WA% rIm I~ aN
7161I1.,TDIMAAVE.
71611.:1 )]ANAA`VE•
P-rV RME CIS, 92504
RIV". RME CA 92504
(909)784.084.0 C];TS 5357
USE OF PERMIT
C11Y,1 AYLILY DWIAUNG
5FD- LOT 45 PLAN 3C PE'R.MIT DORS NOT INCLUIDE BLOCK; WALLS OR
POOL. 75 % PWI CHECK FEE REDUCTION FOR ISSUANCE OF SAME
PLAN TYPY,
CUSTOM CONSTRUCTION %410.00 8F
_ ,
1 �'•
PORC14JPA:TIO 243.00 SP'
CIARAGPICARPORT (8F) 10,564140
ia'GMIA=' COST OF CS,9.fMUC`I103N
204.i677190
%'ERAW.' IE`RE WNWARY
CONSTRUCT104 FJEE 101-000.4.18-000 $1,007,00
PLAN CHECK. FEE. 1031-000-434-318 $266.7'i
M"E?CHANICAL FEE 101,000-471-000 $92.00
A'I..W..` RICALFEE I014)00-=120-000 $149,03
PLrLiMBI1 G FEE 101.000-E419.000 $16.50
STRONG MOTION PBE - RESID 101-000-241-000 $20,47
ORADINO $`.EE 103.00044-000 530100
DZVF,L0PM1 IMPACT FEE 51,9a no
ART IN PUBLIC PLACES - R&SIC 701.000.255.000 $11169
SUB -TOTAL C0N8112T3Crft0N AND PLAN CFDn•:
$3,610,41
1X35 PRW.PAILJ F EF3
$0,00
'D:OU1, YXIM ITI II' 6 DAYS NO- W
A /•
RECEIPT
DATE
B
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
b
Ducts
Slab Grade
Return Air
Steel
7 41Z
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
I�
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
3,A00[
Encapsulation
Gas Piping .
Gas Test
p
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)
l
•
Certificate of Occupancy
City of La Quinta
Building and Safety Department
7
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:
Occupancy Group:
80-658 HERMITAGE
SINGLE FAMILY DWELLING Bldg. Permit No.: 0006-333
R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES
_ 1a'
A4--k-
Building Official
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 9/25/01
POST IN A CONSPICUOUS PLACE