0011-128 (SFD)U)
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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.
License # Lic. Class Exp. Date
Date ' flE��t 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.
AQ 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:
Carver Policy No.
STATE COM, PEWATI TODWO
(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 provisions of Se lion 3700 of the Labor
Code; f shall forthwith comply with those pro�I'�+on t 0
Date: 11 �� rin Applicant—i" f
1 f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authoriiei'representatives of this City to enter upon
the above-mentioned propertyJor M6.pectiPn purposes'. ,
Signature (Owner/Agent) `• --- f �1- -`f ` Date
BUILDING PERMIT PERMIT#,-
DATE VALUATION LOT Q0_0QJ_ TRACT
W44
1111412a 52.04 7SO Q 2M3_1
JOB SITE
APN
ADDRESS _
W17.al.
OWNER
CONTRACTOR / DESIGNER / EN INEER
VIE -VIM wAi xm ROWS
:D'i'EVM WAI.MI& M011
716111Tn31AKAAVL
7161 1 MMINVE
RIVERISADE CA 92504
Rv'GR` E CA 92304
(909)?P4-0840 CrIL4 5357
USE OF PERMIT
1313 { FAMILY DWELL MI
iPJ -. £ZT 4 PIAN 3f, PERMIT J3Z�1�S �ci !3Ck,IPt9F 13fw'10°$Cii��t 1, OR
.0004 767% PLANCKOCK UEL ON Ih ULIAIPTht 11MlL.NCt, OF MUE PLAIN
TYPIr
03TOM G014STRAJC TION 2,450.00 SF
PO?1!C14JPATIO 7.15.00 SF
C.A kA CAkti'-ORT (OF) 1004.40
xsmax� Con 0:1+' cCnsTRu+Cnoff
204,677.90
, 90A AiY
PkWwr W
OW49RUCTIOIN rIF, 101-000-418-000 $1,007.00
fes )
PLLf V, l CHECK trUp 1101 -OW -439-318 $2"A
h� CPir�"i1CA1, 1; 101.000.421-000 SA4:4s�
1<,LYfKa'€RI ;.i L FE -t0 10b-tR ID -420-•(W)
z 't
P1.,tdMt31i40 FEE 101-000-40-000 9180,50
:x FROX-0 PAOT ION' t ''S 1t.!~'; ID 101-000-241-000
ORAa01HOFFIR 101-f3fk)-423.000 $20.
DLIV LOPFA MPACT FEE $49t3'J.00
ARF rN PuBlAC PLACEI.RUN 1101.000.255.000 �1?.6a
•� "�'
3tYB `A"O°Y'.9�:i<,. C01•MMUCTrI,ON AND P CdA# CMEZ11K
$3,600.41
LESS PR9-PAID F",'F s
$0,00
'1OTAL Ti!EMT .ES WE NOW
tib• IDAI
RECEIPT
DATE '
jlf�t�tp
BY
'��..•!1i.
DAT I A
INSPE R
d
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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// Q�
Ducts
Slab Grade
li! ! i�`
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
0. K. to Wrap
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F.A.U.
Framing
Insulation
_
�l �j : _
t%���u` '
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
6 7 (Y
Drywall - Int. Lath
Final
Z`�1o3
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
Waste Lines���
�
Electric Final
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��ICY �/�
Encapsulation
Gas Piping
Gas Test
Appliances
,•5
Z 7!
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. 1.
Smoke Detectors
Temp. Use of Power
Ftnal
Utility Notice (Perm)
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:
Occupancy Group:
SINGLE FAMILY DWELLING
80-718 HERMITAGE
R-3 Type of Construction:
Owner of Building: STEVEN WALKER HOMES
Building Official
Bldg. Permit No.: 0011-128
VN Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA 92504
By: DANIEL P. CRAWFORD JR.
Date: 2/5/03
POST IN A CONSPICUOUS PLACE