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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
748004 I3 04130/201
/ate �'Signature of Contractor
OWN ER-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 UNITU) ]PACIFIC—IN-45 Policy No. XWA20178M-00
(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 Section 3700 of the. Labor
, I s all forthwith comply with those se provisions
bate: �<' % � Z 2 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
he°above-mentioned property for inspection purposes.
Signature (Owner/Agent).. .r-, r• ���`^"�% Date
PERMIT
BUILDINVALUATION G PERMITOT_�
DATE j
JOB SITE
APN
ADDRESS --
OWNER
CONTRACTOR/DESIGNER/ENGINEER
S`I`C�)ENI WALKER HOMES.
S XT.N.W.AL"t ER. HOMES
'716i INDIANA AFT -t..
7161.IN JV1ANA.A:�:
RIVERSIDE CA 92504
RI�t'EI3,SIDE CA 92509
(14M784.0340 C.BL► 53:57
USE OF PERMIT
INGI:E FAMILY DWELLINQ
8FD -'LOT ,20« PLAN 3C; PMWVV I OES hf a't CL'IM I1S;C'CK WA11 OR.
POOL. 75%REDVC'31ON "I'O PLAN CIIECK �'.I:s",E I'�0R W fU LE ISSL ItMrs
Com' SAME PLANnPE
CUSTOM CC3ri�.f!'t,{ - I'%I.' 14 „450,00 4'E
PORC 99ATIO _245.1)0 SI:
9AIa.A�)WC;ARPORT S39.(S{) SF
E "i! �M •lfED a);3'I 4R+ C(�PV�}�'�tt1:i�".A ICkF�
CCZNS'('l� UC:PIOTdT'M .10➢ -0011.418.000 $3,f)aI7.Orj
MAIN C RECrK FEE 1:01>000.4;ry„3.18 %"535.13
��MCf;'H/ ANi�C�Aj i..�`•.k"8 • I01-`�011�3�--�i2�,f1�-1000 $85.50
tot -Oi/Y--V.{,iJ-000. � I.M.W
>?rciAdi3.€i�I+a.EFts ”. pi�t-Sifis 419-0110
SMONO MQTION FEE - f�i,59-.) '101 -?t 0-24,1.,000 320.41
�`r'E.:�DING FEE 17( (tnf� 123-t3(J� 37t1:i�t+
r XZT I:tN1 PUBLIC PLACES - rMSI1, 7()1-000-255»0f14 n� 1.69
Dfs ROPER I:MPAU F'i3
SUB-TMAL CO 1`II:�1C°1' ON, AND PLAN (_'HECK
$3,823.32
r ESS .PILE-FAID FE ES
T�O"��AI.11'ERMIT FEES DUE NOW
S3,8-".3;2
`(`
4It9'r`.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
TRACT ��7' i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 6 Footings
Ducts
Slab Grade
Return Air
Steel
T17
Combustion Air
Roof Deck
jfjj
Exhaust Fans
O.K. to Wrap
40
F.A.U.
Framing
/1
Compressor
Insulation
/ 7
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 /6 —POOLS
BLOCKWALL APPROVAL
-SPAS
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 40.
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
$j
Appliances
Final
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
'Anal
Utility Notice (Perm)
COMMENTS:
SER -21-2000 16:01 WESTERN INSULATION 909,986 8796 P.03i13
WES
I UL I IN�00' RN e
4211 Latham Street, Riverside, CaUlbrnia 92501
Tel. (G09) 686-8760 Fax (909) 6868786
INSULATION CERTIFICATE
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 # : 20
SITS ADDRESS: ' M740 SAINT ANDREWS, LA QUINTA,CA
------------------------------------------------------------------
EXTERIOR_WALL
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 3 %s" R -VALUE; R-16
CETTTS
:
BLOW ,
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 13" R -VALUE; R•38
CEILINGS:
BATTS
BLO W
MANUFACTURER:
GREENSTONE
THICKNESS: 10.3" RNALUE: R-38
GENERAL CONTRACTOR: STEVEN WALKER HOLIES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER• 8
BY:
TITLE: OFFICE MANAGER
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: 80-740 HERMITAGE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-487
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: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 10/6/2000
POST IN A CONSPICUOUS PLACE