0006-322 (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 #pyo Lic. Class Exp. Date) p�M
480Qil.�'JI' Gi
Dated �I �' n Signature of ContractorA ` r
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 11TL'Ys AAt;11'tC IN -
Policy No. 1WA1J.9154540
(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
s6ject to the. workers' compensation pr visions of Sect'on 3700 of the Labor
Code, 1,S 11 II fo hwith comply with' those rov�sio �%
Date: f1 � ) Applicant 10/1
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
coOstruction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for, insp cjion puPs
es./��,/l111°lSignature (Owner/Agent) - r�_ Date"'! dry
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
;
= $30t3,9J.tJf1 286133.1 , .
JOB SITE
ADDRESS
APN
OWNER
CONTRpACT�O�lR�e/IyDE�SthGNERt//tE•NTi (iN7E�EiRi
Y+t� try t YfTr� �? GL c�
a'J ZJrY iL N �W ALaL\.�..i4 61Q1i♦.i.�+►7
��y
a�S t.t'r V .C�[V MYAZ..i�l R 61VAVJ� S
7161 DOW4AAVE.
7161 IN1: IMAAVE,
RiVERXIDE CA 92504
RrVERSME C.4 92504,
(909)'784-0840 CBIS ..535, •«;`�
e
-
USE OF PERMIT
�l:t.CVt IY, F1'1.SY1iLd I 77]:n:.nLINQ
�- •..r f
S70 -LOT 21 PLAN' u8 PERMIT DOES NOT INCL.UDE MoOCti" WALW OR
POOL
CUSTOM CONSTRUCTION 2,."M100 SF
POACWPATIO 236.00 SF
OARAUWCARPORT (.t) 12M6.00
xur,.Cl.YdCLdlz lrotJVr of cobYOmV1-n4rx
2ei{!A908.90
PErAi71i M SUMMARY
CON;1TR UCf)ON FEE 101-000-418.000 $993.06
PLAN CHWK FEE 101-000-439••318 $810.74
MP:CI'1.KWICAL FEF 101.000-421.000 $92,00
RLWTRICAL FEE 1011-000-920-000 $149.47
L Lt3MFITNO F&E 101.000-419.000 $162.50
S ii ONO MOTION FEE t RMI D 101-000-241 -000 $20.09
GRADIN0 FRER 101.000.423w000 $20,00
I ZVtLc1PFR.1MPACT FEE $4901.00
ART IN PUBLIC PLACES - REW 701-000-255-000 $2,27,
SUB-T<YfAL CON =,UC` ION AND PLAN CMC K
$4,156,07
'L"B PRR�PAID 1M
$0.00
TOT L I'K I U1' � EE810ITE NOW
°�a� �►,0i
i
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings Af--
Ducts
Slab Grade
_
Return Air
Steel
Roof Deck .(
// arp
Combustion Air
Exhaust Fansi
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 1J�
BLOCKWALL APPROVA S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Neater Final
Water Piping
Plumbing Finale
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
_
d/
Pool Cover
Sewer Connection
_�L_
Encapsulation .
Gas Piping
Gas Test
dj p
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
U_.nderground Conduit
bugh Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
STEIN INSULATIONS INC
4211 Tatham 8trftt, RWwsi&, CaUft n,+a 92501
Tel, (904) OW -8760 Pax (909106-8786
ENSU"TION CEMLICATE
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 COLLECTION #28803-1 /PHASE 3
LOT #: 21
SITE ADDRESS: 80-752 HERMITAGE. LA QUINTA; CA
�,�jER10R ViIALLS: .
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2 " R•VALUE: R•15
EI BATTS BLOW
MANUFACTURER JOHNS MANVILLE THICKNESS: 13" R•VALUE: R-38
GENEML CONTRACTOR: STEVEN WALKER HOMES
BY:
TITLE:
DATE:
IMLAIMN CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRO 10 ANAGeR
DATE MAY 3, 2001
I
r
Certificate of Occupancy
�1City 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
Occupancy Group: R-3 Type of Construction
Owner of Building: STEVEN WALKER HOMES
Building Official
80-752 HERMITAGE
Bldg. Permit No.: 0006-322
VN Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR
Date: 7/31 /01
POST IN A CONSPICUOUS PLACE