0006-323 (SFD)r 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
M B f 04d0411,0/2(/Date/0iZ1141(_),. 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:
Carrier UNITED FACiFic w Policy No. NSWAI191845-00
(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
s7bject to the workers' compensation proV;ions of Section 3700 of the Labor
Code�I'shall,fo/rthw'th comply wit !those provisions.
sions,.
Date: 2 K ,. ./ Applicant Jr
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
Vsignature
he above-mentioned propeery for:ln ction purposes. )
(Owner/Agent)! Dat
' ,5 " O"BUILDING PERMIT PERMIT#
IMKP,3�
Mty,
DAT VALUATION LOT 1'"" TRACT
OW 2001M.9U low. 28603-1
JOB ITE
ADD ESS ALeE
APN
761..OW078
OWNER
CONTRACTOR /DESIGNER / EN (NEER
S'TEVEN WAT. CUR HONVES
VEVEX WAMM H01
7161 INDMA ALTs.
7161 INDIANA Atm.
A.IVls.2�4W CA 92501
i2IMSIDE CA 92$04
(909)78440840 CBLH 53$7
r'
USE OF PERMIT
SWGI.Y I+'A1Kt1I Y I)WTURN
SPD- LOT 22 PLAN 2A PERMIT DOES NOT INCLUDE BLOCK ,WALLS OR
POOL
• 1 r .-
CUSTOM CONSTRUCTION %M100 SF
PORCWPA,TIO 236.60 SF
GARAWCARPORT ($F) 12,446.00
�J
E917M4'C'.+D COS' OF COiVGMUCIT.ON
200190&90
PkIMr I°g,°1i1: 9UMMARY
CONSTRUCTION FEE 10 -000.418.000 $993.00
P''LAN CHECK REE 101-000-439-318 $$18.36
MECHANICAL PEE 101.000.421-000 $98.50
ELECTRICAL FEET. $148.47
PLUMBING FEE 101.000-419.000 $186.30
STRONO MOTION F"M - RESID 101-000-241-000 $20.09
ORADINO "M 101-M-423-000 $20,00
DFVZLOPER IMPACT FZE $1,9117.00
ART IN PUBLIC PLACES - It, Ir 701-000-255-000 $1.27
RM -TOTAL COkiSTRUMON AND PLAN CHECK
$4,194.19
I,USS PRE -PAID F1f,9
TD.00
MIAL P!' 4'Iit"I' 1IMS _UAW HOW
$4,194,19
RECEIPT
DATE
BY�/,1
DATE FINALED
INSPECTOR
!l."�
01
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS .:
MECHANICAL APPROVALS
Set Backs
4 4 4
Underground Ducts
F
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
p
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
_
POOLS - SPAS
BLOC KWALL
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
Ci
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final .
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Bough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
MAY -03-2001 1026 WESTERN INSULATION 909 686 8786 P.03i14
r
WEST TERN INSITLATION, INC.
4211 Latham Sheet, RivemIde, Qaliibrnis 02601
Tel. (409) 686-W60 Fox (909).686-8786
WSPLATION CERTIFICATE
THIS IS TO CERTIFY TWAT 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 #28603-1 /PHASE 3
LOT #: 22
SITE ADDRESS: $0-764 HERMITAGE. LA QUINTA, CA
EXTERIOR -WALLS:
- - • - - - - - -
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2 " R -VALUE: R-16
CEIL11a1�S: BATTS BLOW
r MANUFACTURER JOHNS MANVILLE THICKNESS: 130 R -VALUE: R-38
GENERAL CONT AQT®R: STEVEN WALKER HOMES
BY:
TITLE:
DATE:
1UNLA110NV C A IRAC1OR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PR CTIO ANAGER
DATE MAY 3, 2001
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
Occupancy Group: R-3 Type of Construction:
80-764 HERMITAGE
Owner of Building: STEVEN WALKER HOMES
Building Official
VN
Bldg. Permit No.: 0006-323
Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: GARY HARTMAN
Date: 10/22/01
POST IN A CONSPICUOUS PLACE