0006-324 (SFD)D
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
r ' f � t r
Signatu e o Co ac o 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 TNS Policy No. NWA1191345-00
(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.provRions of Section 3700 of the Labor
C,r�de, I all fpAhwith comply with,fhose prioRO ate:.7 1Applicant /—!JC"�•\.._.
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
thel�above-mentioned property fofspection plufposes. f
,Signature (Owner/Agend/ / of Date %/Wo
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$204,677,8€1 . 28603.1
�
JOB SITE
APN
ADDRESS
'76.1-09"78•t
OWNER
CONTRACTOR/DESIGNER/EN INEER
STS,VM"WALKER HOMM
8T ?W WAT.M H0
7161 I2 DLWAAM,
7161 J_ND31MhAVF_
RIVER&DE Cts 925&1
RIVERSME CA 92504
(909)784-0840 CBLft 5357
USE OF PERMIT
HINGIL FAN11:LY DMLIMa
-= w1
SMLOT 2:9 PLeAN spilt PEMIT rim NOT INCLUDE, BLOCK WALLS OR
POOLS
CUSTOM CONSTR.UCTIaN 1x450.00 S
PORCHIPAT10 74-+.00 SY
0A.R.AOEICARPORT (SF) 10,964,40
RST.iiltpA77D COST OF C:ONaDIUC170 i
204,677.9ii
1kyRRMIT FILE i MAURY
CUNSTRUMON TFT? 101.000-418.000 111007.00 "
PLAN CHWK 1"Let 101-000-439-318 $926.09 "
MECHANICAL 101-000421.000 $9100
ELECTRICAL FEE 101-000-420-000 $149.03
PLUMB INO FEE 101.000.419.000 $186.50
S7' RONO MOTION FEE - "NSID 101-000-2 41-000 $20.47
GRA171140 Hal, 101.000.423.000 $206 00
DEVELOPER IMPACT FEZ $1,90.00
ART IN PUBLIC PLACES - R1 SFE 701-000.253=000
BUD 4MAL CON 91"1411'C'I9:C' N AINM PLAN CWCK w
$4,220.58
LESS PI&PAID.e9
$0.00
' r0TA.% 1P �.. I' 'S DUE NOW
S 4,2a0M
RECEIPT
DATE
BAY l j ,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _,L,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
d
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insula
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Zj0!
Drywall - Int. Lath
/ 6
Final
Final _
BLOCKWALL APPROVAL '
POOLS - 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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
!S O!01
Encapsulation
Gas Piping
Gas Test
3 fp p
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
Final
Utility Notice (Perm)
COMMENTS:
MAY -03-2001 1027 WESTERN INSULATION 909 686 8786 P.04/14
WESTER -M INSi LATION9 INC.
4211 Latham 9troot, Riversido, Callfwda 99501
TPA. (909) 886-8760 Fax (909) 686.8786
INSULATION QMT
RICATE
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 #28603.1 /PHASE 3
LOT #: 23
SITE ADDRESS: 80-766 HERMITAGE. LA QUINTA, CA
...... . ..... . . . . . ... .
ElCTFR10R waLL6;
MANUFACTURER: JOHNS 41A/WILLE THICKNESS: 3 1/2 " R -VALUE: 8-15
EILIa s:
MANUFACTURER
CEILI _ &:
MANUFACTURER
BATTS
GREENSTONE
8A'I"T
JOHNS MANVILLE
CEF
THICKNESS: 10.3 "
SLOW
THICKNESS: 13"
GENgR L CO TRACTOR: STEVEN WALKER HOMES
BY:
TITLE:
DATE:
1 ULATI®N CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: p
TITLE: PRCTION TANAGER
DATE MAY 3, 20
8 -VALUE: R-38
R -VALUE: R-38
r�
L
Certificate of Occupancy
City of La Quintal
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
80-766 HERMITAGE
R-3 Type of Construction: " VN
Owner of Building: STEVEN WALKER HOMES
Building Official
Bldg. Permit No.: 0006-324
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