0006-325 (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 # Lic. Class Exp. Date
4 0� B 0t2[
Date �'�t Signature of Contractors(' ,
F
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ) 1, 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:
CarrierPolicy Noy
UNITw PACIFIC INS
(This section need not be completed if the permit.,v uation 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_ I should become
iibject to the orkers' compensation provisions, of Sect' n 3700 of the Labor
/Date:
ode, I/'sf�all,lo h ith comply with those po�si6 stC�/L i5�� 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
the above-mentioned propert for iri lection puyposes. ��
,Signature (Owner/Agent) Date
Lf, A ' ��, UILDING PERMIT PERMIT#
DAT VALUATION LOT TRACT
=h
00,90890 28603.1JOB
QTE
ADDRESS �.�SSLL n '~
APN 761-090-07
OWNER
CONTRACTOR / DESIGNER / EN &NEER
3TEV'1,N wiglm HOMO
S77V 'N WJI11LiCI~'1!Z H®A
7161 :I1 DL41NAAd"Vl•:.
1161 INDLANAAVF,-
RIVERME CA 92504
RIVUSIDR, CA 92504
(9091784.0640 CBT;1'�' 5357
s
USE OFIPERMIT
� /�� { T1�gy� T y 7�T
tEI 012, li!A .eV. Y .3.+� W F.L.L4dV G7
SIFt?- LOT A PI—AN X PERMIT DOES NOT JINC:LUDE BLOCK OR
POOL. 75 r6 PLAN CHECK FU REDUt`.?' (ON FOR ISSUANCE OF SAME °yes
FLAN TYPE 1 f
t T,.
CUSTOM CONSTRUCTION 2,379.00 SF
CJ
PURCHJPA,TIO 335.00 SY
06iitf GEICARPORT 12,446.00
i
E "m con or coNArmon
200, .90
1' ffr Fn SITMMA Y
CONSTRUCTION FEE 101.000.418.000 $993.00
PLAN CHECK FEE 101-000-+139-318 $202.69
MECHANICAL FEE 101.000.421.000 893.(m
&RCTRIC1AL M99 101-000-420-000 0148.41
PlIUMDINO FEF 101-400.419.000 8162.$0
STRONG MOTION FEE - MID 101-000-241-000 $30.09
OR.ADINO F99 101.000-423.000 $20.00
DLVELOPERIMPACT FEE
AWr 114 PUBLIC PLA,QES - lt&ST 701 000.255=-000 $2.27
311E TOTAL. CON.T'RtllC"11014 fi ]PLAN t:'k11!:C K
$3,548.02
L1ri.35 PR>y-PATD FMS
$0.00
1..19TAL PXWff'1 S VUE NOW
�I
RECEIPT
DATE
BY (
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4
Underground Ducts
Forms & Footings X
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
l A4/
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 j z
BLOCKWALL A PROV S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
I
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
p/10
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
d D/
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:
low",
MAY -03-2001 1027 WESTERN INSULATION 909 686 8786 P.05i14
Wr EST]ERN INSULATION 9 INC.
42111aCham St=et, RIV=idc, California 92501
Tei. (900) 686-8760 Fax Wq) 886.8786
INSUL&TIO li CMTIFICATF
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 #: 24
SITE ADDRESS: 80-788 HERMITAGE. LA QUINTA, CA
EXTERIOR WELLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 112 " R -VALUE: R-15
CEILINGS: B,gTTg BLOW
MANUFACTURER JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
(iENIERAL CONTRACT- 'STEVEN WALKER HOMES
BY.
TITLE:
DATE:
INSULATI=ON QQNT_ ACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRO ,010N M)AAGER
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
ollowing.
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: STEVEN WALKER HOMES
Tom-.
Building Official
80-788 HERMITAGE
Bldg. Permit No.: 0006-325
Land Use Zone: RL
Address: 7161 INDIANA AVE.
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 10/8/01
POST IN A CONSPICUOUS PLACE