0006-327 (SFD)1
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions�of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) c+) License # Lic. Class Exp. Date
t` tLU Y r*_ L3
0/2C
Z r— Vate Signature of Contracto,�, `� r' pP473
O
J U C) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
O0
Q WORKER'S COMPENSATION DECLARATION
O CE I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
LO Il L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier UNITED PACIFIC D48 Policy No. pF'I�iAI191845-00
ao Z)
r C)
J (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
3 subject to the workers' compensation provi Io •• s of Sec •o`n 3700 of the Labor
/Code, I/s�A 11 fq ��t-h comply wl .those p I'sicrns.
Date: �`�1,1 7s/L.iLf APPlicant',� .���li�.-C. �.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quints, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
th 'above-mentioned property for iinnsspeecti�on'purp ,es. �'j
Sigriature (Owner/Agent)• i'1. ` moi—"- Date` �`�
`I
Ir � ) PERMIT# WILDING PERMIT
N �T--
'�
DATE 'ATION LOT TRACT
S200,908. �Fer •"' 2E6G3�i�.
JOB SIE w
ADDRESS
APN
-761-09"78
OWNER
CONTRACTOR DESK INFER
STFV, WA7M HQ6
MV -VM Y6TlC 3V 0
1161 1l91A 1aAAVL
7161 11TDIA- AAVE.
RI'4t:E41:=E CA 92504
11,W-��TDE CA 92.504
(909)784.0840 CB14 f 555�;'l
f t'•
USE OF PERMIT
2t1 QLE:FA'E4LY 13'U r<L JNC
SP'T2• LOT 26 PLAN 26R PERMIT DOES INOT INC{ ]DE 81A)C1: 11LWA1ls LIR
POOL 7S % PLAN CHECK FRIT: REDUCTCON FOR ISSUANCE OF SAME-
PLJ'i14 iYPE
CUSTOM. CONSTRUCTION zM100 SF
�
PORCHi*PATIO 236.00 SP
t' tARAWCARPORT (SIS 12,446.00
r
EVlilb3.AMM C09T OF CO.IVI`aIRt2'C;T.I014
2,00,9W.90
1 nMIT M GUA04"Y
CONSTRUCTION FEE 101000-4.1$•000 5993.00
P4AX CHECK iEE 101-000-439-318 $204.59
MECHANICAL FEE 101-000-421-.000 $93.50
ELECTR.IC.A,L. IU 101-000-420-000 $140.47
PLUMBING FEE 101-000+419.000 SI86M
S RONO MOTION ng + AESI17 101-000-241-£300 $20.09
ORAD1 40 IRE 101-000>429.000 $20,40
DEVELOPER IMPACT PLP 11,907.00
ART IN PUBLIC PLACES - .&Sit 701.000-255.000 $2,27
SUB-71WAL•. C.'CY113 .` UC;710N AND PLAN C-t•1ZT:C
$3,580.42
IMS FRF-P,ATp 1:TR3
$0.00
l
RECEIPT
DATE
BY/yi //
DATE NAL
INSPECT R
✓�
Da—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR,
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings /
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap (o /A
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 2 dj
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAL
Steel
POOLS - SPAS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test Q
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:
°
/
v G
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
80-812 HERMITAGE
VN
Bldg. Permit No.: 0006-327
Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES Address: 7161 INDIANA AVE
Building Official
City: RIVERSIDE, CA., 92504
By: DANIEL P. CRAWFORD JR.
Date: 8/9/02
POST IN A CONSPICUOUS PLACE