0006-331 (SFD)► LICENSED CONTRACTOR DECLARATION
"f.• r � 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 =) chLicense # Lic. Class % Exp.. Date
w� �!S 04 kS�5 t f30/2C
oZ r- Date �1' '' Signature of Contractor -
0.
ontractor Q r
U CD, OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Cn License Law for the following reason:
Z ( ) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
cr) () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
ON
0)
CL
z
WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X Lu ! = compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O ULO Q Section 3700 of the Labor Code, for the performance of the work for which this
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier UNITED PACIRC INS Policy No. NWA I191N11-00
w �
r` Q
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
subject to the workers' compensat'on,provisions of Se Ion 3700 of the Labor
ode, Vshal!tf¢, hywy'th comply wi�thosetprevisions.
Date:l'� 5l CJ
Applicant -71
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 property fovihspection purposes.
'I/Signature (Own . -
r� �I?s/ro
er/A ent)
�d PERMIT#
DATE - VALUATION LOTTRACT
$204A77.90 49v, 28603.1 ,w
JOB SITE �y
ADDRESSil �E
APN
761,0 90-078
OWNER
CONTRACTOR / DESIGNER / EN INEER
VIEVER WALKER HOS','t
M41YVAL TER HO'kaS
'7161 L4D1AN.AAVP
71+ 1 2M71 NAAVE.,
CA 92504
RLO11w:CDE C.P. 9_2504'
(909)784-0640 CBL# 3357
+ #
USE OF PERMIT
SPD• LOT VRL.AN 38 P,ERIAIT DONS NOT INCL.U1)Ir RLOCIC WAI..LS O'R.
1'006 ?s %P"Puelm 01JECK FR REDIJCTION FOR ISSUA1+WCl� OF ;N;%
PLAN TYPE
CPTO C;oNS' RUCTION 2,450,00 3F
•" ,
P RC3ill'A.TIO ) 245-00.0,F
OA :AOIICARI 9RT (311 106564.40
FOrMATF—D (COSI' OF CONSTRU(;"i'ION
204,677.90 '
CONSTRUVRON FEE 101.OW-4111.000 $1,007.00
PLAN CHECK IEE 101-000439-318 $206.72
i�9'1�:IPAANICAL. FEB 101-000-421"000 $92,09
F,L}ECTr2IML, FRE 101-000-420.0200 $149.03
PL.I MABING FEE 101.000.419-000 MOM
S'SRONO MOT ION PEP, • RESID 101-000-241-000 $20.47
C1}1.ADINO t fE 101.0010.423-000 OMNI
DERVEWPiPR IMAAC"f PIS $!,907.00
ART 01 PUBLIC PLACES - RE9IL 701.000-255-000 511,69
STMt7'1AL CC?=RiU'C3`ION AM) PLAN CTMGK
$3,600.41
MIS PRE, -PAID PMS
$0.00
RECEIPT
DATE
By(/1
1 DATE FINALED
INSPECTOR
4
11-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings
p j IDS
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
f, p/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
v/le
Drywall - Int. Lath
Final
Final !
BLOCKWALL APPROV S
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
PLUMBI G 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
d_
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) U
COMMENTS:
• MAY -03-2001 10:34 WESTERN INSULATION
909 686 5796 P.11i14
,r
WESTERN I11 SU LA i F�ION 9 INC.
4211 1-41hom SUCc% RlvgmkIp, CaUfbir" 92601
TaL (909) 686.8760 Fex (909) 666187W
INSILILATIgN CERTIFICATE
Y • I
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 #26603-1 /PHASE 3
LOT #; 30
SITE ADDRESS: 80-860 HERMITAGE. LA QUINTA, CA
MANUFACTURER: JOHNS MANVILLE
CIIuNGS:
MANUFACTURER
CEIL1143;
MANUFACTURER
BATTS
GREENSTONE
TT6
JOHNS MANVILLE
THICKNESS: 3 1/2 " R -VALUE: R-15
LOW
THICKNESS: 10.3 " R -VALUE: R-38
BLOW
THICKNESS: 13" R -VALUE: R-38
GEIl9EIAL CONTRACTOR: STEVEN WALKER HOMES
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: -WESTERN INSULATION, INC.
LICENSE NUMBER: 481278.
BY: J
TITLE: PRO TION ANAGER
DATE MAY 3, 2001
Certificate of Occupancy
City of La Quinta
Bu, ilding 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: 80-860 HERMITAGE
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No::
0006-331
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
RL
Owner of Building: STEVEN WALKER HOMES
-r,,, 1-k
Building Official
Address: 7161 INDIANA AVE
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 8/21 /01 '
POST IN A CONSPICUOUS PLACE