0011-119 (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
Date Signature of Contractorg
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:
Comer Policy No.
STAT), Cd r t i?.ti MWi. ',!`BD'S 'C
(This section need not be completed it 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' com ensation`pi'ovisions of Section 3700 of the Labor
Code, I shall forthwith comply with tfio a prows of ns.
Date: rI:/t fin."; Applicant �! 11". t. ✓'��i -
Warning: Failure to secure Work6rs' Comp nsation 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 p•ovided 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, indemnity
& 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 propertylor inspect on purposes
Signature (Owner/Agent)Datea iP / ( I n j
/ * A ✓ •
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �rMl9 TRACT
I ttWOW, !0.04,677,M 4_ '� iGFifi2u
JOB SITE
APN
ADDRESS
761-Q9&4)78
OWNER
CONTRACTOR/DESIGNER/EN (NEER
'7161 ]MIANR,,A' R
.7161 INDTANAAVE,
CA 92504-
P"MR:.W. CA 92504
(909)784.11840 C7;LI# 5357
USE OF PERMIT
i
SPI) - IAW 3.1, PL013A, PZ FCMIT 0080 NOT INCI..9, DE BLOCK IVAl,L OR
POOL
CWTOM fw0N+i7`RT;C'TION, ;44930.00 ZIP
l` �Cw"+RC"H(PA7i IO 243.00 SH
63A.RAC1.'MARPOWI (81) €OX4.40
h'rAPI.+f ilLA TED CONr OF '6..010Ul[ U40"MO
2'8 4,6/ d .q0
6:ONSTRU..'TION VEX 101.000.416=000 s1,U11"ln
x � "T
PL-k*F CHECK ",E 101-0063.439.31£4
-
r,r 4
FEC RICAL Pff-. 101--000420.000 1Q89.it3
Ft,'UMBIINO FEE 1€31-000-419-000 S186150
!Y!
a 11C"l+IG MOTION PsE - REWD 101 -OW-24 1 -000 $7.0.47
Oit!^A5.3ING P:E 101-000-421-000 $20.10
:� _•
b3T'•�d'£!k 4 Eft °a{41SP�6:x' FEE
ART IN PURMC PL&CES- REfA . 01.000.255-000 $11.69
ffi-"f'OTALCCCIMS`hR%ICITOMANDT.?l CWCK4s
f�.`4Q4
L&'5'3 PR.i? PAIDTIM
$01063
RECEIPT
DATE
BY
DATE FAL
.5rD3
INSPE R
r t , o r?
f t V
INSPECTION RECORD
.k,
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
s D
5
Exhaust Fans
O.K. to WrapX
to dl
_
F.A.U.
Framing
Compressor
Insulation
(p tS�p�
_
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
; M_f7_�jQlL
_
Final
(_5113
FinallS�a3
POOLS - SPAS
BLOCKWALL APPROVAL
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
v/
��j
Encapsulation
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
I
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
Owner of Building: STEVEN WALKER HOMES
Building Official
80-872 HERMITAGE
VN
Bldg. Permit No.: 0011-119
Land Use Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA 92504
By: DANIEL P. CRAWFORD JR.
Date: 5/15/03
POST IN A CONSPICUOUS PLACE