0011-120 (SFD)T LICENSED CONTRACTOR DECLARATION
(n I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
C) License #, Lic. Class Exp. Date
d LID f
ZO
r-- Date �, ��� Signature of Contracto'
J U OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
Q N
C7
d Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of'perjury one of the following declarations:
Lo H Q () 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
mJ Q performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
Q L Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
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' compensati6R provi'sions of Sec 1, n'3700 of the Labor
Code, I Shall fgQrthwith comply with thosegrpro4ions�
Date: •B /17! Inn, Applicantas!
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
R* 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 property for inspection purposes.
Signature (Owner/Agent /fi��' �:.�r Date'��'jf�t�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
'I 1114=: t2MA".90 4102 7R601-11
JOB SITE
APN
ADDRESS
,ma� TAGR
OWNER
CONTRACTOR / DESIGNER / EN (NEER
16 1 INDWRA A
'7161 INDI WA E,
RNLTIS'1 E CA 92504
MVERSIDE, CA 92504
(909)M-0340 C -BL k :iM
USE OF PERMIT
AA3CS1 , FANDLY DWW_S.WQ
_FFD" . W14 32, PLAW 21AJJ PL,R1,,A1T DOES NOT .INC LUI.DY HLCOCK WALL
OR POOL,
CUSTOM c 1yL?TRUCTION %M,00 OF
Pt3PMRATIO 236.06 SR
QAIRAWCA,i'.PORT (Si) R,44(00
EgluftT COST' Gre C ONSTRTiMON
0
20%9W90
G`•fJIIMPRUt+ 111014 FEE "A 01.000-419-000 5.093s6
,
;;AX,AN C'HPICK ME 101-000-439-318 $918.36
N. ECHANICALF17 101.000421.000 999,50
r,LUC IUCA . $148.47
PLUMBT1140ISP, 101.000.419-0300 Sl86,SO
a
STROM')MOTION M - JUSID 101.000-7.43.-000 $X W
•�•' r; r'' ;
KiS F�%,10Zit 301-000.423-000
X,�L°�1'F�P�P TAlLL?,�C"I"f 3;1,5tDr%f!U
:.« f`»•�; R..
t
AAT 11'rPUBL1C PLACED - RES11: 701-000.255.000 42,27
t r
rs
a'i:hB•'k`t':%CAL CON £1 RITCY10 +l AND MAN C IMCK
$4,194..19
3:US JUKE^PAM IMMS.,
$0100
TOML 1F'FMfF FUS ;If.=. NOW
$4,194.19
-6—
RECEIPT
DATEBY
fi
DATE FINALED
8•a3
INSPECTOR
ttI16
:l
ri v
INSPECTION RECORD
4 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings _ Ducts
Slab Grade�V1. 4 Return Air
Steel _ Combustion Air
Roof Deck �/ 5� Exhaust Fans
O.K. to Wrap _ _i 6/ F.A.U.
Framing ��� �/ _ Compressor
Insulation �.p��A� �,/5�q Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls a'
Party Wall Insulation Condensate Lines
Party Wall Firewall _
Exterior Lath
Drywall - Int. Lath
Final
Final 3 s7 POOLS - SPAS
BLOCKWALL APPROVALS Steel
Set Backs Electric Bond
Footings. Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final Gas Piping
PLUMBING APPROVAL Gas Test
Electric Final
Waste Lines /3i�� 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 %0 b�
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
1 Temp. Use of Power
i
Final
Utility Notice (Perm)
I.
08'/07/2003 07:43 9096868786 WESTERN INSULATION PAGE 02/03
WES'T'ERN INSULATION, L.P.
4211 Latham Street, Riversidc, Califomia 92501
Tel. (909) 686-8760 Fax (909) 686-8786
CFGR INSULA'T'ION CERTIFICATE
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: HERMITAGE / PHASE 4
LOT #: (32
SITE ADDRESS: r80-884 HERMITAGE; LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
BATTS
MANUFACTURER: KNAUF
THICKNESS: 3 112"
R- VALUE: R-15
CEILINGS:
BLOWN INSULATION
MANUFACTURER: GREENFIBER
THICKNESS: 10.3"
R- VALUE: R-38
CEILINGS (PLAN 2 ONLY):
BATTS
MANUFACTURER: JOHNS MANVILLE
THICKNESS: 13"
R- VALUE: R-38
CEILINGS:
BLOWN INSULATION
MANUFACTURER: GREENFISER
THICKNESS: 5.11'
R- VALUE: R-19
CEILINGS:
BATTS
MANUFACTURER: JOHNS MANVILLE
THICKNESS: .6 3/4"
R- VALUE: R-19
GENERAL CONTRACTOR: STEVEN WALKER
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN
INSULATION, L.P.
LICENSE NUMB R: 794484
BY.
TITLE: PRO CTION MANAGER
DATE: AUGUST 7, 2003
.r. .•.�► ;i'=.pc-c Lar; .'K'��s:al�-� a!• .',e e::�Ax;�r
•sw .... .i w ♦:e .Iia -. 41
. M.IO'iW War .sl•n,�a ,. /�i!: ,I%4
• a.� ,.rr u,., .wc. �vw r � II•t iY.�-y.Gei•`.
ry
Certificate of OccupancY
I..mcoarm G
G�
OF Building Y p & Safety De' artment
This Certificate is issued pursuant to the ,requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 80-884 HERMITAGE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0011-120
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STEVEN WALKER HOMES Address: 7161 INDIANA AVE
City, ST, ZIP: RIVERSIDE, CA"92504
By: STEVE TRAXEL
Date: 08-08-03
Building Official
POST IN A CONSPICUOUS PLACE MMLLMU