0011-121 (SFD)A
LICENSED CONTRACTOR DECLARATION
A 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
c14 W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
r --LO
r X " 7 Btlt 1 it j_� 1. /1.
Z Ire Date )! Signature of Contractor
U OWNER -BUILDER DECLARATION
War I hereby affirm under penalty of perjury that I am exempt from the Contractor's
rn 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 (Seca 7044, Business ,& Professionals
Code).
�
r O I am exempt under Section B&P.C. for this reason
O N Date Signature of Owner
0)d Q WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O 1 have and will maintain a certificate of consent to self -insure for workers'
X UJ �: 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 U9) I have and will maintain workers' compensation insurance, as required by
pQ S ction 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
'� Z Carrier Policy No.
(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 a, to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with t ose pro`v slions.
Date:t� t Applicant%1 iii. t �'
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 prop((erty'for inspection purposes,
Signature (Owner/Agent)/'r. J'Y �`• ^ :- Ivy Date fit',•'.! �' ^
i BUILDING PERMIT PERMIT#
TRACT
DATE VALUATION LOT TRACT
11Ifid/2%, $204A7790 4D_* 8603-1
JOB SITE
APN
ADDRESS
T _ MV F
7
OWNER
CONTRACTOR /DESIGNER / EN (NEER
'rh;V. Ws5A1a1= HOM&3
nry �, WAS HOMMI
7161 D�33y�NAAW.
7161 IN I�T.A,f�W',
RMER
(9099YM4wCt O 117MIL4 5357
USE OF PERMIT
87MML; ITAA W. Y DWKILING
S.FD u f.DT 33, PLAN 30, P&d3NIT DOE 140T INCLUDE 13WCK WALL, OR
POOL 75%N P1 AXI C,HECK "IF" ON MULTIPLE [1181JANCL" OF S.ij4ME PLAX
YPY,
CUSTOM CO14STR13'M01.4 4AMU 4P
Pci�irq 245.00 SP
p�i�yd�r�r�erAr;�sa�yp/+�T9 y p
'MLY.iW.IL�,JI}pd„'�.,���f,�bCVdF'L�39 C. e) 10,564.0
'
xsiwA=,covr or, com:r~:ixumon
.204 677M)
COAiS`I'1;'.1Dr~TION 112 101=0015-4,18.000 SLEWUP
PLAW 6..HMC. FEE 101-11W-439-318
Ohl CWl ai�Yit'Ik - 101-000.42:.1.000
ff IXIC Q'.R3 iKl. py-1?
T lA4B8Y3!!MO PRE 101 -0 00-419-000
,.
STR.0140 MOTION RISID 101,.000.24x -000 $i�BO:$"?
� ; �} �:..•;
(MADMOPRE 1,01-000-423-000
f 'jam'?I.,r0:PER ]UPAf..C7 FEE
ART N PUBLIC PLACES - R.E41G 701-000-255-000 e11.60
ix;
SUB -i'i'AL C0NS'111U'(,'ff0— ' Pa1,0 PLAN +CIMCK
$3,600,41
L1 WIL 3 PRE-PAMFR '03
$0.00
IMAL IMAM FMS DX% rD
ACIVAI
RECEIPT
DATE
By
DAT INA L
INS CTOR
�.y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
r1
`
Ducts
Retum Air
Steel
_
Combustion Air
Roof Deck�
6
Exhaust Fans
O.K. to Wrap
_
!)
F.A.U.
Framing4K��IUStIL.
(o-/� e101�
Compressor
Insulation
�/l?/Q/ I `[�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final 3
Final
7/-fp3 _
POOLS - SPAS
BLOCKWALL APPROVAP-S
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Seam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_ ///JJJ
Electric Final
Waste Lines/_
T,r L
Heater Final
Water Piping
/7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
��/�jjj E.
Pool Cover
Encapsulation
Gas Piping
-4 —0,6
Gas Test
Appliances
Final
COMMENTS:
Final
a
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)/�l�y
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'
80-896 HERMITAGE
VM
Bldg. Permit No.:
Land Use Zone
0011-121
RL
Address:
7161 INDIANA AVE
City:
RIVERSIDE, CA 92504
By:
DANIEL P. CRAWFORD JR.
Date:
4/29/03
POST IN A CONSPICUOUS PLACE