0011-123 (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
7,�8004 E
Date,`
Signature of Contractor
�r
OWNER -BUILDER DEC'L RATION
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 3700of 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:
Carrier Policy No.
XTATE CC1MP.EN.TI T.9DWC
(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' compensation provisions of Section 3700 of the Labor
Code, I hall forthwith comply with those p "x" ions.
e
Date: .h + t Applicant -J
(+
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-fo?:,inspection purposes.
Signature (Owner/Agent)a,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT W��,�ZS_�L224 TRACT
1.1114/2M /2M $204.677.90
Zr2c5t�3� I
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INFER
STEMiJ WALM H01
91LIIVW WALK. e HO:le't09
7 MA INDIMA AVE,
7161 INDIANA AVX
RIMS= CA 92504
MVERSME CA
92504
(909)704.0840
Mft 5357
USE OF PERMIT
Ii3�£1 •. LOT 35r PPI 30,11, PF;,RMIT tX)E,S NOT 3NCf..IDE SLOM NMU,
0R I OVIL. WK, PtARCHIC1.1.' IEEE ON 14Y3,VIPLE 180,UAINCE OF SAM t�, PIAN
TYPE
CUSTOM CONSTRUCTION MAN V
POP,CWP.ATIO 245.00 SF
l�''•fa�ii1;°.lv`��t� wi'�I.613,?f�V: r '
CONSTRUCTION YEE ', 101-000-418.000 $1,007.00
PLAN CHECL P'FEF?, 101_000_4391318
MECEIAINICAL, FE 101.-000.421.000 39100
4.
,
L= TRICAL FEE 101-000420-000 $149,03
1:1AWD1?I.1C FFZ 101,000.41.3,000 $186,50
STILONO MOT11014 FEE - .R1i.SID 101-000-2411-000 UDA?
ORADINO IEEE 101, p_000_423 -.000 $20.00
I`i t { `
X7FWM,0PTR IMPACT ME,
AU .J14 PIlOI.,iC FIACESS - .RUSIE 701.+000.255.000 VIA
•, r C fS
�l
�vU.8-TrYrAT, COM1RUC:IION AND PLM (wHECK
$3,600.41
JGe:;3.3 PRE-PAMYTMI
$0100
RECEIPT
DATE
BY
DATE FIN
SPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings I
Ducts
Slab Grade f
I
Return Air
Steel
Roof Deck �0 6/ _
O.K. to Wrap �� !/�a�
Combustion Air
Exhaust Fans
F.A.U.
Framing �- /.��'
Com P ressor
_ _ _
-.5�0
Insulation 9��10�/Gi/1/�d/ ,L/�,�G�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
�- _
Final
Final J*___/�POOLS-:SPAS
BLOCKWALL AROVALS
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
_ �—
Waste Lines
Electric Final
Heater
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
Appliances.
PP \
Final
Final
Final
COMMENTS:
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) _ �j
Certificate of.Occupaficy
4
RAM
OF 9► Y p Building & Safety Department
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: 80-920 HERMITAGE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0011-123
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: BILL GORDON
Date: 03-28-02
Building Official •
POST IN A CONSPICUOUS PLACE