0011-125 (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 Contractor f -r
f i -i1 T-7
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:
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 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 shall forthwith comply with(thos ,'provisions.,
Date: / t - - ApplicanX �� 1
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 prope rty-for.in spection purposes.
i J
Signature .(Owner/Agent) - �� s``•�t - Date A f/F Z -i
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Celt TRACT
11/14/.2(X C200.9MI" B Via' 28603-1
JOB SITE
ADDRESS �
APN
.--_
GE
761 -WO -078
OWNER
CONTRACTOR / DESIGNER / EN INEER
msv;; WMACER HOMES
ER W-A?M6C3w l it MES
r1,iNDLAWANV.
7161 )NDIANAMS,
RCtr'IT.,S� EI)p � k 97.504
MR -IME CIA 925(9
(909)184.0840 MIA 5357
USE OF PERMIT
SLUT012 Mk1"_Y DW2"f:1J:N0
SPC1- i;O'i' 37, PL€14 LA, PERMIT DOFZ NOT R4C'LUDE, BLriCK WAU, OR.
P004 15'A PIANCHM PER ON bit`ULTIPIX ISSUANC Z OF 1AAME Ps, AN
.Y.YPY
CU21TOM CONSTRUCTION 4379.09 SF
Porte) -til AT.10 336.00 SP'
CIARAOIUCAR;P.'ORT U,4 COD
611MAIED CGST Oil' CONSSM217CUION
� ,905.9ai
PX1W,fa's' T 91101MAURY
CONSTRtIG`I'I011 FEY., 1 O1 ^(000.41 s-DOO 8993,x'0
PLAN CHECK PEE 101'1-000.43' 41b
I49:FXfiHANICtAl.,FEE A11-0000-421.000 $92,00
P3,14C a RIC AL Ii'&B 1031 ••000-420-0010 $149,4?
., r
Pi,UMBINO FFM 101,,000-419-000
; '"�.► t . ,
5fRONCMOTION VIZZ - 112 B3 101 -000 241 -030 $y3�e0.(09
%tAW10 101-00e-423-000
I13?'V21,0 PER IMPACT FRE Sf,�B.00
v « t"
-ART IN PIMIC PW0 - k Ji (01.-000-255.000 5317
L.: \
Milt-1V1iA.110014TM(T MON Al D PLANC,FMvX
$3,548.02,
1MI S PIM -PAID Prim
$0,00
RITAI,, IAMAW YEES1) Y9 NOW
RECEIPT
DATE
BY
"
DATE- ALED
I i3 b3
INSPEC
V�,t -�,
7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
�lsl
Ducts
Slab Grade
Return Air
Steel
_ _
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
_
_ -/
F.A.U.
Compressor
Insulation
��/ I
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
d
Drywall - Int. Lath
_
Final
,
Final
SI�'Z✓la 3 1�
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 APPROVALS
Gas Test
_
Waste Lines /-g///
,Q�L �/fj�j��
Electric Final
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
_
Appliances
Final
COMMENTS:
Final
/3 �3
Utility Notice (Gas)
ELECTRICAL APPROVA S
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)
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
80-944 HERMITAGE
VN
Address
City
By
Date
POST IN A CONSPICUOUS PLACE
Bldg. Permit No.: 0011-125
Land Use Zone: RL
7161 INDIANA AVE
RIVERSIDE, CA 92253
DANIEL P. CRAWFORD JR.
5/13/03