0011-126 (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 it �• � ?�!�` Signature of Contractor._ -
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 r Signature of Owner
r
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.
(r� I have and will maintain workers' compensation insurance, as required by
Section 3700 oftthe Labor Code, for the performance of the work for which this
permit is issued."My workers' compensation insurance carrier &.policy no. are:
Carrier E Policy No.
VATS COMPKROAT) TRW C.
(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 Se'ction 3700 of the Labor
Code, I shall f rthwith comply with' those pl ovisions.
Date: P1 f?a*�/ir� Applicant
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 autFioriie representati es of this City to enter upon
the above-mentioned properrty for inspection pur�oses.
I
f / 4.,
•Signature.(Owner/Agent),. ii,, %" `� ._ Date.f
tw .
BUILDING PERMIT PERMIT# ,
DATE VALUATION LOT $;' TRACT
'11/14n(X $204.677.90 A01041��ut13.1
JOB SITE
ADDRESS
XW-9 6-1EUM .3HAC-E
OWNER
CONTRACTOR / DESIGNER / EN INEER
8 W, T W.Ai..KM HCuaI1
S L VE1114WALKER HOMES
7161 INDW '.AAVF-
7161 iNDL414AAV
VERIWE CA 92504
R1
RrVRR1MDH1 CA 92304
(909)784.0840 G:S7,14. 53Y I
USE OF PERMIT
SPT) o L C11 _�?, PLAN 311;1, PZRMI b' DOES 7<3C: T TRC)..0 . Z I1L4V_-r 'WALL
OR POOL, 73% i L&MCHWK M. ON MULTIPLE ISSU&4CL O RAMS PLAN
TYPE
CUSTOM :'ONSnRUCTION 2,450.00 OF
QU'R.C,kii�'PATIO 245,0,5F
GARA.GEMARPORT (3P) lk$64,40
Eflac.A,Px'd T ..li'W1✓Ayr OF C0.N9RAA.6t'Cn0_
.eL04pQ�l1-?."
CONSTRUCTION 101.000.418-000 E1p'Y b
PLAN i~H30I; FEE 10't-000-439-318
MECHANIC -Al, "M 101-000-', 21j. -000
EI.ff t RiCA1, FRE 101-060-420-000 a�i4�T.113
� : ' •' +,_
Ph,CImDow nx 101 -W-419-000 $18649
ST Xf, 140 V.OTION P'a'rt a 1203 D 101 -00-241-000
GRADING- FRE .101-000-423-000 rJA00
,WPFA IMPACT PEZ $1,907.00
. f I-,,
ART Y9 PUBI.,1C PLACES •- RFMC 7031;,000.25'-000 $11.09
�w
•:" "��
tar3
8TJB '.AYrAL CO. Ng RUK'.°i1:C?1`IAND PLAN C1:11L,CK
$3,600,41
LF.W PRE -PAW 1E10.
$0.00
RECEIPT
DATE ff
�L
BY
�Y
DATE FINALED
INSPECTOR
flYl
R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_/ _
3�s1 �f
Ducts
Return Air
Steel _
Roof Deck S�/rd(
O.K. to Wrap_
�/2s�o�
Framing _ _ �O_2 61
Insulation �f�6/b/�Gi7� �D.(
Fireplace P.L.
!Gr',d,�
��
/G/,Q/L
Combustion Air
Exhaust Fans
F.A.U.
Compressor
vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
_
Final✓
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P1bg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Waste Lines �,�/�%�Ar �(i/��
Gas Test
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
Gas Piping
Gas Test6�/j�
��(� ��
_
Encapsulation
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) �_ l
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
80-956 HERMITAGE
Bldg. Permit No.: 0011-126
VN Land Use.Zone: RL
Address: 7161 INDIANA AVE
City: RIVERSIDE, CA., 92504
By: BILL GORDON
Date: 4/25/02
POST IN A CONSPICUOUS PLACE