Loading...
0203-049 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty ofperjury that 1 -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- - . Ez . Date/ a3I k� z �f Date > f OSig ature of Contractor,`" f`�' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that J m 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 "f1�TT' ;1 Policy No. 166. 91.01 (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 thatiif I should become subject to the workers' compensationrprovlslou�s�of�Se_ rt.760) of the Labor Warning: Failure to secure Worker's' 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 anal' 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 i 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 subje�- permit to cancellation - 1 certify that I have read this application and statelthat the above information is v Correct. I agree to comply with all City,: and Statezlaws relating to the building construction, and hereby authorize'rap�resentatives of this City to enter upon the above-mentioned property for inspection purposes Mr..! � Signature (Owner/Agent), XZ' Y' ' -"'^ Date c.s -/4 J ✓t9 -BUILDINGyPERMIT PERMT" DATE VALUATION LOT .TRACT JOB SITE• ADDRESS 47 070 IA ANTLOVES APN 'a OWNER CONTRACTOR / DESIGNER / ENGINEER CA39ADKY &I COMPXNY CANADM & COWANY 17460 L:, 0100 174'&© 3s, 11MI. ter. ;f$106 MOM CA '. 92760 TiMM 01-A 927,20 (71-01)500-4440 COIR 4485 USE OF PERMIT SM -1:( t 197 PLAN 1015. f?IMMIT 001VS NOT T#dr:'IXIDE BUXX WALL% FIOOL, 30A.6}•. DR.lWWAY AYIPRO'AC11 . PORCI'i!R ATIO J JO+Vti SF 0ARAORICARPM 439,00 2F J:.�iI��HM.R�JED Ieku�dYS OF C'�.a�i'LY�J�.f:S.sj Ei.H�.7.M/d�L 1,'4.%146.4,0 1y +p, l�,�+� y; 'p' CI 810-ANAWW CONSTRUCTION TION }?I., 1101.000-418.000 $300.44 PIAN C;1d.ECK "M 4165.98 MECHNR9L".Fil.ME 101.000-42'1x,000 940.3'10 F.LW,T ICAL III&M. 101-.000-420-M) $142,05 .,--.• PLUMTHO Felt 1 O1 -f.'*0-41 MD0 $1 21,51W ST Ri' NO NIOTION PRE - AMSID 101-000-241.000 $14.51 OR.A,HJM 1¢I?E? 101 m000-42:7.000 4X00 - i?I."4r.n.. X)P9Yi' IMPACT ME f�1,407.0i1 J U i � (11� 'rta, rx ►w, ri- r, y'i7 -Now & 14,20 CITY OF LA QUINTA FINANCE DEPT: rRECEIPT (D)ATE q BY /J) DATE F NALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs = o Underground Ducts Forms & Footings _ -v Ducts Slab Grade Return Air Steel - - Combustion Air Roof Deck Exhaust Fans O. K. to Wrap F.A.U. Framing Compressor Insulation 6 -( _ a i $ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath a • vi 7 Drywall - Int. Lath - ( -O Z Final Final o BLOCKWAL A PROVALS POOLS - SPAS 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 Electric Final Waste Lines -0 2 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection v�. / 8 •O Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels IzExterior Receptacles G.F.I. 'Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: f(Certifica tel of Occupancy ,� City of La Quinta � Building and Safety Department.- TM 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: 47-070 VIA ANTIBES Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-049 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL. Owner of Building: CANADAY & COMPANY Address: 17480 E. 17" STREET #106 City: TUSTIN, CA 92780 By: STEVE TRAXEL Date: 02-28-2003 Building Official POST IN A CONSPICUOUS PLACE I