0202-286 (SFD)LICENSED CONTRACTOR DECLARATION
-1 K4 eby 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# , J Lic. Class x . Ddte,
Date �� f��Signature of Contractor N✓�, —� "'
c_Y 77 t:...r''..
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that.l`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).
( ) 1, 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
Sdbtion 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.
STATF. F014.L7 1669391.91
(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,.andJagreethat if 1,sl�quld become
subject to the workers' compensation prrovis on"f SJtioh 3700 of the Labor
Code, I sh ILforthwith comply with those provlsio s. ,�
Date: 'Z .1 i 00AI Dlicant ;�f l r'f'/ L" -r' -��---"'__
Warnind: 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 3,706
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 of
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 repre'sentativee of this City to enter upon .;
the above-mentioned property for inspection purposes:
Signature (Owner/Agent)f'tf % bate
w
- BUILDING PERMIT ,` _PERMIT#
4
DATE VALUATION LOT 0%)2.2,e_N6 TRACT
$14&146 142 26152
JOB SITE
ADDRESS
APN
47-045 WA. Ai 17=15
e"r4��.c Ql3
OWNER
CONTRACTOR/DESIGNER/EN (NEER
C -M ADAY & C;'C)WA ..1' "Y
CWWADA Y a CdOWt1k Y
T •YMM CA 92780
'l1USTW C:'A�w 92790
(% 14)508.4.440 �."e'f��.A 44€3
USE OF PERMIT
01:2F"my DWELLWG
SPD • Lat 1..42 PLAN. 16A^R.PpN.j��t}.ty�#p1IT ip3'yJk[;,FvI��1'O,'�f
(INCgiy.(a,�l'iy7}$E.11iyi�.�p3viy..K
M►AAI.o�JuYy'I'YO�✓��j C!['✓�A. 6.`rS. EJft3V GWd?.8 R2liRV��.ri�`!. PJ'YC J":.flT.A'15:dl�b� ?'6h'•4.
TRACT CONSTRUCTION 3,422.90 U3+
11b11i:1'I/PAT10 379.08 SF
i R .Ci�lCAIZ3 l�`.T 4:14.09 3?
EFIMA.I: Wsr OF (HUNS R'1:1'C.110N
145,146.40
C'•O1Q11rRUCT10N ."E 101-000 416-t)00
PL" CHECK FEE 101-O(if -439.318 $163.98
MECk3ANIC.AI. FRE 101-0W421-000 •000 196,50
;'3L C` RIC..ALk-12., 101-000-420-0W t342.0i
PLUMDING M 101,-000-419-000 5123.714
1^1tONC,f MOTION FER .RZtb„ , '101 X00-24149)0 $14.31
ORAD IT O P ft 101.000.47,3.000 s2fl oo
am4m , C°C►1+1'XXX3U=�•�"1:QW AN�r'?�y1�e'{��'�1f.��!Jr3('�01JU,{t1.���(C',
$3,274.19
y (¢�7 y�
��'
@B`"A_� kJ! 4 5 r��Y�'y� �pj fryer �} y y�•y� yip �;y�
y
�y�} }
2002
MYORAQU
RECEIPT
DATE
BY
DAT FINALED.
IN
IL
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z&11 -?--
Underground Ducts 17
Forms & Footings
Lj
Ducts
Slab Grade
— Z
Return Air
Steel
-
Combustion Air
Roof Deck
6 - -dZ
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
7-2 -v Z
Final
Final
BLOCKWALL 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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
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
l -1 • o L 57
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring Z
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) _Z11_6 z
COMMENTS:
s
NrCertificate,of Occupancy
Citypf La Quin ta
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: 47-045 VIA ANTIBES
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-25.6
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY & COMPANY Address: 17480 E. 17t' STREET #106
City: TUSTIN, CA- 92780
By: STEVE TRAXEL
Date: 11-20-2002
Building Official
POST IN A CONSPICUOUS PLACE