0202-260 (SFD)LICENSED CONTRACTOR DECLARATION
I -hereby affirm under penalty of perjury 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 }� Exp. Date A/
Date - .% / 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).
( ) 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
1'
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.
ctiI have and will maintain workers' compensation insurance, as required by
on 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.
OTATR? FUND 1661.391-01
(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 that,if J�should become
subject to the workers' compensation provlslo`nw, Section /3700 of the Labor
Code, I shall forthwith comply with thos4rois 6.PS-
Date: Applicant ll
='� �'`ff�f''t✓ — �"'��.
Warning: Failu/re to secure WorkersyCompensation coverage is unlawful and
shall subject an employer to criminalpenalties 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 abeve information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize,represent�tives,of�this it to enter upon -
the above-mentioned property for ifnspectlon purposes+..,' t
Signature (Owner/Agent) : �'' % �'�/� `•� Date�� 1 r/f✓jc
BUILDING PERMIT PERMIT# _
DATE f VALUATION LOT TRACT
7 112
JOB SITE v /
APN
ADDRESS '
47-12.5 VIA AN MMM
-1 �a
OWNER
CONTRACTOR/DESIGNER/EN INEE�R
trAH,40AY & COWAM
W
4.J'N.GC'J.lAY t�t,:� OW41.1 f
17480 X 17M n, '0106
174811 �., 1 TW UY '4106
°L'i3 t CA 9VISO
i7.1'MV CA 92190+
C 141j508-4-440 0,BLO 4405
USE OF PERMIT
SPD - U Y7 .146 PL,04 10BR, pB[' UIT D02S NOT II3C1,UI'Z BI.CTC
WALLA P0014 SPA OR. ,til"IWWAYA#'PR,K2.t CH, 't5% 'fAX Cki'F.i X FEE
RE Ut NON 1D'U.1, `1'O MIXTIPLE ISSUANCE Ole SMZ I LkH TYPE
TRACT 0°CildS'L`RUC;'1'ION 2,02.00 Sh
POl2CI^aIPATIO 31101,00 SY
EARA s CARPORT 430.00 8F
;t?:am.'.i' o t`,ng1: OF co;£Ysmui,`'1.'kov
14-%146AO
CO-NOTIt.UCTION Fat 101 LL 41 8 -WO !800.50
PLAN CHECK Fi;9 101-000 -439-318 $16:5,0$
til? 11E'a.3<tt Ai, is 101.000.41.000 $98.50
LI*tr;' `YCE3I, ;t, 101.000-420-000 $142.01
�I r.I$?fil3i�t�`s i'Ph" 101 -OW -419-000
TPPONUI MOT1011 FEEa RESI13 101-000-241-000 �1Q,3I
ORAWN01f E 101.00423-000 SAO
DEVELsCSk'Eli. llAPAC T ITUP.. $I,c,07.00
TA +1�,��t,�p7� •�r� yq p�,yt�, T ..1 vt t ,+aTy
•SJt�1.�drti.�.9�,.y.kl�J.t:t .'�16RD PLAN {,..[�61,.ini...
$3,274.25) r1 y
.3 yr't,'r �fi, a{e�1
MAR 2 9 2002.
k74c2,i��9
MYOFLAQUINTA
RECEIPT'
DATE j
Z
BYE / DATE FINALED
A0
INSPECTOR
C..
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Y —/2—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
3v
Combustion Air
Roof Deck
G _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—oZ
Compressor
Insulation
g
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall -Int. Lath
Final
_
/? o
Final
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
Electric Final
Waste Lin
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
���� 2 7
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 1 Z _ cn>
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles ^
G.F.I.
Smoke Detectors
Temp. Use of Power
Final O
Utility Notice (Perm) _ O
. Ce
rtif►cate
of Occupancy.T
City bf-La Quanta
Suilding and Safety Department. OF', _
This Certificate issued pursuant to the requirements of Section 109, of the Uniform Bui/ding 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
ol%wing:BUILDING ADDRESS: s 47-125 VIA ANTIBES
Use Classification: SINGLE FAMILY DWELLING Bldg: Permit No.:' 0202-260
Occupancy Group: R-3 Type of Construction: VN 'Land Use Zone: RL
Owner of Building: CANADAY & COMPANY Address: •17480 E. 17`h ST. #106
i
City: TUSTIN, CA . 92780
By: STEVE TRAXEL
Date: 11-27-2002
Building Official
POST IN A CONSPICUOUS PLACE