0202-258 (SFD)LICENSED CONTRACTOR DECLARATION
i,fi eby affirm under penalty or perjury tnat 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
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury thafd 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.
STATE FUND 1661139141
(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 ilyshould become
,subject to the workers' compensation provisions oA 06v1 0700 of the Labor
Code,''U6/
shall forthwith comply with those�provYsl.ons.
Date: � � � �S t 1..V Applicant 1Z.Z_A/f � � �-"'". ✓
77 , W C,-
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 property for;ihspection,purposes: ,
Signature (Owner/Agent) t ^ Date '•✓� <if�
BUILDING PERMIT PERMIT#
DATE/ / VALUATION LOT 020-'25' S TRACT
/. 12 $154,471,70 144 261:12
JOB SITE `
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN INFER
C,;ANADA.Y COMP"Y
CANADA.Y' & C131APANT
17460 E. 17`,�'�:% Fr. 0106
17480 V 17M Ur 0106
Yu CA. 92790
TUSM14 t_",/.A. 97780
(71.4)51.5-3490. M4 4485
USE OF PERMIT
a1 ' 4-GLE FA14MY DWELLNG
SVD - LOT 144, FI.A-N 203, PERMIT rX)ES NOT 114MU E f1L0,GK
WALLS, P00I., z13A OR'DRYMMAY'APPROACH
1 RAC d, !r'10 148 d R C l ION S
PORTv`"P.&TIO RF
MAW WCARFORT 426M SP
CC�S'�#.' OF t.01`d�?:�t7L' LION
.
2,54,471..70
,pA�p/ /v� �p /�''� p yI�T
.8 JG�hrRil.4. I "M �J�.JLY.4.8Y!.4 I ,
FX
CONISTRt24'i'JON fgr� 101-000-418.000 10100
PLA.14 CtiB' IC FLS
FEE.DEPOSIT 101-000-439.31.0. 4250.00
Mrui H,t9NaCit#1`l Me $105.00
ELFIt;:`$RI0,Fs1,1?ely, 101.000.420.000 $1418$
FLiii BIM3 FAA 101 -000.419-000 $128.25
'STRON O MOTION I<"EF - €31SID 101 -00.241 -000 $15.43
(3f=JN0 ME MOO
T�1AW&L,OPEi.W.EiC:'& FER
EftM—L'O IAL 4:,rS.YAV..81'R{-f\..3i6. N l•11WLJ PAN CHI .CK
$3,80.71
I'M Pn?_P1MVWB
. L•� �e;81 tr4. n!.
4250M
t�
tP"-Affy FEE SDVE. NOW
-P-'
MAR 2002 t:
I®FL.AQUIP A
RECEIPT
DATE a'
BY C`
DATE FIIyQLED
SPEC TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— 2 - _12 -
Underground Ducts
Forms & Footings
—z
Ducts
Slab Grade
— Z_
Return Air
Steel /rJ
— ®-L_
Combustion Air
Roof Deck
— 3-
Exhaust Fans
O.K. to Wrap
— 2 -z:517,
F.A.U.
Framing
Z C,
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(�-�3 Z4__�
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
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
//-/2Z;2 — Z
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- Z
Encapsulation
Gas Piping
Gas Test
7 T -1-702—E7
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fudures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) • (4-tr3'.0
COMMENTS:
Certificate of Occupancy
City.of La Quinta
Building and Safety Department Ofnf°`'�
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 ADDRESS: 47-085 VIA ANTIBES
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-258
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
e
Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17T" ST. #106
City: TUSTIN, CA 92780
Building Official
By: STEVE TRAXEL
Date: 02-07-03
Il " !A N POST IN A CONSPICUOUS PLACE