0202-259 (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 Ed D'a�te,47py
34 11
Date T Signature of Contractor Ar 4
r
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). z
( ) 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:
Cartier Policy No.
OWE, FUND 1661391.41
(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, a !agree �at/if �I should becom�subject to thgg workers' compensation provisi • ms of Secn&00, of the Labor
Code, I sh f`forth V omply with those'?'
'� ei4pplicant �' �i��'} � '✓,�` f r��
Warning: Failure to secure Workers,Compensation coverage is unlawful and
shall subject an employer to criminal'penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the conditions and restrictions set forth on his%
application.
1. Each person upon whose behalf this applicatimis made & each person at
whose request and for whose benefit work is performed under or pursuant to::
any permit issued as a result of this applicaton agrees to, & shall, indemnifyri
& hold harmless the City of La Quinta, its officers, agents and employees ��
2. Any permit issued as a result of this application becomes null and void IfF• i -
work is not commenced within 180 days from date of issuance of suchf'
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the•above-mentioned property for inspection purposes
/signature (Owner/Agent) � . �A� "D t6'Z
BUILDING PERMIT PERMTN
r.
DATE / !r VALUATION LOT Q'rW_%.2 TRACT
S1 .;14£ 145 "161,12
JOB SITE
APN
ADDRESS'
47-1.05 VIA ANTMES
OWNER
CONTRACTOR/DESIGNER/ENGINEER.
0MADAY & COUP44Y
[lAWAi1.AY & COWA RY
174190'-& 17111 x1 W. , 106
1'j' 480 * 17 H IST. 0106
':1ving CA 92781a
TI19.�a,�`RI CA 92790
y y�
CID1111 4485
USE OF PERMIT
3 ILE FAN, "13WELLaTO
M7)41,'O ' 145 PUN IVAP,. PIC*'MIT DOW i NOT IIti3CFwL1L. e fnxxx
tht'.i LL,% IP0014 UPA AOR DRIVIWAY APP3?.C'aACR. 'iii, P$AA9 CH,..KCK 9X
REDVI TION DUE TO 2MULTIPLS ISSUANCE UPSAME l LAN 't'"' PK
7RACT C0349I':tLVYCTION 24222,00 S£t'
PC RCHIPA TIO re'.t?h Sit'
MMU M. CM 0r, CONURVC110N
14S1146A0
lk'K'E I f M. &TMMA Y
t'ONO T RUG"..00)4 FU 101.0w,418.000 � il, t►.
,.-PL.A,,'R CHE`i'K.I~' -7, 101-000-4` 9.5418
FV. Z 101-000-421-000 59810
T?1,XCTPJC,A$, : T,1e, -101-000-420-000 1-000-420^000 $147.05
k'l,iYmmK1ra, 101.000-419.000 SI Z."
STR.OWEt MOTION I?F% - RY-SID 101-0�3.(,T4A I-"i!t't0
CiFt.r°aDWO X1$1? 101-000-42'.00 i $20,00
DL?V'1WPZR'JMPAZT ",F,
• /�y� °tom C 3,M'1"MUMKXqAW) PLAN MIECT.
$3,.274.29
,� US
$0.00
MAR 29 2902JOT FROM ]VENDS DUE NOW
-..,
RECEIPT
DATE
1
BY .1
DAT FINALE
'`,.;p
INSPECTOR
- :''l, ;:
Cf
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- Z
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
' Z
Return Air
Steel
Combustion Air
Roof Deck
- -Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
p Z
Compressor
Insulation
- 2 _ e)
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-ja , 2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
z
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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 S
Utility Notice (Perm)
11 - O
Certificate of Occupancy.
City of La Quinta Y
Buildin, a.nd Safety p�De artment G��OFgr
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'regu/ating building construction or use:. For the following: 1
BUILDING ADDRESS: 47=105 VIA ANTIBES -
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: •, '0202-259
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL"
Owner of Building: CANADAY &COMPANY - Address: 17480 E. 17" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 11-26-2002
Building Official
POST IN A CONSPICUOUS PLACE
T
Certificate of Occupancy.
City of La Quinta Y
Buildin, a.nd Safety p�De artment G��OFgr
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'regu/ating building construction or use:. For the following: 1
BUILDING ADDRESS: 47=105 VIA ANTIBES -
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: •, '0202-259
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL"
Owner of Building: CANADAY &COMPANY - Address: 17480 E. 17" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 11-26-2002
Building Official
POST IN A CONSPICUOUS PLACE