0202-257 (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 #` Lip. Class Exp. Date
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).
( .) 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 '
a°
WORKER'S COMPENSATION DECLARATION
;ti
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
Se tion 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.
STAik FUND 1661391-01
(This section need not be completed of 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 I should become
subject to the workers' compensation�prvisio�ns of ection 3700 of the Labor
Code,,I sh I orthwith comply with those,provisions
s /Date: l71� 4121 Applicant -
7 ^•-^ ""
�f
Warning: Failure to secure Workers (fCompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to.the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his -
application.
1. Each person upon whose behalf this application is made & each person at.
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation..'
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorizeyreproiKK Yat' es of this City to enter upon
the above-mentioned property forrnspectlon p f rposes:
�Aignature (Owner/Agent) Date_-,
BUILDING PERMIT PERMIT# „
DATE , ° VALUATION LOT ti TRACT
143 26152
JOB SITE '
ADDRESS
APN
�yp�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C:MADAY COMPANY
C IADAY & t ;OWWN
174,90 R. ITITI M. 01,06
17480K 37*n, 1 �a" T, #I06
w wnw CA 9=0
Tuarw CA 92790
���}SOE3-4440 CB1.fi 448
`
USE OF PERMIT
SWOLE FAWL.T : WIMLWO
SFA • LOT 143 I�I.�Id 308. PZPAIT i�CS.�S N i' INCLUDE SL.00K
W!f<I,1A POOL, SPA, OR Y5'RNLPWAY APPROACH. `i�'�•o Fi�1t$ 011:�?C!'�. �>
IxEDUCTIO14 I:Ut TO MULTIPLE ISSUANCE OF UAME PLAN TYPE
TRACT CONSTRUCTION 10 4.0U 9F -,
PO CI•IiPAT1G 2_73.60 SF:
EIA33AC31�tildl:'Ci�'C $�tl.aC S�'
MMKIND CC?Yr OF
180,751.70
CaNa'L1 ue,T]OH' 101 -.00, I41 8a000 $923100
PLANK HECK FEE 1014=-439-318 $194.04
MECHARICA s r+EE 101-000.41? -000 $105.00
ELECTRICAL PEA .1131-000-420-000 $1<i 129
FLIJM111T G FEE 101-00.419.004 S19I130
S'I'RaNa M0TJ6*+4 ;FZ?, -ASID 101.000-7A1- 00 $13,08
KiTtA.l INd FRF K, 101-000-423-00 $20.00
DEVE-LOPER "1.UPACT MR, w1
4,
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LMY(l flON AN.y[.�lPc�nPii'a C.n�3+CLi-.�X�Ay. gt�i7�
V, 3s 526.911
PFM MIM".9 ME NOW
S.
RECEIPT
DATE
� , B
DATE FINALED
INSPECTOR
1*4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
a g
Underground Ducts
Forms& Footings
-Z _
Ducts
Slab Grade
_
Z - Z
Return Air
Steel
Combustion Air
Roof Deck
pZ
Exhaust Fans
O.K. to Wrap
.Z
F.A.U.
Framing
Compressor
Insulation
-7. :Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
s
Drywall - Int. Lath
Final
a
Final
POOLS - SPAS
BLOC KWALL
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 Lines
— - y
Heater Final
Water Pipingq_
Plumbing Top Out
_
/
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
�i�z
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) f/�T/
Certificate of Occupancy
City of La Quinta'.
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: 47-065 VIA ANTIBES
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-257
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
Building Official
By: STEVE TRAXEL
Date: 11-13-2002
POST IN A CONSPICUOUS PLACE
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