0202-255 (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 Exp. Date
591561 3 /311/02
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
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.
ST&FE FUND 16613.01-01
(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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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 sed 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 inspection purposes. -
i Signature (Owner/Agent) y
Date
-BUILDING PERMIT PERMT# -
DATE VALUATION LOT L9dA7G M.10 TRACT
q • '? C, .., y $1.4:,'x.3.46.413 111 26152
JOB SITE
ADDRESS
APN
x@7.025 VIII A L' $ $
-0.i is
OWNER
CONTRACTOR / DESIGNER / ENGINEER
•
CeA&v%a DA.'Y• & GONPPi.�CdY
CANAD Y A COMPANY
74811 E, 1 `a° ril D'. ;S>t106
^o �t€10 & 1'x'-11 ST. 0106 -
'ru''STW CA 9.2780
'iwrw CA 92780
(I 14)5081 4440 CK4, 448.
a
USE OF PERMIT
SIV D - LOT 141 PLAN 1008. PERMIT MES NOT lNC4_.I.?DE BLOCK
�VALI,; PO04 $?A, O'R 1r)Rt•1f•F,WAY t-,Pf'l O,A(..'H-?S% °LAX CHFX K C.EX
!<k'.� X'TT'ON DUR '1 O MULTIPLE 1 i,513AWC& OF &€ E PUN `T `PE
'1"t3A,C•1' t,X%+i 8TRY3("'l WN 7,02,00 SF
ba0RC€it'PAT10 V4.00 Sig
G&RAWCARPORT 439,00 9F
E317MMxX0 C0617 off. CoNfrnii1c1lon
A!5,246AO
CO1+ttg'1'R,?L1CTION F", 101X000-4)8-000 �8f►0.S4
A'
PIAN CHECK MM 101_000439_318 6165AS
SICXL�a13ICe`.i.FUR 101-.0003 421.000 $98.50
-40-000 r' -3IA. PR3;A, 101 JW °
P,LISO)c3'ING IIISE 101-0004,19-1000
STRO G INIOTION PEE - RISID 101-000-24.1-00
ORADtN4 FEE 101 -WO -4U-000
1'31,W,L0,PP.•R IMPACT FUR
n.
AIX
MAR 2�
Orr OU RTA
RECEIPT DATE a
BY;
DAT FINALE
ALE➢
INSPECTOR
/ o y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-/!l - v
Underground Ducts
Forms& Footings
,4-2_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- 7,
Exhaust Fans
O.K. to Wrap
2 - 9 -dam
F.A.U.
Framing
Compressor
Insulation
f —off
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�- v
Final -�� oy 5�
BLOCKWALL APPROVALS
Final
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
/O -
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster .
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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) - - Z
COMMENTS:
,
Certificate of Occupancy
City of La Quints �
Building and Safety Department OF Q`'
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: 47-025 VIA ANTIBES
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-255
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY & COMPANY Address: 17-480 E. 17T" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 11-13-2002
Building Official
I POST IN A CONSPICUOUS PLACE
I