0107-095 (SFD)LICENSED CONTRACTOR DECLARATION
Thereby 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. pate
!`% ��`•� f Signature of Contractor
D j
OWNER -BUILDER
I hereby affirm under penalty of perjury that I'am exempt from the. Contractor's
License Law for the following reason:
( ) 1, 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
i'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have an4,; ill 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.
(„d 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 FREMONT COMP INO Policy No.
(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 becon)e subject to the
workers' compensation laws of California„and agree that i)/I should become
subject to the workers' compensation provislpryo�,Sl
'�Seetio 3700 of the Labor
,Code, I shall fo hw h comply with thoS�e pro%�Applicant
—
i J
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. d:
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. I
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 ceprese�i ativesl'of this City to enter upon
the above-mentioned property fomn pectlon purposes.
Signature (Owner/Agent)
BUILDING PERMIT PERMTk
DATE VALUATION . LOT' �f ` TRACT
1:1113t2lo : V,455,146A i 150 1
JOB SITE
ADDRESS
APN
M34W-0 °2.
OWNER
CONTRACTOR / DESIGNER / EN INEER
CAMADAY A C°C7M A34Y
C 4.WADAY & C:O.W)ANY
17480'X 1 TDA ST. 0106
17400.& ,k WEI Or', #106
CA 9.2780
TLATIT9 CA ,9;Z%80
I4)5081a't Q CKA 4465
USE OF PERMIT
:?i DIVLAN 30HWP:R22lttJT DOM' NOT INCLUDE BLOCK WALIA P00I, OR
I; IUVEW'WAY APPROACH
9RA,CT CONSTRUCTION MUDD 3F
I
P0RCWP.AT%i5 379.00 SY
10%R OF'i` IARPORT 439,01k SIS
ESMMAM COST OF C0Hb7VU.,`n0N
145,14649
1;' ]9� .:r A 5 SUMMARY
C:t N.15°]IRUCTION IM -E 101-000-'4.184000 $923.00
PLAN C311: K FPXI 101-000-4-39-318 MX.14
1UJuCkIANIGAL f EE 101.000.421-00 $105.0.0
1e%F,CTRICaU,FEE 101-OWA20-000 $Its?.29
;PlIUDN'l INO FEE 101 ••000_'19-000
F)4'RCJi�c3: a�`rlt�NFRE -REBID 103.1300.7.41-000
ORAD1140�, 1 {11.4310 .2:5 -00CJ I. X30.00
0-WRLOPE-1 MF CT KE
*'TUR-110`i".A�.{,"C�. i iX;7d�'tiC)T�.KkTDPULMCHEM
�,'ICiS�.fi1
NOV 13 2001
�81�®FLA®UIP1T y.1X'1fl- arFMP; Pup. 1 ow
OF DEPT
'Kix--NID101
RECEIPT
DATEBY
j I
D ALE
IN CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
/ Z y
Underground Ducts
Ducts
_
Slab Grade
Slab
(
Return Air
/ - -
Steel
Combustion Air
Roof Deck
0. K. to Wrap
/ %-d Z,
�(� �ryj
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/ _ 227 - C9L ro
Final
Final.
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
-
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
f �i �?1
Electric Final
Heater Final
.Water Piping
_
`_ _ - -
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
.
COMMENT
6� l�j� •
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
91 �0
Utility Notice (Perm)
G ,2
-
C'ertificateof Occupancy
City of La Quinta
Building and Safety Department OFM
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: 47-205 VIA ANTIBES
Use Classification:' -SINGLE FAMILY DWELLING Bldg. Permit No.: 0107-095
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17T" ST #106
City: TUSTIN, CA 92780
By: STEVE TRAX_ EL
a' Date: 09-30-02
Building Official
POST IN A CONSPICUOUS PLACE
I