0107-093 (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 #e 44 Lic. Class ,I Exp. Date get
," Date 1t 1 I ;� j Signature of Contractor
r OWNER -BUILDER DEC ARATION
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
F 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.
n( I have and will maintain workers' compensation insurance, as required by
S. c'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.
(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 gree thatfif I should become
Subject to the workers' compensation�rouisio eceon 3700 of the Labor
Code, I s UD hwith comply with those'��ovi 9�.
Date:�� 3 r1f Applicant J !' f 4
! s A!
Warning: Failure to secure Work' 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 thisapplication 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 rep 111e�ntativ es of this City to enter upon `
the above-mentioned property, f'� p J tion purposes ,
a M�
Signature (Owner/Agent) + ! ° `' p ! ✓ Date�2)
..
BUILDING PERMIT PERMIT# '
j.
DATE r VALUATION LOT�(�"� TRACT
�a
r •i 4�tJy��':; uac a t.4, lZe 7t.7{B 148 u,, 1.
l
JOB SITE ` �
ADDRESS
TA
4746S, VIA AffrWER
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C~AId., D",'' & COWAW.
C;A14ADAY JA,� C01"ANY
1'7*180 K IM UT. 0106
l OM E, ITTi13T. #106
4rfjS0nX C;A. 9278-0
rixf W ICA 9211 go
714 08-4440 rIMITAff .4485
USE OF PERMIT
SM PLAN :�t►.t , .PgkM'17 DOl✓S NOT INCI.U011 83.=K' WAIAA FOOL,
OR DRIV8WAY APPROACH
z
PORCF1trA,TIO WHO Sit'
GA'k.P/,ElE MR -POR`,!' 425,00 3
E�, rft"TK'D C OS)r OF CONMUC.MON
154,471,10
C ONSTT1MICTI N" RE 101.030 0-4164000 "32100
,PLAN CHECK YEZ 101-0001-4.39--118 $00.16
RE 1;FW31T 101.000.4x9-318 4250.00
Itt3;1r,,.CHANI C',A0.,L, lFMP, 1131-000-421-000 $105.00 ,
BEXIto'1RA AL FEE 101.0tXi-420`000 $147.85
PL.L3MU3+617FEE 101-Cf1DO-415'-OD1;1 $128.25
TMC3sidOWtON FRE- MID 101.000-241-{°.0101 $13.45
CARADDIO legs 301,, 0 .423-000 $20.00
mG 'adC�I' fd IMPACT FEE R9xp0"/:OCA
�
A• •� .�q �{ y`' p.,,y
L Sic�"�..}r �q.0 �
�RUXNDL,Il.'Qii&4..KJOI
r'pi ► ".PAID ?.iii
"+�'2,~Jp 'Do
SOF LAQUINTA
J w •�
RECEIPT
DATE 1
11 + f
BY,
DAV S LED
`J
INSPECTOR
/ 1J ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I. DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings `7_ 6� ��r
Underground Ducts
Ducts
1=��
Slab Grade
Steel
��
Return Air
Combustion Air
X. op—
Roof Deck
/ tl/
r
Exhaust Fans
O.K. to Wrap
BZ _
F.A.U.
_
FramingCom
P ressor
Insulation
l - _ a2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath_—�vZ
r
Drywall - Int. Lath
Final
Z -
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
_P_y_�_
Heater Final
Water Piping
_
L'
Plumbing Final
Plumbing Top Out-a.���
_
S
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
/l-� d
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
/ /
-or
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)
Certificate of Occupancy
City of La Quinta
Building and Safety De* partment
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: 47-1.65 VIA ANTIBES
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0107-093
Occupancy Group:' R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17T" ST #106
-F-64--t
Building Official
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 05-22-02
POST IN A CONSPICUOUS PLACE