0203-047 (SFD)LICENSED CONTRACTOR DECLARATION
I -hereby affirm under penalty of perjury that 1 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.
LicenseQ# ��jj �p�1/yy99 yL{ic. Class Exp. Date }A{{
6i9,f..
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 8TA'Th' V(MD Policy No. 166MI-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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Saf4ly
for a permit subject to the conditions and restrictions set forth on As.
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, Inde' .�, y
& hold harmless the City of La Quinta, its officers, agents and empl' j
2. Any permit issued as a result of this application becomes null and f.
work is not commenced within 180 days from date of issuance u
permit, or cessation of work for 180 days will subject permit to canc io .
I certify that I have read this application and state that the above inform tion C1
correct. I agree.to comply with all City, and State laws relating to the t uilding
construction, and hereby authorize representatives of this City to ente
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
PERMIT #
._.
BUILDING�PERMIT
���.-�
DATE .1" " ... 3 " VALUATION LOT. TRACT
133 26152
JOB SITE
ADDRESS 7 "i`15 V.A.AVANICE?
APN l:
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C"AMY & &WANY
twOTADA.Y ,5% (:OMPANY
17480 X 17TH VT. 0106
174130L. 117TH �°'4° 0105
' %C A. 92780
LIST1' CA 02,7W0
(714)508z11440 { B14f 448!
USE OF PERMIT
SIN CYLE 1?AWY .V vYJ:aL, ,1 G
W01 1,07 133.3. PLAN MAIL PEAMJIT DOES NOT D;C:.1,VDDZ BY.O X
WA1.LA 1004 SPA. OR DRJV"F Ot'.dA.V 4VPR=3ACH. WA PLANC:13ECK &SER
REDUC` IO14 FOR MUTATPLE IS. U'ANC;1: OTi'.u.N IMP PI„AIJ TYPE.
TRACT C0N$T1WCT1,(W 2422,0 SP
1xORCtifS'�T10 3'l .Uii ;9F
GARAGUCARPO T 439,00 SP
951MATED V --015T OW C':ONUIRliGTION
l4.'yNX 6.40
Z 00.wS' ME, SUMMARY
CONSTRUCTION ITE 101-0 00-418-0%) $800,50
PL," Ckl"F..C:1."". FEE 101-000439-318 216198
>ME, c mICA1, lin., 1 Ul -000-4� 1.000 &93,so
ELFXTRIG" VEZ 101-000-420-000 V 43.05
i+t lii 'DYNO FEE 101.000»419.000
I°11fJNS5MOTION M-RMSID 01?000-241-000
GRADING FM 01.000«423-000 SAGO
O'.RVE-LOPER IMPACT mak, �i.f9G►D.O�t
't
=A"`3'C.aI`.Al., C0Nff1_RTJ" MN' At-.T.D PLAN CI -117M
$1,214,29
L1W. PRE41AV) EMU
$0100
V Ni v l.V�(. .
i
TY OF LAQUINTA
FINANCEDEPT.
RECEIPT
DATE
BY
DATE NAL
INSPECTOR
.p
a� o
hi
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS 19
MECHANICAL APPROVALS
Set Backs
— Z0
Underground Ducts
Forms & Footings
— —azo
Ducts
Slab Grades
— C, Z
Return Air
Steel
Combustion Air
Roof Deck
_/ —®
Exhaust Fans
O.K. to Wrap
. O L S
F.A.U.
Framing
p . e
Compressor
Insulation
p • • o j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.O
Drywall - Int. Lath
_(p•pZ 5
-
Final
Final
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 77—U
Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
10 eJ 2. S�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
ate of Occupancy
City of La Quinta
9►Departmentw
Buildin and Safety c�Moti9
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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: 78-815 VIA AVANTE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-047
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
By: STEVE TRAXEL
lam Date: 02-24-2003
Building,Official
POST IN A CONSPICUOUS PLACE
I