0203-048 (SFD)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
�j:Wpter 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
f .y RAF"i�
Date _—_/: � . T % Signature of Contract or/��`J ----y'
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
K.
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
Se tibn 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 gTAT'S pUND Policy No. 1661391.01
(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 agre5,t atPl should become
subject to the workers' compensation provision
t' 3700 of the Labor
Code, I shat forthwith.5 omply with those,provlsions.,/!`
Cod
l%HPPlicant CN �'`a�✓fit _ ----.
Warning: Failure to secure WorkersCompensation 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 r
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
e' .
& hold harmless the City of La Quinta, its officers, agents and employe' .n
.2. Any permit issued as a result of this application becomes null and voids flJ
work is not commenced within 180 days froO� date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above information is
l City, and
te
ing to
he
constructiocorrect. I n, and hereby authore to comply with a'llze rep esenta ivies of this tC.ity toenterlupe n
the above-mentioned property fodrispectioynepurposes:,
Signature (Owner/Agent) r`'�� �r Date <"r0;� 9�•'/f
r
PERMIT#
BUILDING PERMIT;:: :.
,
DATE VALUATION 7 9 n "; L'OT.'•r TRACT
134 26152.
JOB SITE
ADDRESS `di tTdt's
APN ls�1 FrDs
OWNER
CONTRACTOR/DESIGNER/EN &NEER ?
CA ADAM & COW. f Y
C°MIATDA`1r &. OOIvli?s�. Y
17480 F. 17TI13T, $i£l06
1748{_)1 , 1'7TH.71! .4106
TUIV CA 99,780
11119M4 CA 92730
(714)508.4440 MIA 1485
USE OF PERMIT
SINGLE YJ"LYDVK,.U..WG
ST) _ W9' 134PLAN 20HR— PEil XI T DOES NOT INCLUDE BJ=K
WAlsIA P00410PA, OA I ► E'uVAY APPROACH
TRACT CC3NSTRUCTION SF
PO.RCtli11A.`f Iii 392.00 3
(IULAWCARPORT 426.00 aF
:hME A, D COST OF C6C3MMAXWON
1MXn3d.)
CaRSTRUCTION FEE. 1'01.000-418.000 W2100
FLAN Ch PXK FEE 901• '0$1439-318 $690.16
1+ ECHANIMLYFE 101.00"21-000 T105.0II
W.,9CTR1CAL PEP, 101-00-420-000 $147.95
PLU iA RIN G M19 101-(M-419-000 $120.23
STR•CiNO PA O IC)'N RM, - REBID $15.45
CkRAI)Ftdd1IEK 120,00
S1,VELOPER. IMPACT PEP, $1,907. OD
f;3Mz,'D M'.AL. 0.C):'1;i'MUG'°1".1:C,ik3',PM") FLAN (-Mit"1:
M3,841.11
_. .1, 9 F'.R.E�-PA§I. Ji F-20,0
$0.00
__ -
ilk-.-_
a t
6,i+Yi AT, 3. F.•. - .1..W� �I'ES X./\ E I OW
PMS'71
1iUNl 2 61002
CITY®FLAQUINTA
FINYANCEDEPT....,
gRECEIPT DATE - r
BY I
DATE F11 IA D �
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
_ISet Backs
—G9
Underground Ducts
Forms & Footings
— _per
Ducts
Slab Grade
— o
Return Air
Steel
Combustion Air
Roof Deck
- - 2
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
ao
Compressor
Insulation
z_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(• �f • p 2
Drywall - Int. Lath
- D Z
Final
Final
d
POOLS - SPAS
BLOCKWALL A PROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
�,n �� •d a� �7
Encapsulation
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)
r
Certificate of Occapancy
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: 78-795 VIA AVANTE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-048
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY & COMPANY
Building Official
Address: 17480 E. 17" STREET #106
City: TUSTIN; CA 92780
By: STEVE "TRAXEL
Date: 02-26-2003
POST IN A CONSPICUOUS PLACE