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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
Date'-�' ionature of Contractors="•r1 •�'""�
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
S( ction 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 STA !M FUND Policy No. 1661:391-01
O
- = BUILDING PERMIT PERMT# -
DATE VALUATIONLOT TRACT
'1l4.S,146,� O 131 7.6152
JOB SITE
ADDRESS 6Jai\� TY oA A1P$` APNYwr!
OWNER CONTRACTOR/DESIGNER/EN (NEER
C.ANIgai3AY & c(DeA "f O ANJOK t` A COWAN YN
17480 E. 1717181, ,106 17480E. 17'.['1':1 ZE .01 C5
1 FJ►5° ilf Ch 92,780 '(r81W. C.P.9,2780
(714)50$-1440 tML0, 449S
USE OF PERMIT
MGIE F':ATM..:Y 13 I nit�3G1
SM . LOT 131 PtA14' 1.0B. PERMIT DOES NOT INCL -11111„ SLOCK
WAL60, POOL, SPA OR Jti3QiSlENV''AY APPROACH
TRACT o Uk43 'ftVCT1QfJ �42ZDD Sr.
PObLC:I f4y.dt'T1Ci 3i .t1{t SY
GASIAMMIARPORT SP
96I'1'$E f COW OF COIN TRLI 1DN 145,146A, 0A
IS.4f;11.1f1A1'r if YR SUMMARY
(This section need not be completed if the permit valuation is for $100.00 or less).
CONS1 RUC'T1c714ME
11 01 -000-418- OW
$31301$0
( ) I certify that in the performance of the work for which this permit is issued,
PLV4 CHWII LP
101-000-439-318
2165-9$
1 shall not employ any person in any manner so as to become subject to the
1 1 43Ai2CAbrFi, F
1 1��00-X9.21.000
$1$.94
workers' compensation laws of California, and agree that"if-I should become
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GLEC:TPUCAi. PEt
101{tLir�••a�,'�t�••
- 00
$141.05
subject to the workers' compensation provlslons/of Section 3700+of the Labor
ig -.
Code, I shall"forthu�!it�h comply with those,proulslohs• ,f��/�<
s
PLUMBING ME
1t71yU4(i-41��3i!
$105,74
Dater / �' gPplicant ,`/ :� ,!r!°7` ✓ -�', ..• -,,.,...+•r•"'�
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STR.0140 MOTION FRE » Xti? iii
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Warning: Failure to secure Workers' Compensation coverage is unlawful and
(MAD1N0 FFR
101-000-42.3;000
00,00
shall subject an employer to criminaj.penalties and civil fines up to $100,000, in
D-V'tf-�.4.91aER IMPACT M
$2,9fY%RO
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 hts'r
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 ' . ;' D
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.
g. 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 f
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:
Mfr e Ar P'.' I r
the above-mentioned property for,+inspectlomourposes. RECEIPT
fF
Signature (Owner/Agent) �j-'��'' Date?
t
IM'tM A14 L9.1P�, PLAN CHECK $3,T1419
X Js�3 �EZ3?pI'A11� PIM $("'00
I.
M PIWWr FEW DUE NOW 93,2 74,219
OFLpQUINTA fA
�INANCEDE�•....
DATE BY.
DATE FiNALED / I INSPECTOR
. A.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs / _ Z
Underground Ducts
Forms & Footings `2_ c,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap —4t)
F.A.U.
Framing o- o z s 7
Compressor
Insulation o • a >
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath O- • c y "'
Final
Final o
POOLS -SPAS
BLOCKWALL AP ROVALS
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 —29- 6
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewjr Connection ( 0- JY. 4 S7
Encapsulation
Gas Piping
Gas Test 7—
Appliances 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) 6
Certificate of Occupancy
'City of La Quinta
Building and Safety Department oTMt°`'�
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: 78-850 VIA AVANTE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-046
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY & COMPANY
Building Official
Address: 17480 E. 17th STREET #106
City: _ TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 02-24-2003
POST IN A CONSPICUOUS PLACE
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