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9900-164 (SFD)LICENSED CONTRACTOR DECLARATION lohereby 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 o. Exp. Date ,Date I' y� 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.�(or 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 t tq�, 1e Policy No. 110 1.191 14 1,°? (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- provisl ins of Section 3700 of the Labor Code, I shall forthwith comply with'those provis�lon.�- Dater ,(;� j C/.r� r " Applicant— /Warning: pplicant /Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. / Signature (Owner/Agent) �� ��Date BUILDING PERMIT PERM T# VYQ0 CCdd DATE VALUATION 151C)7,347.70 LOT w f3 TRACT JOB SITE 47..C;5 VIA. MON 'f ANA APN 641,1254,13i ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER OANA fW&C ►NIVA^aV CAANIAMY&(7(eiM.PANTY tJP{9 AIt Hf�I,X,IJOT4r i1 �e � { 2G$ 1 Y,70'0,91.jOWCai,r,01h, DIU t;, sur v.2w SANTA. ANA VA 92705 SANTA ANA CA Ail` 0 USE OF PERMIT �Ihti.G 14AMIL 1)tJ�dt'i,L{N arb -fj. i< N R.4 -18A x,o`[ 263 - PUINiff [OW), Nt i`It: 1?*.1f.J&LfSi,{.Ae K WALL OX IAC", PLAN (111 f" VES- RaWt'AON QNB. N :V1,f +i L 1tA'tSWAS_N(:.C.6 f_).f" $ANIL''t-NN'I9"N E. CC-aS x IONN' v4,079.y0ro ;zF iTRAM .,'.i2G;;" i,3•ti3'.AlsE�l;i�;fdf�<3NC$' .. a�auU wit+ CE>)NSTIzi3 7It-IN)-'hE S94Z i) Pt. AN i'11"�C to !'f t: 10 1 -Af10-4V)-'V R sllilfit 41% MIXI1ANI(''AL FIrl 10;-009A21-009. 1:.5 X) f of IQAL. F111s ,fot�l-O-420-000 549.4,3 ` lrt..t3&T'4 INO E'1<i."s lii4.-WU-411AW 81rh.50 sTR�<)V(:; ton'iftSXJFF-iRFi'.110 1h1 1.741-0044 t aRADIN(1 M'N' s f°t 0 a�Liv.,113 - 701-000-255 OW S it" J6 S+Jl � 1,)1"P41INp'(' I(�I�f999i9 e -a�fi = ' .Uti w Sy 1t(-1T)TAI, MN's'rf;{i tryQt)N ANY) PN,AN, (1—TIPM.. �%�; x°,°� kir S3,n m . eQ RECEIPT DATE BY 1 DATE FINALED INSPECTOR INSPECTION RECORD ` OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs G+� Forms & Footings L Underground Ducts Ducts Slab Grade Z Return Air _7 Steel _ Roof Deck , Z(pd0 Combustion Air Exhaust Fans 0. K. to Wrap 07V F.A.U. Framing /fir . 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 Final /Z_Z BLOCKWAL A PROVALS Final POOLS - SPAS 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 Water Piping Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection / Z S"� Pool Cover Encapsulation Gas Piping Gas Test Appliances . Final COMMENTS: Final f Z Z 61i 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) -varL„�";'3�w.F��•„�r,'3���r.�:�i�y,.i�..Ai �y�.�v�,,,.�.+xr”i....�:..�y,.a�..-..-.{'"°�;�S1.ii��'u�:r='�F� f*"#,rq`i P.O. BOX 1504 APPLICATION ONLY Building �/ 4- 78-495 CALLE TAMPICO Address ©Q , ! /"Ip v r `i Et, LA QUINTA, CALIFORNIA 92253 Owner Mailing((+ BUILDING: TYPE'CONST. OCC. GRP. Address I (l ' W A.P. Number3'�?� 03S City Zip Tel. t �r r To 4 ! d �� % 7 1 Q1-S�&' 4 vr y Legal Description �� Z• �� l �i- , Z 3 Contractor Address ty State Lic. City & Classif. S T 1 _S616 L Arch., Eng r., Designer Lir N U1 Address O n r r f_ O ut 5 S Q y Y.)C City (' Zip b `G State V ('� 1 Z., C?_ Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and effec SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a Permit to construct, after, improve, demolish, or repair any structure, prior to 'its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). 1-.' 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did notbuild or improve for the purpose of sale.) 1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1-7 1 am exempt under Sec. B. 6 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.1 Policy No.— o. Company n Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City, State, Zip roject Description < Ifo - R'q -1 Sq. Ft. 6 C' No. ' No. Dw. Stories Size ! Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ra ar AMOUNT X I � C; CD o r ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION -Desert Sands Unified School District 47-950 Dune Palms Road r Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 # CERTIFICATE OF COMPLIANCE Date 10/21/99 APN'# 643-120-035 , a No. 19493 Jurisdiction La Quinta Owner NameCanaday & Company Permit # X47-600 Via Montana' ' No. Street ,� - Log City La Quinta zip 92253 Study Area ' Tract # Lot # 263 Square Footage 3079. ° Type of Development Single Family Residence No. of Units 1 ' Comments Lake La Quinta .At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory,, -structures or replacement mobilehomes. It has.been determined the above-named owner is exempt from paying school fees at this time due to the following, reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 intheyamount of 1.93 X 3,079 or $ 5,942.47 the property listed above add that'buildmg permits and/or Certificates of Occupancy for this square footage in this proposed project may now tie issued �r Fees Paid By ccB of A/Canaday & Company /Te1ephone 771' 9636 Name on the'check f / L By Dr. Doris Wilson El ` r'• `:w; , Superintendent Fee collected /exempted by y Juanita Green . - Payment Received $5,942.47 Check No. 2016297584. , Signature CLU� NOTICE: Pursuant of As mbty Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the Distrtct('s)(s') behalf, whichever is earlier.' Collector: Attach a copy of county or city plan check application form to district copy for all waivers. r Embossed Original- Building Dept./Applicant Copy- Applicant/Receipt Copy - Accounting t PUBLIC WORKS CLEARANCE1ETTER FOR CUSTOM HOME LOTS' w Dear Builder: Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or more., of the -following: 1. Verification that rough grading is complete, and the pad'eleVatio*n,certifidations prepared by a licensed surveyor, .o,r engineer,` are ohjile ',in,the- RublicWorks �� ~t Department.',-, , ,� i.', h ; .�1r . s." }. r<fia x .'. ..iw,.r s.r'.f� t% .a i-,s+•,•�"„s s E . ...,t t _t F M.` }y-._,.ry•i,V } Iyi 4V,,4: x ,j`:,.i' . a •A''1 t,.� r'S' -tt ;i.r M,. i. c. R '�R ''' ..a`'a';. :.—*I. IV,,..t __ st ��.;�rt,�°'�,'T`�•;; +� "� '4 � .1.kF,.���.. �: .Z t .�.2 =. ;rVenfication.xhat �nfrastnacture improvements;andotherrequired;tract;improvernents'�; bs" <" r.r Ks- s, . ;i c•'f"' .r.. is `t.. :.t'' sa r^• ..�.. •. awx.. x4-'3 .. +' "�. .�sF?'«. c'. ..t, ii •ht .'Y;{`.rwyt,....i'i1 r .s•": r ;_ ay3 xr ; �' r y. rare complete,;�orpsufficrentlyadvanced'to warrarat�bi#din permiissuance r - ; z `, _ w -, ;.Tr4..s + r f :l _,,; .. .,�S. r Jr4.•r� s• �Y ' iG?t'K I'r �' � 5& S,r��x'l ..i+;'Y t v"t•" . f1 y. O •. y. - it •. .0 .. ..,• :.F y._�f 3. Prepare an engineered grading plan that provides for on-lot4. storm v►rater.retention, and have it checked and approved by. the 'Public-Works'Department . • Tract 26524 (Estancias) ; u • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that. provides for, building 'pad grading , in t t t u accordance with the existing soils •report and,.tract -grading. plan, and ; have' it;., checked and approved by the Public Works•Department. ` ® -Tract 28034 (South ,ValleyEstates)- d; FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT TRACT: �L15 LOTS '• a . 23q, Z4 q, 26 PUBLIC WORKS AUTHO4RATION A 4TE? 1 COMMENTS: