9910-167 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C%pfer 9 (ccmmencing 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
/ate Signature of Contractor
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
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:
Cartier r m eq v r.,vc+ Policy No. •Ulap = ai w q
l'ivaCA%4 11b .UV C,Q ,i a.+.rL a x bi�•.e�s � �
(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 tothe wgrkers' compensation provisions of Section 3700 of the Labor
Code, N phal�fgrt(iwith comply with those provisions.. s "
Date: ' .� Applicant ) w
VWarning: 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 PERMIT#" -11111467
DATE VALUATION ,SIOX4949 LOT U6 TRACT
4 ra 2(o ` 91
JOB SITE 47-670 VU MONTANA
APN 643-12,1138
ADDRESS
OWNER
CONTRAACTORq/�DESIGNER / ENGINEER
CONTRACTOR
y l` gy ay
C Mi tT11 y & 0 iisk I�AI , i•
� g
. A'N'fl+a� A! & f7fAlC AIi NY
1370 tSRCODMIGL1AJWl,:RIVE,�1F��-.
SUITE 209
SANTA ilrlvA CA, %1405
SA. IAA ANA CA S12.10-5
(7J4)7%1-41'it i'f t f! 4414:5
USE OF PERMIT '
F° i.ii f
*Fb - PLAN R.30,A WT 266 - MftifT W1 S -NOT IIWIILWT- .R :ICAC
friJtttF1DIIAT110 Sii
(1ARAOiJS'.JRTr't Rl' 64100 SIS
Y'A}TK.AiUR I D C -03 "S' OF `i..'A.11N14.7 A R Vr.'4i''}1'1
Y.fiMy Y .V
10 i-4391" -419..rM 2923,00
Pf,A 4(`71 rIg ITTP 101-04)414_318 $rrr,-4j*
faf. +rzdtlt.�%ZFC IQa U?}(3�4 -f � $190.91
,i"1'tafl;Aif;r ZftFeF'tt")'nl f• •- Ff,l�.`3iE� ;ft3f3f -
+1}�}r��t�1i}��/i�}
�iideiS.�ING1"EX i0.t-i�fx>'-423V pct
ART it✓1:POELLICPf.ACIiS -.iii:„SX 701 4404 S- tl 12
3�''f�i.F,Plf'�S3'i'£42I-�tf9}-d.�)"•:���+ •�`23t3.E✓�(3
1�'F7rf:�.f nfi��r i�tx'►J1R�`r a�F.'iY �i,�7,c�
,
SIP,) frYI' i,C"0NI54'TSitVit""g'>ONANDPi,AN:''HR"'K
LESS PREPAID ��}���
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r
•�•'L331,.'T�f ����,����'' ����.�1 q.�iij�; I�Q.6� ` r
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y.
RECEIPT
DATE
BY 1i
DE
INSPECTOR
INSPECTION RECORD
s OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Jorms & Footings
4r LDucts
Slab Grade
,Z .
Return Air
Steel
Combustion Air
Roof Deck
19—n-4-11040
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
OEM
Final
q�
Final
PO7LSSPAS
BLOCKWAL�L
A PROVALS
steel
Set Hacks
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
l CT 7
Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
/YibZ7
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)
�b"';aT%+ws`'srr��l.v�-7��,t+pw?wr.�,'�y�w.r'�s'a^bs�-�'9ia-�• _ , . _ .z�l�•*� •ns
a
A -tyl T 4
P.O. BOX 1504 APPLICATION ONLY
Building i l r / 78-495 CALLE TAMPICO
Address �70 �� �� ��G�1Ib1� q Z b rp LA QUINTA, CALIFORNIA 92253 r
Mailing ,..fit• ���
Address
City, Zip , Tel.
Contractor
Address
Zip I Tel..
scare LIC. r clty `
& Classif. 5 `�' S6� Lic. # 9
Arch., Engr., j .,
Designer L—C J )J
Address Tel
1��C� 4yq-s.�y`14 9461,-
City
•l\i1IZIp,ILic.t#.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Ihereby 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, alter, improve, demolish, or repair any structure, prior fo'Rs 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 Cade, 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 ($500).
I:, I, as owner oI 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 not build or improve for the purpose of sale.) -
I'1 1, asowner 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(3) licensed pursuant to the Contractor's License Law.)
1'3 1 am exempt under Sec. B. & 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.)
Policy No. 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
Of 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: It, 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 shafl be deemed revoked.
CONSTRUCTION LENDING AGENCY
I 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 of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
r
WHITE = FINANCE
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number } / l�� — �J �— -2Jg
Legal Description �i f tDI Sri-'" LA" .4
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:
YELLOW = APPLICANT
. • 5�^ii�� 11it��11
PINK= BUILDING DIVISION
Sq. Ft.
No.
No. Dw.
Size
Stories
Units
NewV, _ Add ❑
Alter ❑
Repair ❑'
De olition ❑
t , f„
_
f r
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
250 c'Ci
Plan Chk. Bal.
I
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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:
YELLOW = APPLICANT
. • 5�^ii�� 11it��11
PINK= BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: :La Quinta, CA 92253
Document Cannot Be Duplicated. 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 10/21/99 APN # 643-120-038
No. 19496 Jurisdiction La Quinta
Owner NameCanaday & Company Permit #
No. 47-670 Street Via Montana 41 Log #
City La Quinta zip 92253 Study Area
Tract # "' Lot # 266 Square Footage 3018
Type of Development ' Single Family Residence No. of Units 1
Comments
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 in the amount of
1.93 X 3,018 or $ 5,824.74 the property listed above and that building'�'`!
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be�ssued.
Fees Paid By ccB-of A/Canaday &Company Telepione771y 9636
Name on the check' ;#<
Y
By Dr. Doris Wilson s !�
Superintendent
Fee collected /exempted by Juanita Green Payment Received $5,824.74
Check No. '2016297584
Signature
NOTICE: Pursuant of Assbtnbty 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 District('s)(s') behalf, whichever is earlier.
}
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant 1� Copy - Applicant/Receipt Copy - Accounting
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
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 elevation certifications 1.
_are; complete;xor.sufciently ad �Iniced'to�warrant;b1u i,lding�erm itJtsuancen
R r r ,,.. � k ti , r x�.w�:.�",r+�X%��'ii�,aa--�rr's,"':2"'!`•�"..'rir';tisk�''�,".`a*n@.v�i•"f."S.: S.r'hF
' I • ; ` .•+Y S, i ' �`'�, ..�-y .:s_....:M1"
3. Prepare an engineered grading plan that.provides'for on lot storm watejr retention, 4
and have it checked and approved by the Public,works Department
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates) 3 f r
4. Prepare an engineered grading plan that provides 'for building pad. grading in
accordance with the existing -soils report•and tract,'grading plan;.1and have -it
checked and approved by the Public.Works Department
' • - Tract 28034 (South Valley Estates)
J.
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT:
LOTS.'
LO -W ZU s", i Z7T, ZB), Z-0 i
PUBLIC WORKS AUTHORIZATION VTOE�
F:IPWDEPT\DOCS%FORMS\PW CLEARANCE LETTER.ss
s
Certificate of Occupancy
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: 47-670 VIA MONTANA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9910-167
Occupancy Group: R-3. Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY AND COMPANY
d
Building Official
Address: 17480 EAST 17 TO ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 09-12-00
POST IN A CONSPICUOUS PLACE