Loading...
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 ��}��� " 'r �2 �t.Qf3 r •�•'L331,.'T�f ����,����'' ����.�1 q.�iij�; I�Q.6� ` r ., aS'�,������ 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