9910-168 (SFD),A LICENSED CONTRACTOR DECLARATION
-4 hereby 6iw4 Cn under penalty of perjury that I am licensed under provisions of
v.(iapter 9 (commencing with Section 7000) of Division 3 of the Business and
Drofess;, ?als Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
1501 U1jfN
vDate { r ,Signature of Contract
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).
( ) 1, 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 t7�+.,rryv at a�� t,+ ('r Policy No. ' VM51A srlt/ �.i 17'
A� INS, Cc � ,JiJ.JrJ� f.:+ail,• R'bl rJ'
(This section need not be completed if the permit valuation is for $1.00.00 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 provisions of Section 3700 of the Labor
Code, I shal fgthwith'comply with those provlsiE ns..,.+.
Date. SL C"r r'Applicant
Zarning: Failure to secure Workers' Compensation coverage.is unlawful and
shall subject an employer to criminal penalties and civil fines up to 0,000, in
addition to the cost of compensation, damages as provided for i ection 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 repyesentatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date -
1
BUILDING PERMIT PERMIT#��
DATE VALUATION 3197,342.70 LOT 27+9 TRACT
!()�iG4CI
JOB SITE 47-475 �' �.?�r. MONTANA
APN 693-!1 4-53
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Cali ,k0l AY & L".ON1P.4'
C A vADAY & COMPANY,
s7o �.1�.C�i}.;�;,8uirl o .w l K[V.-rt;, .�iirm 208
1: 70 3ii.L:n:}ji�.2.�OLL.f3�iW DOW. SU17Y 208
Sr'+WA ANA t.'A V2705
sA.iyirA ANA CA '42705
f71. W;4-9151
USE OF PERMIT
�+tgli4,sz:� �.����1,� L►Vb�lr.Llrf)�fle
.
:iii►- PLAN .R4-t1.1k LOT Z9 -:�£ lt& f .LX .�1 NOT 1t�K;sr:iil E 81.Ct''
WMA, lift PLAN ; FJ!, .tfi[a;F3C1`i0N ON ?#1U .31?LE' USSU 1,N(.'•i,
OF S A AW PLllti 7YPE,
IRACT CMiTRUCTIQ4 3.6.9.00 SF
110VIL Ufi+ATIO 550,00 SF
OA.0 0.tisiylCARPL}RX 65S.(a(t NF
��yi y,. y 14,.00 r �1,7i��y q� / �7 3t,�
9AF,NA19�.,Ks�\..Le']r1� 6..s�"C.1fr,�1„'�itPa�ICTION
I �'
*y�� 77,,��� �++� ,y rt
AIMARN
C1107NS'rRU T)ON FEE 101 -IM -418-1000 :�ikt7.St7
MAN f 1'1t''•PK .f!tJ t ct1.0llii-419-31 R `1.198 a.4
A10 5�5.�)1410
fsd f..`7`fU 'Ai: VEL, $19137
PLUM 13CNO- Fa,' 101 Lii)k)•9j�-iSt� Sft�li5i0
r�g�ti)n+t€►vt'r�rtCytar��'-��?`i��t f(11 f1d1(1-�'41�H1�.t �+;�?�
C;ifiAiJfi43 ;,TX- 101.. 000-123-000
.A&' r .1N PIASLIO PLACI-.S - IQ,,=701-t7(0-ZS5.400
FEE Ot~P031 f lfj#-(l0ti-x&3 335 - �Sa.uv
SM13-WOW, (11rfV"A,11('.' ION /h MO PLAN t`141:!OX,
t,
;.X? 775 41
,,
n :LESS PRE -PA -11) FPk S
rI
-1.00
RECEIPT
DATE
BY
DATE F ALE
INSPECTOR
A
0%
INSPECTION RECORD
'r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3
Ducts
Slab Grade
Z !✓
Return Air
Steel
Combustion Air
Roof Deck
-W:i;; lo' <
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
4_5 _Z-C'� ,� --
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath "—
29
Final
%`Ao
Final
POOLS - SPAS
BL CKWAL� IP
O A P OVALS
R'
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
Q
S�
Heater Final
Water Piping
7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _ ' _
���
Pool Cover
Sewer Connection
�/
Encapsulation
Gas Piping
_ L�
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 E�
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
i..:.�..:>tivrw;A.i"'+.�?'MtKs"4''1�.%.':..-:±w..,.'i �RHi�.,+`S�iZ..rye+%"�`..,r'�r"Lv=�ii�'h"�f:%°s"i'�•%t+"r� + ":.�'i`+"ir�.�;y'.�i�.�. r �'�,,•;-:K,tYilt?6:>�9q;n'0S
P.O. BOX 1504 APPLICATION ONLY
Building / ry 78-495 CALLE TAMPICO
Address L' 7fO7 V I O �0�oQ LAOUINTA, CALIFORNIA 92253
Owner
Mailing
Address ��j / j (/
City k+� � i �✓ ZI 1 ITel.
Tq r Cf 9D
Contractor
State
State Lic.//jj City
& Classif. � JY Lic. # LI q
Arch., Engr., 1� ^
Designer L mO t�JQ\
Addre_ % _ �6ot9 i �jri y y6''
CitX__f_
�t (U Zlp `�71p�� Lic.t#
LICENSED CONTRACTOR'S DECLARATION
1 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
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5%siness and Professions Code: Any city or county which requires a
permit to construct, alter, 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) or
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 rive hundred dollars ($500).
1-21 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 ofcompletion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or sale.)
I'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.)
i 7 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. ❑ 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 (S100) 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 or the Labor Code, you must forthwith
comply with such provisions or this permit shall 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 adplicanl Date
Mailing Address
City, State, Zip
WHITE = FINANCE
LDING: TYPE'CONST. OCC. GRP.
Number 14* Za — b i1
al Description 7V ' -Z-61 � Cl r- 2'7Ck
Project �sption
`J 1 -
Sq. Ft
Size
Estimated
No.
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
t')
raw L„ r
t
AMOUNT
I
2S -v - C_
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 PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified.School District
47-950 Dune Palms Road
La. Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
F
Date 10/21/99 , ' APN # 643-120-051 ,
No. 19497 - Jurisdiction La Quints
Owner NameCanaday, & Company' Permit #
No, 47-675 Street Via Montana Log #
City La Quinta zip 92253 Study Area
Tract # Lot # 279" Square Footage 3079
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 'fies at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 - m;the amount of
1.93 X 3,079 ' ' or $ 5,942.47 the property listed above and`that building, -
permits and/or Certificates of Occupancy for this square footage in this proposed project may now beIssued
Fees Paid By cc/B of A/Canaday & Company
Telephone 7_71-9636
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $5,942.47 ,
Check No. 2016297584
Signature r�
[N,0TICEl Pursuant of A mbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approvalperiod in which you may protest the fees orotherpayment identified
ove wll 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
llect them on the Distdct('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan cheek application form to district copy for all waivers..
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
0.• 4,"e • t = - 1
'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
Y
Public Works Department for -one, or,more, of theJollowing
1. Verification that "rough grading is `complete, -and :the pad elevation <certificationS . Y
prepared by'a ,licensed aurveyor,.orl engineer dare_ on fele in the#Pu,blic Works
Department.
r 1,-ar�� ,rY....�'g�aw-.,.R•``,' ....'1.'a',=RkFt.",y,.r'naN,a�y�`...-Sr."wd1 A�'y1}.fa',""4,F`-`,:;r'ul[_'.'!,�f",.,•„r..sn..,.j
'' r-- , 2" CSC^`� VenficaEionth t infrastructure��rp�ovements.,and 't
.0
ri eld tfacttunprov4emehts �K
,
f' are completetorrsu##iclentlyadvaracedto warrant buildng:permitxis�uance
` :n,►''4, �'nn v = c ,.� a +r y i yj n d- c Y st u r a
y,,, ♦r �,'C '..•}'Y/4S ^xl.Y �§ _ ; _^S. f' y! � ��" RyTs M1,. INP [t'M'!. Si�ai.i '-!�•i'a# s.do_dN •
+} 1�'�rF'a'7'z' �.'G :-.4•r.'tr.� X'—•y }� ��, 1 . ,rtxy �: . r .. 'y+y v •. •J
3. Prepare an engineered -grading .plan'that provides for,or� lot; storm water retention, . r '
and have it checked and approved'by thePublic 1Norks"Department
• Tract 26524.(Estan6ias) f�; '' +F' '' ,•, .
• « Tra6t,26769 (Mountain View:Estates).
4. Prepare an engineered :grading plan that, provides Jor building pad grading_ in',,
accordance with the existing poilsreport and. tract ,grading plan, :-and , have ,°it,,
checked and approved by theyPublic Works Department .-^;
.. • t .a c.f .` '. K ';" ,''• .tet YA �'.«.. :., !.! ,� 4 i ..1 -
. Tract 28034 (South Valley Estates) ,e'
... i'. .tee Y .° y -•,Ys h' .�` ♦ R
.. ' t, .. a .!-. J .` n. :. _L � a•! a '� "� .. ',`` • _• d ,
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: ! '
LOTS 23� 3v�j
LpTS'a Zl e s, 2te 1 z7 , Z80, �8 f
io,126h ,
PUBLIC WORKS AUTH RATION ` « , TE'
F:%PWDEP'RDOCS%FORMS%PW CLEARANCE LETTER.ss