9910-170 (SFD)LICENSED CONTRACTOR DECLARATION
Lby affirm under penalty of perjury that I am licensed under provisions of
Chapt�mencing with Section 7000) of Division 3 of the Business and
Profe,. a s Code, and my License is in full force and effect.
License # Lic. Class Exp. Date 0t
r"
1
Date +' >�jr ! � ' 6ignature 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:
( ) .1 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 YT,1 •An,1^1c, 0 Policy No:
.AJ4l�
a+trsn 04.;, 41
66tV�1•W ('RA4tb r14 44.! `.LI kyA, #•.,V lA`t ), l ;0
(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,agFee\that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall fort6ith comply with those provisions.
Date: f C �`� 2 (Applicant ��• t� i
r i
✓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-fot inspection purposes.
,11 ? _17
1 1 Date I! (�/
Signature (Owner/Agent)
f
BUILDING PERMIT PERMIT9910-170
DATE VALUATION S197.,0Z,70 LOT 281 TRACT
(0JOB •�� '!�
47-715% VIA�.MONTANA
APN "3-12"53
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
' AINADAY. & C ONIPAINY
Ca;NADAYti+ COMPANY
1570 MX)1t.r1f:Jl< d.%ihi RIVE. SUI 208
1370 6R:OOl,.hOLLO-W DRIVE, SUITE 208
SANTA. ANA (*A 9-005
SANTA ANNA CA 02705
17114)7`4-9151 VAL)f 448.1
USE OF PERMIT
SIN 1.,1.'• l�.A 4.S1,1t' Jit L ,lt�ktf
SFU -.PiA14R44A LOT 2*1 PI:W:tl'>+:,u.4W-4INCI;t.;ti6OLOCIi"WA.LL
t W 11(.KiL. PLAN v1*',VK NI.V.R1^�£?1A 1'1(JN ON N i q,.!H! .k; 15.81.IAM.Ji UP
°t it 'KA,N TYK.
'linitt►l."I� t�71CN„r,1T E:+v'".l::4ilor -1,0-n- o sib
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tv0N13TRt;C'.t 10N FhF 1.01 AW -41 �+re 00 59411.59)
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tAt.UXU113INa:T ksi 101-M)_419-000 5.1.86.50
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Attfifs 't119L>%, i'I,AC.t ti -RL -8 701-(di.)i/-2.55 $�dt3.ati
VEE J.)EPOSIT MI -QW -4-39-318 .5256 00
RT 111.TOTAT, C`()NSTPtT( 1(71N AND T}t,1A+1 C1.11iVK
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LESS F'RE-t?A.ia FCCIS
Vgt1.00
a xA U, VIF:NOW
$3,525.41
RECEIPT
DATE
BY
DATE F NAL
INSPECTOR
Q60
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Backs t Underground Ducts
orms & Footings % Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck /—,3/ -gyp 6 Exhaust Fans or
O.K to Wrap F.A.U.
Framing Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wali Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
ata— 11--7zly
Drywall - Int. Lath
/CIS Z Zfy
Final
Final - Y0 T�Co,
POO SPAS
BLOCKWAL(� ' PPROVALS steel
Set Backs I I Electric Bond
I I
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Tor
Shower Pans
Sewer Lateral
Sewer Conne
Gas Piping
Gas Test
Appliances
Utility Notice (Gas) V 0//'/ " I K", '
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rn��nh Wirinn
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K for Finish Plaster
Pool Cover
Final
COMMENTS:
i
.�j�•�;sw...==.. _..+��,�,_.,-ti'`i.-.�-r�; `k r'��.".;,__,,.,.-.•--."-'�-•---�..i',i�.-„+''Dw.:'y„',-w.-�-r-•.. s---`:..,-..-,sr,..-....-...,-•-f`�.,�,,�•�,,.r�..�.,:d».•�..,-. wr,,.+,�r*Jt��..r.-.r-,i'-rr`;r-.^•+•v'....+`•Ji..� ..-;,-•�'''`�
e ,
BOX 1504 APPLICATION ONLY
Building! M-495 CALLE TAMPICO
Address LT D3 ll� U P °' f l�h�G� Ot LA QUINTA, CALIFORNIA 92253
Owner ��},, �t d t n , BUILDING: TYPE'CONST. OCC. GRP.
Mailing GG� � AA // ,(
Address 1 -7 Q 9) l! . '��� '�1 � v �1
A.P. Number
City S Zip„ Tel. t,r� �� � kti � r):� „•. ��. � Q
�7� ' '�g � 7' Ya Legal Description 1
Address 5 G e .%, I
City ILIP Tel.
State sic.�� + City
8 Classif. 1 Lic. # �.
Arch., Engr.,
Designer
Address Tel.
City Zip State
)f 9D bn Lic. #
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
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).
C'. 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, Bulsness 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 buflding
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.)
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 contrac(or(s) licensed pursuant to the Contractor's License Law.)
i ] 1 am exempt under Sec. B. 8 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 ($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: 8, 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
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
Project Description
(-,� fD - (e- Ll -
Sq. Ft. / q NO. 1 No. Dw. `-
Size / 1 Stories 1 Units
Add ❑ Alter ❑ Repair ❑
PERMIT AMOUNT
1
Plan Chk. Dep. a• U Q
Plan Chk. Bal.
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:
:a
YELLOW =APPLICANT PINK =BUILDING DIVISION a
Demolition ❑
,
• '
r, 1
PERMIT AMOUNT
1
Plan Chk. Dep. a• U Q
Plan Chk. Bal.
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:
:a
YELLOW =APPLICANT PINK =BUILDING DIVISION a
Desert Sands Unified School District =� T
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 # 643-120-053
No. . 19499La Quinta
Jurisdiction
Owner NameCanaday & Company .` Permit #
No. 47-735 Street Via Montana Log #
City La Quinta Zip 92253- Study Area
,Tract # Lot # 281 Square Footage 3079
Type of Development Single Family Residence No. of Units 1
4
Comments Lake La Ouinta
At the present time, the Desert SandsUnified 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
j" 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 3,079 or $ 5,942.47s e property listed above and tyat building-,
permits and/or Certificates of Occupancy for this square footage in this proposed project may no1w, be issue `
Fees Paid By cc/13 of A/Canaday & Company Teleph6de,7719636
Name on the check
;li�
By Dr: Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $5,942.47
Check No. '2016297584
Signature
NOTICE: Pursuant of A emby Bill 3081 (CHAP 549• STATS. 1998) 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 nun from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to -
1 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 Copy - Applicant/Receipt . Copy - Accounting
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 frorn the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete,-, .the pad elevation certifications
prepared by a licensed- surveyor,�or engineer;;; are�o.n,file!'m the Public Works . ,' r
�E Dep artment G y
e , ,•9.sa.— } , t'1`�'.i sy2 [ki i' "' 3 �.ae S3L.L•S'3' r. 3.
• c } v 1 -
1110-61-
+ic.. rt`f I'? tia. ar . , 's f '!` 1• '
: r to - j,
,� �. �. �•,� � 2 :-� ; `Verification that infrastructure improv�her��uiredrtract�irnp�rovernents
�-•r•.�1�, .:,. _ � -"`�., are comptete;.,or,sufficieri_tly: advancedtofiwarrant�bu�ld�ng perrn�t:sst�ance�p; • � �' } �;
RAW
_ ..•�. �-a:r � Rte.., t�:. ,y ca.,* `�f•��z�'-''
3. Prepare an engineered grading plan that�providesfor on=lot storm water retention,
and have it checked and approJedby-Ahe Public Works Departmerit .
o • Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)'
4. Prepare an engineered grading plan: that `provides for building' pad grading in
accordance with the existing soils report -°and tract grading plan, and have it '
checked and approved by the Public Works Department.
• Tract 28034 (South Valley Es_ tater) r
,, - •- a .N- t x .:t ; els vt.%? ;.. P
r S ... ti L. -art - '� ' . +�'• `
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT:
LOTS '
iZrd Z-74 Z80) Z-0
PUBLIC WORKS AUTH IZATIONTE
F:%PWDEPT\DOCS\FORMSIPW CLEARANCE LETTER.ss �" ,
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:
BUILDIN&ADDRESS: 47-735 VIA MONTANA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:. 9910-170
Occupancy Group: R-3 Type of Construction:.. VN Land Use Zone: RL
Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17T" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 10-1-1--00----
Building
0-1100_ Building Official
POST IN A CONSPICUOUS PLACE