9807-188 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby 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 #' t Lic. Class Exp. Date
r� si :3 �� 3131 /00
Date ^ ! /r Jgnature of Contractor �'�� t n �`
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 11 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).
O 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 ofthe 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. -
(Jo<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 Policy No.*
VNI.CARE TNS'CO .4. dO-.f 19744179
(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 provisions of Section 3700 of the Labor
Code, I sh II forth4ith comply.with those provisioIjs.�
Date: ✓ r) / rApplicant �` t l.•1/C)Ll L�rr'
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 above1riformation 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-inspecfion purposes. '
- f l
Signature (Owner/Agent) s i Date t%2
PERMIT# CONTROL#
BUILDING PERMIT
DATE VALUATION. S15OSS74.20 LOT -97 TRACT ry((��,
yy' t 5,
JOB SITEI_
ADDRESS Q - J� �F 10PF
�_ {
APN 11tt
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CANADAY & t✓ONIPANY
CAN.ADAY & COMPANY
1570 }3C�Lk�kiIJL.:LOVV M i , SUl'� 40
1 70 h'C��'.[�klaL .0W DR1VE, Stiff!°E 208
S.A.N:t'A ANA t"A 9270-1
SA:td'1'A..ANA CA - 92705
CBL# ..448
USE OF PERMIT
CiNCLE PAv:. LY is WBULNI 3
•
r
S 6 - OLAIN lik - PM.ltff't' DOES NOT tNC.'a: bE IBL,OMV vr4.i: L OEt f'OO.. r
i.,AN c fiec- . f:.E'E REDUCED 750/o IKA �vt(71:'t'tkX ISSUANCE OF SAW,
PIAN 'TYPE;,
- AAcH�.•t Ol.V5ki�lr�.�%.{. A •en %.L��6 S'•
CGAKAGF�fCARP0,LT' 624,00 S2
4F
S a MIA; U) (,D8T' 0'u ¢''€)NSTYsr.N
b MAW 2�
P.cum l't t.4;VAIMAK
C0NS14JkVC1.1T0N 1VI?.k. _ 101-E00-4.18-000 1818100
PLAN CT' EO:KFEE -313 $17:3,73
Vic,,17,t?1 CitiiT. •l01-QUU-X139-31.3 4250.00
WdHAN%CA% $16.50o
PI UrmWICfEP;:. -.?Only(i�t/t�f-4�1(!9-/t?�fnnN1
([.
.:lA1RONd MOTIONIM, ^.RES1U .�4J1••{)t)0-A .t -•lJVQ WAS.VY
ORADING FE8, d0i-i)t►ri-tf23-000 �1r_�,fi6.
!%'RAS"t'RM1UKF'F13E " 22:5 -000 -*13-3442 $3.139. 1:1
ist pul.guo PL A.C.ES - RESIN : '701 W- 55-000
SUB'.IiC•XTA . COI�iSTRLJC,'L`IUN r1I�TO PLA w G:I EXX
K932.35
LE 'PRE,-:P�11) FEES
4250.00.-
4
f ci f A%J, ;I�t.�a %� ' F:EFUS DOE NOW
RECEIPT
DATE
By f
T
N
INSPECTOR
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
�. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Bac ,
Forms &,Wootings
Underground Ducts
Ducts
Slab Gride
YY
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
(p —
F.A.U.
Framing
(- Z Q S
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
(— —57
Final
Final
_
' •- —
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
? _ J
Encapsulation
Gas Piping
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
G. F.I.
Smoke Detectors
Temp. Use of Power
t
f
Final — —co
Utility Notice (Perm)
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 6/28/99 APN # 643-140-041
No. 18957 Jurisdiction 643-140-004 .
Owner NameCanaday & Company Permit #
No, 47-935 Street Via Opera Log #
City La Quinta zip 92253 Study Area
Tract # 26152 Lot # 97 Square Footage 2,507
Type of Development Single Family Residence No. of Units 1
Comments Lake La Quinta(Tract 26152)
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:
r
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 2,507 or $ 4,838.51 the property listed above and'that buildLi? .y
6.
permits and/or Certificates of Occupancy for this square footage in this proposed projC t;muy no -,'v be ;slued �4
Fees Paid By cc/CA State Bank/Lake La Quinta Communities�ti T ieethone'771, y636
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $4,838.51
Check No. 51152
NOTICE: Pursuant of Assf bly 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 frofA 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 Dislrict('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