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0203-044 (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 # Lic. Class Exp Date 591561 702 �ISlgnature of Contractors OWNER -BUILDER DECL'A'RATION 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). 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 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. .(T) 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:a MATEFUND Policy No. 1�¢a1341Q1 (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 thdtoif /should become subject to -the workers' compensation provIFs` rps"of-ISection 3700 of the Labor Code, II h` 11 fBrthwith-com I with those rovl.slons Date: , Applicant a"� ✓ rZZ_46 oe .Warning: Failure to secure Workers.' Compensation coverage is unlawful and shall subject an employer to crim nal 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 phis 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. j' agree to comply with all City, and State, laws relating to the building eF.•f, .X i construction, and hereby authorizer�epresentatives of this City to enter upon . ice the above-mentioned property fonms,pectiori purposes t ti Signature (Owner/Agent) r=>> Date g'�;-" see 4 PERMIT # BUILDING PERMIT DATE VALUATION LOT TRACT izi JOB SITE ADDRESS 4T..3'8'��"�.�A.�.���eCi�i.�N APN OWNER CONTRACTOR/DESIGNER/EN INFER 0,. T'.€�. AY Vii. COW. W. -ANY CMADAY & CCS GAMY "r"u:rW CA 92780 `.CUTRW CA. 92780 -714)508 .40 USE OF PERMIT TOLE FAMILY DWEVANG SK) • 1.x'1` 125 PLAV 109. PI?i .IT tDCiMS INOT INaW,01t, A. LDCIC W}l.L-011 P004 SPA OP, DrtNYWAY AF'PRO,/twC!H., TRKCT CONS7'�+`Uvi1014 ?922.00 SY POM•ir'PL- TIO 37b.Ji1 SF QARAG1WAfif'Oft`f' �i:19.00 Efff M,71113) COST OF CONYMUC11110H 14.541416,40 ("O N13TRUC"1ION 4?EE 101.000-4184000 500015tt PIAN CHECK rErt, 3b'1EC1'1"1G.ov, MY, 101.000.421.000 $90.150 )pi.}�i."!'fi�1L',.ftH..l�:t? i0t••0?!0�l•SS1••0.�41 �fd�..ri:� 1,1,M01),40 FEE01.4 00-419o, 00 $17!4W P3�r-ii��5'b I D I �-0��1��'{O��.i,,1)-((�1�o�o $14,51 y �Iq'1y'�iklJ••�AtC,�y@�9yC�Y�r',pElow 5'JIG.1'�?P MIM Mire, J'. 4l,i. G°1.#{1:i7°� ,A "`74JN- V140.60 fii J • -` yF`•�• .. g p ��yr�. S p.��ypy 1, f •5yp �p �•ry�fyvt ►3 �'.6 1.110 A -IL, (11,C* MIRTd 11101,, �Stl'0 ,i.'",A.iJ"r:A:F� Q..1L'L S:•S.a'l�i. $3,214.29 q��t ,ry •�P•�,,21 4.a 9 . o .. rURMIT MoS .13Uk .i!1�'Cg tJ 2 CITyOi' QUHNRAA )ECEIPT DATE i.t BYDATE FINALED INSPECTOR Y. _ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION '. ': DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — S Underground Ducts Forms & Footings 5 — Ducts Slab Grade Return Air Steel Z Combustion Air Roof Deck — - �_ Exhaust Fans O.K. to Wrap p • , p 1j 57 F.A.U. Framing • e Compressor Insulation , cZ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath p- . e L Final �� Final POOLS - SPAS BLOCKWALL APkOVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines — —p Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection O . ((p, 0 2 S'7 Encapsulation Gas Piping Gas Test . p 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) 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 # Lic. Class Ezp. Date - 591561 B 3/31/02 Date Signature of Contractor 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 rnmrongntinn will rin tha 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. Myy�workers' compensation insurance carrier & policy no. are: Carrier STATE FU Policy No. 1661391-01 (This section need not be completed it 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 shall forthwith comply with those provisions. Date: Applicant 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 for inspection purposes. BUILDING PERMIT - DATE VALUATION $145,146.40 . LOT PERMIT N 0203-044 125' . TRACT 26152 JOB SITE ADDRESS 47-380 VIA FLORENCE APN 643-110-013` OWNER CONTRACTOR/ DESIGNER / EN (NEER CARADAY & COMPANY CANADAY & COMPANY 17480 E. 17711 ST, #] 06 17480 E. 17TH ST, #106 TUSTIN CA 92780 TUSTIN CA 92780 (714)508-444.0 CB1,# 4485 USE OF PERMIT SINGLE FAMILY DWELLING Or LJ - LIJI 16J rL.l'll\ 1VL. CLiftavaaa uva.+u a�va a, WALLS, POOL, SPA OR DRIVEWAY APPROACH TRACT CONSTRUCTION 2,422.00 SF PORCHIPATIO 378.00. SF GARAGE/CARPORT 439,00 SF ESTBIATED COST OF CONSTRUCTION 145,146.40 PERMIT FEE SUA04ARY CONSTRUCTION FEE 101-000-418-000 8800,50 PLAN CHECK FEE 101-000-439-318 $165.98 MECHANICAL FEE 101-000-421.000 $98,50 ELECTRICAL. FEE 101-000-420-000 $142.05 PLUMBING FEE 101-000-419-000 8125,75 STRONG MOTION FEE - RESID 101-000-241-000 $14.51 GRADING} FEE 101-000-423-000 $20.00 DEVELOPER IMPACT FEE. $1,907.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK LESS PRE -PAID FEES TOTAL PERMIT FEES DILE NOW RECEIPT DATE I BY I DATE FINALED Signature .(Owner/Agent) Date I I $3,274.29 $0.00 $3,274.39 1 C f Occupan,cyCerti cate o�. a. . City of La Quints BuildingSafety and Department OF 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: 47-380 VIA FLORENCE Use Classification: SINGLE -FAMILY DWELLING Bldg. Permit. No.: 0203-044 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CANADAY & COMPANY - Address: 17480 E. 17`h STREET #106 City: TUSTIN, CA 92780 By. STEVE TRAXEL ,. , Date: 03-06-2003 Building Official p POST INA CONSPICUOUS PLACE