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