0004-079 (SFD)LICENSED CONTRACTOR DECLARATION
I h� eby afflrm`.'under penalty of perjury that I am licensed under provisions of
s
Chapte 97commencing. with Section 7000) of Division 3 of the Business and
"Pro'fessionals Code, and my License is in full force and effect.
�-Ii''•License # Lic. Class Exp. Date
r
fate € t Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1. 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 .r B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
t
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:
Carrier FPEMONT COMP INS Policy No. BF -0-119990-141`39
(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
JC96e, I shall f61fthw;th comply with those provlsi6ii Axin ate: Applicant �-. P .;
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. w ,
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,l representatives of this City to enter upon
the above-mentioned property,fo`r inspection purposes.
l r
S' nature (Owner/Agent) Date
j-) _00BUILDING PERMIT
PERMIT#
P ERT*W. F'1'f F Siif.S!iMARY
DATE VALUATION LOT
$154,471.`70
000"79 'TRACT
CONSTRUCTION FEE
101.000.418-000
JOB SITE
ADDRESS 47-44(? VIA I?1sOF�'.'E J4C7E
-TPN
a
.1-110-011
.64.1-110-011
101.000-439-318
OWNER
CONTRACTOR /DESIGNER / ENGINEER ,
FEE DEPOSIT
101.000-439.318
CAI3ADAY & CO.kd3.iYAN"Y
CANA:DAY &. COWANY
MECHANICAL PER
1.01-000-421-000
17480 F_ 17TH 31.0106
17480 E. 177.: 9f,#1 06
�
101.000.420.000
MEW- N CA 92780
TiTv�3 CA
92790
101-000-41.9-000
$123,23.
(714)50$-44.40 CML#
STRONG MOTION FEE - RV131D
101--000-241.000
$15.45
USE OF PERMIT�l•
101-060-423-000
$20.00
DEVELOPER IMPACT FTE
$11907.00
wI�A-PERMIT DOES NOT INCLUDE BLOCK WALLS OR. POOL
TRACT CONSTRUCTION 2,995.00 SF
PORCH/PA•TIO 392.00 SF r
GARA;CIFJOARPORT 426.00 OF \'
H9MIATED OOsr Op? C0.»sMUCnOW
1.+4,471.70
P ERT*W. F'1'f F Siif.S!iMARY
CONSTRUCTION FEE
101.000.418-000
$832.00
- r
PLAN CHECK FEE
101.000-439-318
$696.16
FEE DEPOSIT
101.000-439.318
-x;250.00
MECHANICAL PER
1.01-000-421-000
$1.05.00
9LECTRICAL FEE
101.000.420.000
$171.85
PLUMBIT40 FLE
101-000-41.9-000
$123,23.
STRONG MOTION FEE - RV131D
101--000-241.000
$15.45
OR.AD1NO FEE
101-060-423-000
$20.00
DEVELOPER IMPACT FTE
$11907.00
SUB =fMA% CUNTi.RUC"3.SONAND ?PLAN CBPP
IXESS PRE -PAID {' 4250.00
• 'I'0'�A� P1t:1ZN1:�'�.', .!�.� 5 �171� iYC!fdV �,t+2�,7ti
f
r
RECEIPT ;4:. DATE (I/BY lAn I DATE FINALEDv INSPECTOR
INSPECTION RECORD
- OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— —63
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ e>w
Exhaust Fans
O.K. to Wrap
--two
F.A.U.
Framing
Insulation
.--Ir- —.90
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
' . Lath
Final
Final
BLOCKWALL APkOVALS
POOLS - SPAS
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final --(�
Utility Notice (Perm)
COMMENT•
�e,%Ls o /c 11 ST /6—era
4 666
�,. P.O. BOX 1504 APPLICATION ONLY
Building J O'o,
1 78-495 CALLE TAMPICO
Address C 7 `t` LIO �(Z, LA OUINTA, CALIFORNIA 92253
Mailing Address ' 9. I ��'1
City' % " Zip Tel.
7/ ( 1C
Contractor
Address
p I Tel..
State Lic. PC.#
ity
& Classif. � ri 9995
Arch., Engr.,
Designer
Address C C) )
Y � ` '7 58 L }
City ,/ Zip State
Q 1 Vita C•t yC, 7 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
effect.
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, 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) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for thealleged 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).
[] 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I1 1, 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.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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
I'1 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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: If, after making this Certificate of Exemption you should become
subject to theWorkers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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-adplicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number �(
egal Description
Project Description
Sq. Ft.{A "� No. No. Dw.
Size / Stories Units
New Add O Alter O Repair ❑ Demolition ❑
VAIU
\IA11 A C
g1-ry OF ILA QUINT
Estimated Valuation
PERMIT AMOUNT
t
Plan Chk. Dep. > 2-12 1
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Renter Line
Rear Setback from Frear 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 DIVISDON z'' '
Desert Sands Unified School District
47-950 Dune Palms Road
Notice:, La Quinta, CA 92253
Document'Cannot Be Duplicated 760-771-8515 j
CERTIFICATE OF COMPLIANCE
Date 4/12/00' APN # 643-110-011
k No. 20287 Jurisdiction La Quinta
Owner NaameCanaday & Company Permit #
No. 47-440 Street Via Florence Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 2595
Type of Development Single Family Residence No. of Units 1
Comments
SFD - Permit does not include block walls or pool.
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:
Aj
EXEMPTION NOT APPLICABLE.
This certifies that school facility fees imposed pursuant to Government Code 53080 in f►e amount of
`2.05 X 2,595 or $ 5,319.75 the property listed above and that building
Permits and/or Certificates of Occupancy for this square footage in this proposed project may now b:, issued
Fees paid By cc/Bank of America/Sue PelletierTelephone 760 771-9636
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $5,319.75
Check No. 2003099565
Signature /
F
TICE:Pursuant of Assembty BNI 3081 (CHAP 648, STATS. 1998) this will serve to notify you that the 90�ay approval period in which you may proteaftlte fees or other payment idert6fied
ve will 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 Dlstrict(s) or to another public entity authorized to
ed them on the Distdct('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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting " ,
Of
PUBLIC WORKS CLEARANCE LETTER .
Y
'FOR
-'CUSTOM HOME LOTS
- i.
4.
nr ,Dear Bwlder k,�
Prior to�issuance.of a building permit, you Will 'be required to obtain clearance from
Public Works Department for one,. or more; of the following
1..
Verification that rough grading Is complete, and the pad elevation certlficat
_
a licensed surveyor, or erigineer, are on file m ttie Public W�
prep'ared ,tiy
y
Department:
r
2
Verification that infrastructure improvements and^other required tract improvem
are complete, or sufficiently advanced to:warrant building,permit issuance
M 'j '
_ f T _,. �F 'N r�: �- �f. t�A +st wt � '•j =.-}�i
-3:
Prepare an engineered grading plan that provides for. on lot storm water reten
�y
-and by the Public Works "Department
and have it checked approved
• Tract 26524 (Estancias)
-
• Tract 26769 (Mountain View Estates) t: ';�
4.
Prepare an engineered grading plan that provides for building pad, gradir
accordance with the existing soils report and tract grading .. plan;. ha
Fang"
checked and approved by the -Public Works Department.
• Tract 28034 (South Valley Estates). ti
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT'
TRACT:
LOT: a3> Ia�
.WiFu'dW611VIA0HORIZATION DATE
F:IPWDEPrDOCSIFORMS%PW CLEARANCE LETTER -ss
Certificate of Occupancy.
City of. La -Quin ta
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:
BUILDING ADDRESS: 47-440 VIA FLORENCE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0004-079
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL,
Owner of Building:. CANADAY & COMPANY Address: 17-480 E. 17th ST #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
'�! d Date: 10-28-2002
t
Building Official
POST IN A CONSPICUOUS PLACE
MIM
. Occupanpy-
City
rtificate of Cea
of LaQuinta'...
Building'and- Safety Department of
This Certificate issued pur%suant to the requirements of Section 109 of the. Uniform Building Code,
certifying that, at the time of issuance, this structure was in' comp/lance with the various ordinances
of the City regulating building construction or use. For.the following:.-
BUILDING ADDRESS: 47-440 VIA FLORENCE
Use Classification; SINGLE FAMILY DWELLING Bldg. Permit No.: 0004-079 -
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
4. By: STEVE TRAXEL
( Date: 10-28-200.2
Building Official