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0004-078 (SFD)' LICENSED CONTRACTOR DECLARATION 1' h?reby affirm,:urider penalty of perjury that I am licensed under provisions of Chapf?r,9 (comFriencing with Section'7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # i Lic. Class Exp. Date 591561 E1 .., 03/31/2( to cl/,71 to .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 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 y 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. My workers' compensation insurance carrier.& policy no. are: Carrier FR3�MONT COMP. INS Policy No. SE50-I199�0 ),4179 (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 work �s' compensation laws of California, and -agree that if I should become subj�ct to the workers' corrtpensation provisions of`Section 3700 of the Labor f Code, I shall forthwith comply with those -provisions. � • -' Date: - f ; "s l YAPPlicant % ' � 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 corre t. I agree to -comply with all City, and State laws relating to the building con ruction, and hereby authorize representatives of this City to enter upon the above-mentioned property;for inspection Purposes. ' %� VSignature, (Owner/Agent) w ``41f Date�`� -- ^ 3 BUILDING PERMIT PERMIT# DPTE VALUATION LOT 00"4)78 TRACT �JEE3d1,°D51.70 122 26152 JOB SITE APN !' ADDRESS 41-470 VIS. FLORENCE 6543.110.010 OWNER CONTRACTOR/DESIGNER/ENGINEER CMADA� &. 66_N PRAM `:, CANADAY &' COw"Y , 174801:. 1 ?TR 171'. #106' ;,-, 17480 F. I7TH Ff. it 106 , Tums CA 92780 TI:TSnN CA 92790 (714)508.4440 CBIA 4485-'- USE OF PERMIT MROL E FAM(LY I)WMIMG x'10 SPD -PERMIT DOES NOT INCLUDE BLOC.KWAI.L" OR POOL w ti1Y T11 XT CONSTRUCTION `. 3,(134.00 SP - , PORCH/PATIO 't 275.00 SIS' C3ARAGFJCARPORT 630.00 SF �4 ` ES'rJMATXD COST OF C0.11TSTRUMON 18D,751.70 PR y°I: iSlIlAU"RY a CONSTRUCTION TEL 101-000,418.000 •., $923.00 PLAN .HECK: FEE `` 101-000-439-318 SWI.14 . FEE DEPOSIT ~'1019000.439-318 -$250.00 MECHANICAL FEE 101-000421-000' $105.00 ELECTRICAL FEE 101-000.420-000 $191.29 PLUMBING FEE 101-000-419-000 $192.50 =0110 MOTIOAI PEE - RESID 101-000-241-000 $13.08 OR.ADINO FERE 101-000-423000 $20.00 DEVELOPER'RIPACT ME 5I,9a'7,00 BUB -TOTAL COITS TtUMION AND PLAN CRIEC : $4,139.01 LESS PRE -PAID FM. 3 -$250.00 TOTAL `'FLtIVfff FEES DUR NOW RECEIPT I DATE INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Z.rpp Return Air Steel Combustion Air Roof Deck -,c-v Exhaust Fans O.K to Wrap F.A.U. Framing — —U1J Compressor _ Insulation Vents _ Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath (Jp Drywall - Int. Lath Z, Final Final BLOCKWAd PROVALS steel POOLS ASPAS 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 b —pap Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances • Final Final p" Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fudures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final ,w Utility Notice (Perm) ' COMMENTS: I �,.W�v..�:�.-w'r..,'y.nwd'+'Yvs>y�wdT�sY'rfn+-Ys>fir.�u"'i►:.5�'vy""Y`"'1.*5t1-ir�-vvh'7�+i`^�.w3��"°A� _ .. ,. _rw�' � r �. .. E .th?,F�R: 1+..,,.+i;-."^a'°1�y1�y!`'":�,.,""✓rY.F1'r�[v*7•.-.--.J..c^...�•�iwr�.�"yw' . ,.. }"4 j rf/t C664) �-4 7U 70 P.O. BOX 1504 APPLICATION ONLY Building I t `� 78-495 CALLE TAMPICO Address �'/ (� 1 Q v i �U� �i LA QUINTA, CALIFORNIA 92253 Owner inn 'N QZM Gr BUILDING: TYPE'CONST. Or'.C.GRP. Mailing '^� ((,,���� /� .l Address ► bU T' Vl' �O l0 A.P. Number M0City } ZiP� Tel. G 4 Z• b S (� t l a S' i �h 7 W � 71 C,. �'QB' / L.� � � Legal Description 7Y Contractor Project Description Address 3 City Zip Tel. L A 1,J0 0' State Lic. City & Classif. �, � Lic. # Arch., J A Designerer !!'�� rr (,, } 4�'. `(� ( Address._ 'l, G .[ ' 1Q n Vt ej�' S �1 �`t 3 CityjZip r State �^�1-'C� � i � e- 1� 6�3 ic. # 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 Contractors 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 rile 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 thathe 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 ($500)• I[] 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.) Il 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 contractor(s) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. & 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 t7 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: If, alter 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 it 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 applicant Date Mailing Address City, State, Zip WHITE = FINANCE Sq. Ft. LJ No. Size J _Sto No. Dw. Units Newer Add ❑ Alter ❑ Repair ❑ Demolition ❑❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT Plan Chk. Dep. 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 Droperty Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT LTJ A>i . PINK = BUILDING DIVI31ON I Notice: Document Cannot Be Duplicated • Desert Sands Unified School District 47-950 Dune Pahns Road La Quinta, CA 92253 µ 760-771-8515 ' CERTIFICATE OF COMPLIANCE 1 Date 4/12/00 - APN # E43-110-010 No. 20285 - Jurisdiction La Quinta Owner NameCanaday & Company - Permit # No. 47-470 Street Via Florence Lo # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 3034 Type of Development Single Family Residence No. of Units 1 Comments SFD - Permit does not include blockwall or pool. M 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 3ollowing reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 3,034 or $ 6,219.70 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By cc/Bank of America/Sue Pelletier, Telephone' -760 771-9636 Name on the check By, Dr. Doris Wilson Superintendent ' Fee collected /exempted by' . Olivia Aguirre Payment Received $6,d 19.70 Check No. 200309956tH Signature NOTICE: Pursuant of Assembly Bill 6081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 day approval period in which you may protest the tees or other payment identified above 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 District(s) or to another public entity authorized to Dolled them on the Dlstrict(•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 _l ;<��r s�Yxb, � +'' y�.k, .t, r:.M+.,..►.i q�2•:��:r�•� � .rt���„�.,�.:: �. ���; _ ._� _;r�� iinh,s_>q—'T.�ar _ ..� -- ..r•:.r1x:,'�"bl . JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 Project Name: 0. L4 r o_ e Io Project No: Date: Project Address: UBC 6 ' Title 24 Other: Client: Sub -Contractor: Weather: S' wn n General. Contractor: Co, Architect: Structural Engineer: ESQ m �n� Location of Samples: Welding lbrocess / Electrodes: Slump (inches): Supplier: Time Sampled: Mix De igt"� Time in Mixer: (min.) Specified Strength: (PSI) Water Added @ Jobsite: (gals.) Admixture: Concrete Temperature: (°F) Truck If: Ticket#: Ambient Air Temperature: °F Field I.D. Marking: Welders: r'""'""" f Unresolved Items: None ;FX See below El Description of Work Inspected:p ((�� �; 0 1n m �to< �'� o S con _ 1 le. CO P eC2Ce)0 Ccx1le `1 COn r e- oo 't n cz tASi'n o S o r' ,� t h co h S W, c0 11L ' i - 1 its 0 0 Sr O� e o e n CCkw a`r orr,�c�ss©- os� Q¢ J X .v eh r C V o SA_r z l "r I hereby certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications & applicable building laws. Final report issued at project completion. Page A=Of Inspector: -'a G. L , 0% �1 lb��so Contrac or`s R rec _seritative: Cops CM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Certificate, of Occqpancy.T City of La Quanta Building and Safety Department OF*ti° 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: 47-470 VIA FLORENCE Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0004-078 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: TUSTINCA 92780 By: STEVE TRAXEL a' Date: -02-13-2001 Building Official