0203-042 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapjler 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
r
Date < A) a, =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 (Ser.. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with Iicei)Adel
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. '
(,r)' 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 STAIR FUND Policy No. 146091.01 _
„ (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 sObject to the
workers' compensation laws of California andragree thaMf Iwshould become
subject to the workers' compensation,provisionls�of Section,3700 of the Labor
Code, I sha oforthwjfh3cpmply with those proulstons�,; ,✓irk
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 personate
Whose request and for whose benefit work is performed under or pursuant to. f
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 dresult 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.. t
correct. I agree to comply with all City, and Siate laws relating to the building
construction, and hereby aut�honze/representati� e`s of this. City to enter:upon
the above-mentioned property for'inspectronpurposes`' e
�Sjgnature (Owner/Agent) •r•� Date.45
° /r
PERMI
I. BUILDIIVG'PERMIT
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DATE VALUATION .;$145'1460) , LqT 120 TRACT 26152
JOB ADDRESS 47i 5411 W , .1.?.�.�OR�.�T�� ;
APN
OWNERV
CONTRACTOR/DESIGNER/EN INFER
CAI4ADAY & c.'CA;L�iT?a!3•S1t'
Cin;,l DAY & C"CaM13t ITY
17480 F_ 1 aT1i 1 ,ill 06
17480L 3.Tfa r. X106
l a t CA 92780
'Cfm°t" CA 92780
ly714)Sd3> a4 (i MIA 4.485
USEOF
PERMIT �g�g q qy q��{m�
0.7.5 CR �t'.t91CViJ:Lv:T D'V�J•S'.:.i,.:t, No
SM - IVY A26 Pi.,JVIR JIM Pffl-WIT DPJ&'i NOT INt:P..UDE BLOCK
IRALL , I)OO$,4 51'A iP,1)RWPW.AY APPRiJ. cii ;
YC37 t °%tP k t 9f i 1fit. til; Sly
0ARMIEUCARPOWC 4"M PP
ENll'MAIE0 COS': OF C019STRU "LION
3,45,1laM10
F tice' d1''li E 9 Lrm WWIY
V,0HS'I'9t1,bC'`TK''rN'R . .1:1.000.438-0 0
PLAN CHM FE-ze 101-000-439-318
1b9IX31A111C.d1LnS 101.000,.421.000
iy1.Wl"WC ,fF.?., .161.-000-420-000
PLUM NOFF}X 101.0001-419.000
S'1`WN0 MOTION FE09 o R MS11D 101-000-.241-000
t11�1Lh1.1 101.000- 423.000
1:AWELOP1M IMPACT 11.92 �3,yffri.C�
•-.�a,�r �.${,�`f t�,tryv'3 �yylr'yv ,'1 A.�T��y y p }���r��y
—..� N �'tiRL',�,1YIANI4f]..S:J�..d►.
pb:7 e9+y ,C q
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JUN b 2001y :�7JpEMrri!~q S D CIE, 1J.0Wr
PITYOFL.AQUINTA
FINANCEDEPT
RECEIPT
DATE S�
BY
DATE FINALED
INSPECTOR
z-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— 1-5-01-11
Underground Ducts
Forms & Footings
— - p
Ducts
Slab Grade
-
Return Air
Steel
Combustion Air
Roof Deck
9_ _
Exhaust Fans
O.K. to Wrap
m • a•o Z_
F.A.U.
Framing
- , 0 2� S
Compressor
Insulation
o - < co
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
j ,o Z_
Drywall - Int. Lath
4.02.
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-- C.)
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
p -( o Z_
Encapsulation
Gas Piping
Gas Test
i rD 7
Appliances
Final
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) -p
COMMENTS:
(Certificate'o-f Occupancy
City of La Quinta
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
ol%wing:BUILDING ADDRESS: 47-540 VIA FLORENCE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-042
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
By: STEVE TRAXEL
Date: 02-07-2003
Building Official
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