0203-041 (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 `
102
Date Signature of Contractor�,r Y�
OWNER -BUILDER DECLA RATION
I hereby affirm under penalty of perjury thafl 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
1 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. ,
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 STNrF, FtJIN :f Policy No. 1661191-41
(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 hould become
'subject to the workers' compensation provisions of Section 700 of the Labor
Code, I sh}I.forthw't. c mply with theWprovislon
Date: �A�pplicant j�^��j��
�r c..�-
Warning: Failure to secure Workersompensation coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensat on, 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 forthon ,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, indemmfyi
& hold harmless the City of La Quinta, its officers, agents and,ems�
ployee
2. Any permit issued as a result of this application becomes null and void I I
work is not commenced within 180 days from date of issuance of. suc `I
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and S�tate'�laws relating to the buildi g
construction, and hereby authorizerrepresentatves of this CiMy�,enter upon,,
the above-mentioned property4for/inspection�hpurposes�""—. s J?
Signature (Owner/Agent),,. Date �p✓?'"'
BUILDING PERMIT PERMTk
DATE VALUATIONLOT TRACT
S145,146AG 119 2615*2
JOB SITE w
ADDRESS 47,570 Wt'9,.YLO—Ul "M
APN
OWNER
CONTRACTOR/DESIGNER/E-GIN ER
(1ANADAY & tiy;OUP:WY
C.rA%".x4DAY & c;:°OWA1,1 ?l
174-80 E, 17TAX Ur, #'111 06
17490 X 17T -1-19Y. 0106
nxnaw CA 92780
17=179 Ch 9MO
(114)508-4440 CLO 4485
USE OF PERMIT
SF'O a 1.0P 119 TAX A14 IUAP_ P.ER ro3IT VVES TMST IAIC11,01)X T?L.00K
WAI,L14 P004 SPA OR DRNMAY APPROACH ,
TRACT (.!ONSTRUCTION 2,422.00 19F
PIyDRC:I•M"A"flo M1.60 IS
0ARAGFJ,.,ARP0KT 439,00 Ir
13Cn"AED COST OF COMCLUION
.1.45,146.44)
y
PFAyM191M SUIUM RJ
C011311WUMION FE 103-000-418-000 SM30
PLAN CHOCK WIFE
MM"IwA.C. FE9 "101-000421-000PLUMDMO
,�k.�;,Ciit:IC,l3:I:.1�`t?I t Qfl �•�fii�w�2(i�-€1�bU �347:.CtI
Piss
.M10a0I.1MOTION ASSID 101I.OW-241.000 $101.31
1
CIRADINa. pn� 101-000423-000 $20.00
r
D01.1BLOP?R IMPACT IES
•4
` ... ♦ '' I�•:., CT�LAN FIAidY" Vt6+W� YCTLn!aJ q
9
$3,174. 29 .
�y(E
AVIMP
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i4YA.._.L -)apJ 'FOS DUE VOW
jui b 1 l
CITYOF Q1111VTi4
�►N�NCEO c
RECEIPT DATE tr 3,,y
t
BY
,
DATE 5fNALE
INSPECTOR
.;'
. h
b 3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—7z
Underground Ducts ;
Forms & Footings
-_ -B
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ >r -.
Exhaust Fans
O.K. to Wrap
p -Z.O Z
F.A.U.
Framing.
%.o2—
Compressor
Insulation
o - e Z i2zVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
A . L w �-57
Drywall - Int. Lath
Final 3
BLOCKWAII APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
t
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
Pool Cover
Sewer Connection
�Q. (� • OZ 5�'
Encapsulation
Gas Piping
Gas Test
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) D 3
COMMENTS:
Certificate -of Occupancy.
T`o
City of La QVinta
Building, and Safety Department OFTM
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
f
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 47-570 VIA FLORENCE
s .
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-041
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY & COMPANY
Building Official
Address: 17480-E. 17" STREET #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL -
Date: 03-24-2003
POST IN A CONSPICUOUS PLACE