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0203-039 (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 #f p Lic. Class Ex Date, Dates Signature of Contractor " !� <° /•�'. �'� OWNER -BUILDER DECLA` ATION 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 Datet 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,certlficate 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 86 tion 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: Camer�.'Policy No. 1tid139D=19! (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 tharif/�ho& become subject to the workers' compensation proViiis on✓pf �Se Iori3700 of the Labor Code, I shall forthwith comply with those p'rov,669s Date: +°ems 42 a` Q 2 Applicantc',. -rWarning: Failure to -secure' Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to' $100,000, in addition to the cost of compensation ",damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety; - for a permit subject to. the conditions and restrictions set forth on "his. application. 1.'Each person upon -whose behalf this application is made & each person at whose request and for whose benefit work is performed'under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employee' 2. Any permit issued as a result of this application becomes null and voi t f work is not commenced within 180 days from date of issuance of su permit, or cessation of work for 180 days will subject permit to cancellati I certify that l have read this application and state that the above information is correct. Cagree to comply with all City, and State/�ws,relating to the buildi g construction, and hereby authorize 'represe�nfatives,�o`f this City. to enter up n the above-mentioned property foroinspection p6rposesf Signature (Owner/Agent) f "� ° �f "�Z�- Date A , BUILDING PERMIT PERMI�Ti/#Ory, 039 LOT TRACT DATE VALUATION IU 45, 46. 117 Z •* .� Z. ADDRESS 4 1 [7^' 0 I FA FLO.n EA APN OWNER CONTRACTOR / DESIGNER / EN (NEER CAt ADAM & C,01b9PAWY CIAR.NDAY & L LNW"Y 174,80 E 17TH *)X16 17480E. I'M -M. -H-106 H'1©6 "`Y.1'S'M CAS 912710 TT.IMN CAS 4=0 (714)508,,4440 CM0 4465 - USE OF PERMIT lim f'�if IrSC' 'Jd �( 11iC3 391') ') 1,0T 10 P1,AN 10AP_ PERACT DOW, 110T INC) '11ri%`731JC_"ICI+ WALLSy , PO L, SPA -OR DRIVEWAY ,PPR )ACC TRACf.CONSTRUCTION X4221 00 SF P00.0 '171�A►`.1`6Gt �f70.00 SCi' .RAOMMPORT 4310,00 SP � 8MM& cod,'° OF f:t)A61MMOV 145,1 46.40, J�r:): SaUVOIAARY �nN�r��c��:`rlQ�a �1�� • � O� pi�c�a 1 �w�1Cti1' �'�tal3f� !S fail GYi:L�s✓ .FItr Y0'Y-t?C)0=�t-39�$tti X65:8 MEC1`1.AN1CALPIMM 101-WO.421000 $quk 91:WITRIC:.A 1, PTO, -'000 :,$14405 PLUA1iWHO FER 101-000-419-000 $12$3 S'.1`RCi3+YCiMOTIaN FEE -'RESID 101.030-241-000 $14.31 "� Ki12.�;ti3CNC1;"+.i�j " 1.01:«t5C)i?-4'"�'�•�t9�9U ��,�f� DF.V210PER IMPACT "ILI' �1r900,0?J1 R s �t�1� A .CAAI''£f:0=09AN:C PLANTC°1+ ",. $1,772.2+t L� --XV,I'T A). Aa11M4. V.rEl 9.D1+X�.' .iVOYH $1,772.24 CITYOFLA(lUINTA ' FINANCE ®EPlo RECEIPT DATE :y g BYE DATE FINALED INSPECTOR 'Ir INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ©Z Exhaust Fans O.K. to Wrap9 .p ?_ F.A.U. Framing Z Compressor, r, Insulation p. a ti Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath tt If • a Z -( Drywall - Int. Lath 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines -017 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 . 1& .p z 5 7 Encapsulation Gas Piping Gas Test 5 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) �0 COMMENTS: Certificate of Occupancy City of La' Quinta Building and Safety Department This ,Certificate issued pursuant to the requirements of Section 1.09 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: 47-630 VIA FLORENCE Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-039 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL. Owner of Building: CAN ADAY & COMPANY Address: 17480 E. 17`h ST. #106 City: TUSTIN, CA 92780 By: STEVE TRAXEL Date: 02-12-2003 Building Official POST IN A CONSPICUOUS PLACE