9806-227 (SFD)r
r LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions. of
Chapter 9 (corrimencing with Section•7000) of 'Division 3 of the Business and
-Professionals Code, and my License is in full force and effect.
License # x' ` Lic. Class Exp. Date
r. 3/311001
V0ate 0 17 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 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
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.
(1) 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:
CarrierPolicy No.
� . ttt jd
(This sectionlneec° otlbe completed if the permit valuation sfor)$100 00 0V(This ss).
() 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 , gree that if I should become
subject to the w�6rkers' compensation pro sion's of Section 3700 of the Labor
Code, I sh II fo . ith comply with those,p ovisions. '4
yDate: _
Applicant—,
Warn g �, ilure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
Of.the Labor Code, interest and attorney's fees..
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to •the conditions and restrictions Set forth on his
application. , I
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit Work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&'hold harmless the City of La Quinta, its officers, agents and employees.
'?.,Any permit issued as a result of.this application becomes null and'void,if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the'above information is
correct. I agree to comply with all City, and State laws relating to the buildirLg
construction, and hereby authorize representatives of this City to enter upon
the,above mentioned property for in purposes.
,,Signature (Owner/Agent)
-BUILDING PERMIT PERMT# .
r'
DATE t VALUATION LOT TRACT
9806_227
JOB SITE _- -2
AP _ ...
ADDRESS.
47=60q i A ! i
3_. I 0-.fk'VA
OWNER CONTRACTOR/DESIGNER/ENGINEER '
CrANA:DAY & COMPANY C"psNADAY & CONIPfANY '
1570 t R,00Ii.1'iOT.,1.OW 13R1'VE, SUrfF, 208 1570 BR001;'HO1.1.(:)W DRWEy SURT 2108
'ANTA—AUNAA; CA 92705 SANTA ANA CA 92705
1 (7191751-9151 OW 4485
USE OF PERMITDW�LSt ,
.l • Ll 51 Ls. 1 V
SrD PLAN 352 1 irI2M1T DOES NOT dI22oi 1XDE BLOCK WAu1 I.S OR POOL.
r
'
-MACT CONSTRUCTION 2,628.00 S1:
POi2.(,'IHfPA.i iO 330.00 SF
OARAGWC.AR.PO'Wr 542.00 SF
TeS TIMI f T is CQN T OF CONSTRUCTION
I
PERMIT FEE SUMMARY
VEE i'. EPOS.TT 101-000-439-318 4250.00
r~CizJ3't'kiifF ['ialt+f F'wzlt)1,;f1f113.�118.0011). SR.tJ,50
ri s r•iIGI;C 143C i.()i tl00 `I ly s1Ss �"i t7:
Pvffi!L'1_iA.NI:CALh"(H l/Uf �)yt�ftgl�i'_}fgfi�l}i►(l�l;,
@$ti.i�l!
W 1�..,1RICAL bl.l:' 101
b
i+� tFAlFtlt t;xk'trF' itnnjl t 1{i 1l9-(0) Xma
��Jyilk_�)VV iVlil,l j ..4.4Y f'�.+L.� �r✓Jli% �l V.t `1lVt/'aNJ-'VV6iiJ.g/
_
t KAJI)IN W_h i4�1 tl4fl142.3-11JOU $2t),Ull
tNF'RA,'ITRUC'i URE FEF' x,15.000,.4:13-312 S:3,491",
kti
ART I3V'.FUBL'IC PI:ACE.8 - Rf"31 '701-0004255.000 31'15.13
UI
4
fa(tH iY)°�s�f°tT��aN 1`dl t(sj__ AV0Pl„,;nja�r�f-ECK_
Fi 15{iK 1j
AUiG,j2 61998 t� SS PRE->aA f,'LTE
4250.W
TOTAL P.EIWIT FELS DUE NONIT
,5.,05.39
j
RECEIPT
DATE °
BY
DATE FINALED
INSPECTOR
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 / /
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing ,(is
Compressor
Insulation -2 _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 4- -6--
Drywall - Int. Lath
112
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
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 3
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) i
COMMENTS:
Desert Sands Unified School District ,
47-950 Dune Palms Road
Notice: E La Quinta, CA 92253
Document Cannot Be�Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 8/26/98APN # 543-110-026
No. ' 17587Jurisdiction La Quinta
Owner NameCanaday & Company Permit #
No. 47-695 Street Via Florence Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 2,628 1
i
Type of Development E Single Family Residence No. of Units 1
Comments
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 replF-cemegt mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason: ,
y EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in..rhe amount of
1.93 X 2,628 or $ 5,072.04 the property listed above and that ildmg� w}
d uu
permits and/or Certificates of Occupancy for this square footage in this proposed project max;nnw tje issued,
Fees Paid By CC/City National Bank/Cariaday & Company TiPphione :714-751-915I�
�
Name on the check 1,;:, ? t, r-�
By Dr. Doris Wilson
Superintendent �x {'
Fee collected /exempted by Juanita Green Payment Received $5,072:04
Check No. 01058611
Signature '
NOTICE: Pursuant of Assemb Bill 3081 (CHAP 549, STATS: 1996) this will serve to notify you that the 90 -day approval period in which you may prote-t the fees or other payment identified
above will begin to run from th4 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
collect them on the Districl('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 Dept./Applicant Copy - Applicant/Receipt Copy - Accounting `
gip} �y,,. �. a .wr— ��,,� 3A`� yi ,.,"+t• '.c"` AM�`ry1 $444.01111.11D+n: ;s". T
�+r 1 • ��IY��'� r w
twl
ildinq�' P.O. BOX 1504 APPLICATION ONLY
l �� `` 78-495.CALLE TAMPICO i
Addrress "'4%¢695 Via Florence LA QUINTA; CALIFORNIA 92253
r%
Canaday & Company/LLQ, LLC
BUILDING: TYPE'CONST.
OCC. GRP.
Address 1570 Brookhollow Dr., #208
643-110-026
A.P. Number
Tract 26152,
:.ot 225
City
zip
1914/751-9151
Santa Ana
92705 l
Legal Description
Single Family Detached Residence
Contractor It
Canaday & Company
Project Description
Address
1570 Brookhollow Dr., 0208
Santa Ana
Z�2705 '
/114/751-9151
State Lic.
& Classif. 591561
City
Lic. # 4485
Sq. Ft. 2,628 No.
Size Stories
: No. Dw. 1
Units
Arch., Engr.,
Designer Len Nobel Company
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
VV:s BOX 16606
T2,14/559-4305
cit
ryine
Z�2713
State
Lic. #
f�
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.
Estimated Valuation
`' t
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.Susiness 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
PERMIT
.AMOUNT
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 Any Section 7031.5 'any
i
Plan Chk. Dep.
exemption. violation of by applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
Plan Chk. Bal. a
V..
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
Const.
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
Mech.
.
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.)
Electrical
I'1 I, as owner of the property, am exclusively contracting with licensed contractors to corn
Plumbing
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
S.M.1.
Such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
I'! I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Infrastructure
Date Owner
WORKERS' COMPENSATION DECLARATION
'I hereby affirm that have a certificate of consent to self -insure, or a certificate of
Worker's C"i e y''r �r f@gC� l�bf�a4litied copy thereoJR?f1V&0,0&b1ff5e,,
Policy No. Company
r] Copy is filed with the city. ❑ Certified copy is hereby furnished. I
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.)'
I certify that in the performance of lhp 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., It, after 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.
r
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 if work thereunder is suspended for 180 days.
I certify that I have read this application and slate 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 aliplicant Date
Mailing Address
City, State, Zip
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Fear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by: PAI U
Validation: MY 0 1 i998
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVI OJ—N ®F Lia QUINT' `
-ES I/FME., Inc.
Structural Engineers Date : 5-8-98 By: R.R.W.
1921, East Carnegie Ave., St. 3 J
Santa Ana, California 92705,
p y _CO.Project Name: S
" outh Shore
Company CANADAY AND CO --- ..............------...._ - :_.._ .. _ On .,:... . .
Address : 1570_Brookhollow_ Drive, St. 208 Lake La Quinta
Santa Ana, CA_ 92705 _ _ _ _ ESI / F M E Job No.: 298-8436
Contact : Steve Sante _ Project Eng.: R.R.W.
Phone : -(7114)--751-..9.1.51- FAX: (714).751'9152 PH.: (704)261-1811 /Fax 261-8506
X Phone Conversation Field Meet'g Meet'g @ Client's In -House Meeting
City. of La Quinta
Department of Building and Safety
78495 Calle Tampico
La Quinta, CA. 92253
RE: South Shore On Lake La Quinta
PlanWR2,/.LQT ..225.,.:.i,
4 695 ,_Via Florence
To Whom It May Concern
We have reviewed the truss drawings and calculations by Truss Works for the above
reference project and find' them in substantial conformance with the structural framing
plans prepared for submittal 'to the City Of La Quinta .
TrussWorks
P. O. Box 626
Thousand Palms, CA. 92276
Ph. ( 760) 343-3461
Fax ( 760) 343-3491
' Qa0FE5s�pN
Ramon R. Wong, II, S.E.2345 �; x
W No $2345 rn
°C Exo ( 2.31-8j
c.c.: Steve Sante78-095 >k
ste
La Quinta CA. 92253 � OFCT UF�`���
, CA
ie: .
Y
Certificate of'.0ccupancy
City.of LaQuinta,
Building and Safety Pe
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: 47-695 VIA FLORENCE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9806 -227 -
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
Dater 08-06-1999
Building Official
POST IN A CONSPICUOUS PLACE '
now
u..