0107-097 (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
.5910 q p
,,-Date t , ,y' 1� Signature of Contractor f,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury thatsKam 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).
( ) 1, as owner of the Pi`606fty, am exclusively contracting win licensed
contractors 'to construct the project (Sec.. 7044, , Business & Professionals
Code). '•
O I am exempt and Section _ B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION •
I hereby affirm un°der 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 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:
Carver IMWiv'NT't4.Cel4 M9 Policy No agaitg iIA4C1it 14th
(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 ash to become subject to the
workers' compensation laws of California agree,thai ifol"should become
subject to the workers' compensation pro4isi* of.,Sedtion,3700 of the Labor
Code, I sha I fo wit comply with t os FproWSIO s'•.'�7 ;
Date: ! �VApplicant �
Warning: Failure to secure Workers' Compensation coverage is unlawful and
il
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.3
IMPORTANT Application is hereby made to the Director of Building and Safety t
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 cf 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 building'"
Construction, and hereby auth6rize.r5pyesentaUves, of this City to enter upon `
the above-mentioned property f6or.•'inspectipn�purposes.WX
. �.
Signature (Owner/Agent) -f� " '' /� Date
BUILDING PERMIT PERMIT t/
a
DATE VALUATION LOT �`7�7,?�TRACT t.'
Edg�/�,ae'a
114 2615 2
JOB SITE
APN
ADDRESS �
443 110-012 ,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
�
17711 9L X106
1 `7 HST, 0106
r1�rv°��Y40ty3+'Jgy�;
f�� a�q ^
C.A 9!r 7 80
+�lr�'�y4��{ipt,17:�.
f � p �ry 9 d,
.E Ld�iTIN - e.nA JV l C?( .
C114)508-4440 CM04 44€ 5
USE OF PERMIT
INit,
SOT-) PI -W 10 f1-PEXMIT DOSS NOT INCL40 8J.,0CX WA1L.S OR POOL.
�R,.T"1. 1 �1��{ i� 1t1mucTioN Foit A�tS�,:a:6�ix PFIRm19 e' v" L
PLNN TYPE
TMOT CONWI i.'R.1CT•ION 4422,00 SIS'
POI;CWP T'IO T'MOD :.fP
0AR&MOARPORT MOO 2F
9'r 03 CV'AlSM11r.4 G+11'ts�4
145.1`'8[9.40
yy�� Qy�//p ����yy �p,�,,,,@�ppy,Bay.S.S.iRa.i�b'�F..LS�►d"5r'k
Y,Fxw <9 �71+. i b3w.t7JF.WJ.F RY
(110 83'I'IR:13 71011 WE $0 011"
DRi
I`bAX CHECK VEE 8 $165.99
FE,E.PLOOSIT 101-0004.49.318
I't+KCI"I.kN;GAILFi ; 101-•000-421-000
Rshb1 a.9]'C?l•`iGGTuuC//AL I 1 -i/C-�lf(i•�I•��Qy�f[JC)�t/Z�
/Q
aYtKE
�Fr+i4y2o:r���c
d�nGtdtBlgdt'C\i .P L'L 11J�-i,itYil��7"iLldvd gf M -i. 7.I
STROITi"T:;�C�TION F��i' UK'() 101.OL -241-000 $101
6'st Al thC3 �d . 301-060-42,3-000
L I; i >N!k$lAC�' . r IX490�
F
°Cf,4la_,'i3�'.f'.?. AND PLA.Ily CIS,
$3,2u.29
NOV .13 2.091 ims i�RF.%.P=Fvzri
-.125 o. a 0
WYOFLA®UI �D1P ''If DUR1.NOW
FIRIANCIF, (DEPT.
`024.29
RECEIPT
DATE jjp.
BY
DA� F O
I INSPECTOR
r r .. 'A--
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
/�/y
Underground Ducts
_
Forms & Footings
Slab Grade
/Z�3 -^� 6'
Ducts
Return Air
J - Z
Steel
Roof Deck
/ K
Combustion Air
Exhaust Fans
O.K. to Wrap
��
ii�'+���-
F.A.U.
_
Framing
% �y �� _
Compressor
_
Insulation
z�_�,�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
Exterior Lath
0
'Z — S -02--
Drywall
Drywall - Int. Lath
2 — % •—� 2—
Final
Final
=3-Z
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
���®�/�
Heater Final
Water Piping
roL
Plumbing Final
Plumbing Top Out
I/ y
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ Q,
Encapsulation
Gas Piping
Gas Test
Appliances
e
Final
COMMENTS::
dl -
CJ G�
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
..
Rough Wiring
lj
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
^�
Utility Notice (Perm)
Occu anc Certificate__ of �.
. o obi
j
City of La Quin
Building and Safety Department. OFti°�
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
ollowing:BUILDING ADDRESS: 47-720 VIA FLORENCE
Use-Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0107-097 `
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: 06-03-02
Building Official
POST IN A CONSPICUOUS PLACE