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9807-012 (SFD)t Ql� LICENSED'CONTRACTOR DECLARATION ; =1 hex!Y affirm under penalty of perjury that,l am licensed under provisions of Ch �ie-J'Awmmencing with Section 7,000), of Division 3 of the Business and' ProTesSlonals Code,,and m_y.License is in full force and effect. License # f`_ h Lic. Class Exp. Date Ji Kyr d"pate (� gnature 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: ( ) 1, 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 I hereby affirm •under,penalty:of perjury one of. the following declarations... , O 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. (K). 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 Policy No. VV yEINS CO S 5 0-11191. 1:. ry1� (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 should'become' subject to`ffig workers' compensation ppovisions of Section 3700 oftheLabor. ,/ode, I s, al rjortMwith comply with th ee prove io s '✓Date:. �r �' Applicant �� �� 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 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 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 building construction, and hereby authorize representatives of this City to, enter upon the(above-mentioned property foAnspectiowpurpos s -" Signature (Owner%Agent).. ✓ Date BUILID�ING PERMIT.,. PERMIT# ... CONTROL# DATE f �' VALUATION LOT TRACT' 7s.3o 404. I H �jj V ' JOB SITE "A ADDRESS. 79-95 �`�,� ''.� J IENC`..�s APN f 066 • . . 4. yl _ .1643-130 OWNER CONTRACTOR / DESIGNER / ENGINEER j C:ANADAY &COIDA'ANY CANIADAY & COA, PANd1 r`15 i0 I?"ROOIwHOLi. O V IJ: UVE, "URE, 268 1510 E3&t: MHOi:I.OW DIZ.M., SC,.tg PE 208 . A SARrA ANA. i 'A. 9'l'?OS &AeI+JA ANA CA 92105' 60 USE OF PERMIT. Sib , tcivii l �i ;t�8 i4(1 � �ivCLs +t�?� �1.4c Eti 'vJai i.a of"2 i�r4%. y, ^tV CsARAGUC' RPOPU� .599-W SF rRAC T G10N.S'rRMC"1`.ION S,t* " •+ _ ��`.i�16+�A'�'d�'�> �;�y'!' tD�+ O��1ti'; �:41�`g�D,'� .. . • •,8x�, �9��e l.ZEEXASPOSIT 1U1 -O00 f35�- ! 1�23tJ.t1f) 1?LXN CHUROK, .ISH, 101-OW4391-318 f.ON51'it.1.1C'1'iONFEE, _ � 01AWA18-000 s",Ib. 0 *' 19�� tIAN' CA1 f q ld�'t-000-4'21400 3i6 50 , } LEC 7RIC.AL, k_.t 1O1-OW420-,000 S145;94 ` $TKONG 10N.f`LrL' •-1'ra''sSW .10.1-000-241-000 $12.1+ PER ORA.t31�N'G .1 0 1 -00042 3 -*000 $20,00 . .. YNrRA RVC,T.TURH FTX, • 22.5-000-443-142 $2,71'x.5+! .RT WI �+1:d,!�s 1G.�' aACM - RUIC ` 011-000-255.000 ' S53.95 €-'1'G?tbN 5YRU'cY l©NN,t l'dlJ l' LAN C1 I E CK , $4,47x,00 LESS 'PRE -PAID FEES -W4100 TOTAO:. PERMIT F ERS DU&? NOPV . $4;224.00 , RECEIPT DATE—t-. BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR �.r BUILDING APPROVALS MECHANICAL APPROVALS Diet Backs. Underground Ducts _ _A Forms& Ikotings �/ Ducts _ Slab Grade �� Return Air Steel Combustion Air Roof Deck / �� Exhaust Fans _ O.K. to Wrap �2 to - P F.A.U. Framing _ Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath • _ Drywall - Int. Lath 6�5 Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 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 Testt� - 2 +f S Appliances Final COMMENTS: 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 t Final Utility Notice (Perm) ��{�'tSsLi�• "� �i^SQ + r"y ",� i.t ?.;i ,.1y ., t1i'!'�l ; r� "T '"'�S`^�5 . t� x `.., �. s�` .: -y14-44 Ti4 BOX 1504 APPLICATION ONLY • ' Building 78-495 CALLE TAMPICO Address 78=985 Via Florence LA QUINTA, CALIFORNIA 92253 Owner Canaday & Company/LLQ. LLC Mailing BUILDING: TYPE"CONST. OCC. GRP. Address 1570 Br00kh©110W Dr., 0208 A.P. Number 643-130-063 City Zip Tel. Tract.26152o Lot 104 Santa Ana 92705 14/751-9151 Legal Description " Contractor Project Description Single Family Detached Residence 1570 Brookhollow Dr., #208 City Zip Tel. Santa Ana 92705 714/751-9151 State Lic. City & Classif. 591561 Lic. # 4485 Arch., Engr., Designer Len Nobel Company Addresl. P..SBox 16606 71 714/559-4305 "Irvine it Zi State Y ry i ne 2713 Lic. # 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. 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, Business 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 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 exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). i.: 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who 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 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.) 1.1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the proiact. (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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1'71 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby �+ affirm tqh�att 1 have a certificate of consent to self -insure, or a certificate of Work 's C 'US I. r I�ura�ncc,gr�a�g6tified copy thereoS.,Lel.0 JWb J ns a r7 Copy is filed with the city. ❑ Certified copy is is hereby furnished. 1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thF 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: If, atter 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. 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 state 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 apiplicant Date Mailing Address City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDIM DIVISION i 9 i 0 F LA 0 U1MI TA Sq. Ft.2013 Size No. 1 No. Dw. Stories Units 1 New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. `, 6670 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR i Issued by: Date Permit Validated by: Validation: APR J 2 91999 WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDIM DIVISION i 9 i 0 F LA 0 U1MI TA Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 7/15/98 ,, API` # 643-130-063 ' No. ' 17334 } Jurisdiction La Quinta ;t Owner NameCanaday & Company - Permit # No, 78-895 Street Via Florence IT Log # City La Quinta zip 92253 \ Study Area Tract # Lot # Square Footage 2,013 Type of Development 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 o- replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this, time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 �„nvthe amounof4¢ a •, 1.93 X 2,013 or $ 3,885.09 the property listed above anc,rhafbuilding - .,Xy: permits and/or Certificates of Occupancy for this square footage in this proposed project ,na-y now ti'e is`suedl Fees Paid By City National Bank/Cahaday & Company Tel 6ne. 71,,-1-75`1 915 Name on the check ' Q t��n�„ 4 s By Dr. Doris Wilson Superintendent _ Fee collected /exempted by Juanita Green Payment Received $3,885.09 Check No. 01058491 Signature NOTICE: Pursuant of sembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in whicFi you m ay protest the fees or other payment identified above will begin to run ram the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to tolled 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