0001-010 (SFD)% LICENSED CONTRACTOR DECLARATION
1 -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
1 +Ct.t
Date ' Signature of Contractor _�� R►� `�
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 exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) 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.
�I have and will maintain workers' compensation insurance, as required by
Se6tion 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.
1`111 P11171Z, 417, C"C11t1(' IAN) ; i1' 0 J.;`01 I It 179
(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 the workers' compensation p ovisions of Section 3700 of the Labor
Code, I shat { rt with comply with those�provision
Date: "Applicant—
Warning:
t'
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 propertyJfo—rinspection purposes. ) r
Signature (Owner/Agent) -� +. - Date �! b fJ
BUILDING PERMIT
DATEN VALUATIONsfa,i�% t49 LOT
YYY
JOB SITE& * b
ADDRESS �tl J,4�t`E%+I.,R4lu5�1„,
OWNER
(+n!,reg kV V-f1f)`[PA1,Ty
DRIVE, Siyf M 20S
SANTA ANA CA 92 10
USE OF PERMIT
6tt`4CA,L .t'AA4.11A 1)i'V:ri1.Li;tN0
PERMIT#
IcaW I M
1441
APN
TRACT 261'w2043446-643
CONTRACTOR/DESIGNER/ENGINEER
f' � N n f )1Y �� r1(�n,TtP ArTY
d �� kt d, Ci. �,., to\tf. 1 3
, `, etS 11RO ?KiiC)i.,i.OW DRIVE, S-UFrt 208
SANTA ANA (_A. 42105
(714MI-9151 CRT,#1410
+ 1)A,(if it}o V' Lt%A +ik3.f':Ea;(Nj1T 1: 01;S ��TOT 3(v� Lui) , f3LO+,K �k 13,6 Ok
POUL
,.w ”
il.A U►v. IRUC `IKON 7,501.06 ar
i'O:i C ftp. iii l iO IS9.W a& -
0., ,MtIWCAiik'vRT 6"Z4.00 tib'
ti:` )NS` '1?.LX .ri(JN F.f? Ifll difiCf> 1 00U 3 lff.U<t
fTt-4-N CTO,!K VFV I.fTfv(j()(}-a13��-iIR �nffi,91
Nff;("1XNJCi'kL 1, "
HAL
KAINIBINt}-94lb
tiJ _000-A 21-000
101-0W-42"00
101 -000 -41.9 -OW
I T`iRt�i( R�tiY#`TCapd ►Tr - R`tT T O f-(1Ot}'?4t -M11
3RADINU s=u 101,000'423,=000
!. Vic:L,()-0rdt, IMPAC'!' FfX
ART IN VUBLIC;11,tNIV 8 - i2}sS0 701 -OW-255,000
t='i+ir i�FP(�ST't° !0'f-fT(iU-d�ci-"ITf;
$i�is.iC►
X14 !19
S210,(41
l.,yur.t9n1
41'' 1 f
Sf IR -TO TA (, roN�'T Ift*VTt )N ANSI PT,MN C'Ii(:(5`
`VOCAL PIN'TiiEOU°1' :€'Fr* ES DUE N+1. VV
r
RECEIPT DATE �� f() I BY 10E INFO INSPECTOR
1,90,474.20
$250 041
$J,772.44
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
c'
Set Backs
� —
Underground Ducts
Forms & Footings
Ducts
Slab Grade
3o -A —p -Z:
Return Air
Steel
Combustion Air
Roof Deck
-%-
Exhaust Fans
O.K to Wrap
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
Final
FinalZ�
POOLS - S' AS
BLOCKWA
PROVALS
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
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
Final
0 Alt
Utility Notice (Perm)
T4tV1 0 4 a"
BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
AddressW`05 V i o Fla'M 1,-e- LA QUINTA, CALIFORNIA 92253
Mailing
Address( D `3
City , , lZip Tel.
��Ti 4 41 f \ C) fli 17 R[ 5b? -1-1 91-10
Address
Zip I Tel.
State Lic. City
& Classif. Lic'. # Ly
Arch., Engr.,
Designer C kJ /J
Address Q6,� ay Tel..
T 4 17A 5 (f--- Q
city, Z' State
,—r.,- 0 1, xv I Ila Q-,)-2) I Lic. #
LICENSED CONTRACTOR'S DECLARATION
Qrob firm that I a licens d under Provisions of Chapter 9 (commencingfwith Section
effect. f bi'vision 3 of thanBusiness and Professions Code, and my license is In ull force and
_�]_GNATURE 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 rile 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 in
ie alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civilpenally of not more than five hundred dollars ($500).
C.1 1, as owner of the prope rty, 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 iinprovements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the oner-builder will have the burden
olproving that he did not build or improve for the purpose of sale.)
1*1 1, as owner of the property, am exclusively contrac If ng with licensed contractors to con-
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
such Projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I'! I am exempt under Sec.—B. & P.C. for this reason
Date —Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.1
Policy No. Company
n Copy is filed with the city. 0 Certified copy is hereby furnished.
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)n the performance of thp work- for which this permit is issued, I shall not
am ploy any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date_Owner
NOTICE TO,hAPPLICANT: If, after making this Certificate of Exemption you should become
subject o a 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. 309 7, 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 it 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 a0plicant —Date—
Mailing Address
City, State, Zi
ILDING: TYPE'CONST.—OOC. GRP
Number
,I Description7( t -:2 (1 1 A -0 1c)
Project Description
Sq. Ft.
Size 507
No.
Stories
No. Dw.
Units
Ne -W, -X Add 0
Alter 0
Repair 0
Demolition 0
OCT 2 9
1999
Estimated Valuation
LA
%9.4.0 IN:;,
PERMIT
AMOUNT
Plan Chk. Dep.
cx:�s
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S. M. 1.
Grading
Driveway Enc.
Inf rastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
—Front Setback I ron Center Line
Rear Setback I rom Rear Prop. Line
Side Street Setbadk from Center Line
—Side Setback I romi Property Line
FINAL DATE
IN-SPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK BUILDING DIMION
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 2/15/00 APN # 643-140-043 '
No. 20037 a - Jurisdiction La Quinta
Owner NameCanaday & Company' ~ •' '
Permit # 000-010
No. 78-915. Street Via Florence Log #
City La Quinta Zip 92253 Study Area
- Tract # 26152 Lot # 106 Square Footage 2507
Type of Development Single Family R6sidence No. of Units 1
Comments Cross Reference with Certificates 20036 to 20040. ,
Certificate 20036 -to 20040, are paid by 2 different checks. {
Check#`656651658_ for $14.10099 and check# 656654660. for $9.400.66=$23.501.65
At the present time, ,the Desert Sands Unified School District does not collect fees on gaiages/carports, covered
.patios/walkways, residential additions under 500 'square feet, detached accessory structures or 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 in the amount of
1.93 X 2,507 or $ 4,838.51 the property listed above and that Building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now Se issued
Fees Paid By CC/Washington Mutual Bank/Robert Walker Telephone 760=771-9636
Name on the check
By • Dr. Doris Wilson
t; r
Superintendent:
03
Fee collected /exempted by . Mary Ann L. Borja Payment Received: x$4,838.51
Check No. See Comments
Signature
fcoNOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90�ay approval period in which you may pro est the fees or other payment idented
ovll begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) orto another public entity authorized to
llect them on the District('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
<' C'` / .���y rid ,tF x j `. � f Y,.{.. .._• - ,_ ' ... - .
• ` �" Z ti 1Gl����I."
ok
k.
OF tN
PUBLIC WORKS CLEARANCE LETTER
• `•. FOR a; 3 -
'CUSTOM HOME LOTS
w. • a •. 1 Y -U Sd
t
ti
Dear*BuilFay
tx v`N t 7� R y 5• 5
-x
i
3
:rHr �' )- 4 1•v ...� +'.i _ .,1r $�x�. ., TY � ;' C t � �V�
` Prior'to issuance .of a building permit, 'you vnll;be required to obtain clearance from the- t
Public Works Department for -one, or more, of the following,
.z � i e. ... o y ^t _ _: fie;.. * :. t - - � '.. - ' x a�•^ 42
1... Verification that rough grading is complete; :and the pad elevation certifications;.
prepared�;by a, licensed -surveyor,,. or engineer, are on file m the Public`
�. Department. ! t x X t�
<r F
iy+
2
Verification that infrastructure improvements and other;` required tract improvements y" :
are complete, or sufficiently advanced to warrant building permit issuance
L'� 1v . * 4 : f [. � r'xMR j F �� � � �" G� n, -„•Z
'3. Prepare an engineered grading plan that provides fora on lot storm water retention,
.and have it checked and approved by the Public Works Department's 3x"�
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
• F : -„ � � �y� �< sari �' ' ~�.,�a 3 �
4. Prepare an engineered grading plan that provides for building pad grading'in��'"� '.
accordance with the ,existing soils report and tract gradmg. plan; and have itf N$
checked and approved by the Public Works Department.
• Tract 28034 (South Valley Estates)
Y:
A
FOR WTERNAL USE BY PUSUC WORKS DEPARTMENT' y ..:,
TRACT: 26 l 5 2
LOT: l — 9 15 y ict P10
1V li Q
"PUBLIC ORWA&riHORIZATION DATE
FAPWDEPTVDOCSIFORMSIPW CLEARANCE LETTER.ss
COMMENTS:
16
.. S 1 "•,_ T3MG�.
_ sfi