0001-011 (SFD)LICENSED CONTRACTOR DECLARATION
k;by affirm under penalty of perjury that I am licensed under provisions of
Q,(eurrmenoing'with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # e Lic. Class Exp. Date
I0381 loi
7 }}
Date Signature of Contractor t t ��'•
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 fol lowing, 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.
pQ ) I have and will maintain workers' compensation insurance, as required by
$e ion 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 ►w Policy No. i
llul',i 01irl C 4q*t[� INS .`ii_1,�i.-.I:41*111:117`1
(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 provisions of Section 3700 of the Labor
Code, I sh' II forthwith comply with those provisions..r f—
Date : Applicant—
Warning:
pplicant 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 for.inspectfon purposes.
Signature (Owner/Agent) ���t'� ��,'�`+ Date
BUILDING PERMIT PERMIT#
#Ciiib 9 -±ti 4 1
DATE l ` VALUATION LOT 10� TRACT 7(115
JOB SITE
ADDRESS 73-92-5 VIA FLIJ�I�: NC..�3_' APN 6&3-140444
OWNER CONTRACTOR/DESIGNER/ENGINEER
r'-VIAI AY Cr)NIPANY ('dANIA-111.t Y &IF"O'kWANY
i370 BROUiiF:iOLLOW DRAT, SUM 2168 L570 0 BRU'OK tOLLOW Di:.tii,E, SIJUE 208
SANTA. ANA CA 92705 SAN'1A.ANA, CA 91705
f71A1`1Si-9l4j (1'140 4.1115
USE OF PERMIT
SWOLE i•.t1ti1I�, 4' ilirY l,l, �3t�r
TRA<>°1`i C0N5TJiUC A 1t -M
UAR.A%t-%C'.1RPOWl' 6 i11.(tFt Sfh
'i✓1'�T1111ATED COST 0 Ce"IN a T RUCTION. �s�9��c.�
COtr 'i`iftIC:',t'lU?dYkE, 1,01. 000419 -OW s821�,°119
P4. AN f'T-WM, 17,PW I, f1 i-tintl-4a�-3 18 i 64rl rho
L"JI , s KLC`.A0LL a1 i(Ii-000-1120-000 St;.,)J9
P.LIAM11INe3 PhE I01 -OW -419-000 S1150.419
!�'ji'�♦C{l1{v: �('+IYtO'h F!lt3 F"Fk, . ii�'�TII 1 f(1!-+pi)fn)-?A+� i-O�!(�1/L)� � 1 /5
S20.00
AR.'i' iN PI)AL 1,C; i i_ ACES - k2.h&U,10I-WU-25,-000
F'M7 rVIPOSI° f 1111-f3()(1-4 iii -a1 St 57511(30
St f14-T(i?'AL C01.4 M IC T'KYN ANI.) PJAN CHECK 44,n7I 4'!
12
T01'Allr►4raMUCFICES011eNOW si,Trr_.:m
RECEIPT DATE ) BYIyA}�E INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
f Set Backs
Underground Ducts
F ro` is 8 P ootings
_
Ducts
SLlab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ —/d — p a
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
— 91—CID
Compressor
Insulation
— /—per
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
All
Final
Final
POOL - PAS
BLOCKWAL
A 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.FJ.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address � D .� oil a �(n i� f'ti;:: LA OUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE'CONST. OCC. GRP.
r
Address + �' `C ° tQ �Q
A.P. Number
City- �,^ lzj� Tel. y 'y
t +1 ht1 7 0J /q 5_0Ug14 O Legal Description` ' ISL �..Q} 1�
Address
City lZip
State Lic. cit
& Cla sif.J- 91 (0, .0 I Licy#
Arch., Engr.,
Designer Le rV M 6 W
Address � � G�. � � V�✓ � � ��� ` � �7 �`�..�✓
City Zip State
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 1 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 ($500).
I-,, I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does Such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I'1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor($) licensed pursuant to the Contractor's License Lew.)
i 1 1 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.)
Policy No. Company
n Copy is filed with the city. ❑ 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 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.
Date Owner
NOTICE TO APPLICANT. If, alter 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 aQplicant - Date
Mailing Address
City, State, Zip
WHITE = FINANCE
Sq. Ft.
Size .J j
New Add ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech:
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
No.
No. Dw.
Units
Alter ❑ Repair ❑ Demolition ❑
;T 2 9 1999
AMOUNT
�. c) - oa
I
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback frorr Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from 3roperty Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by
Validation:
YELLOW = APPLICANT PINK = BUILDING DIVISION « ,};?
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 # 543-140-044 ,
No. 20038 `, Jurisdiction La Quinta
Owner NameCanaday & Company Permit # 000-011
No. 78-925 Street • Via Florence Log #
City La Quinta . zip 92253 Study Area
Tract # 26152 Lot # 107 Square Footage 2591
Type of Development ` Single Family Residence No. of Units 1
Comments Cross Reference with Certificates 20036 to 20040.
Certificate 20016 to 2(104(1_ are, nail by 2 different checks-.
At the present time, the Desert Sands Unified School District does not collect fees on gauges/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 . he amount of "
1.93 X 2,591.- or $ 5,000.63 the property listed above and that bailding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC/Washington Mutual Bank/Robert Walker y Telephone 760`771-9636
Name on the check N.
By Dr. Doris Wilson.
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received $5.000.61-.,t ,
Check No. .See Comments
Signature /
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will 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 District(s) or tc another public entity authorized to
collect 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, .waivtas -''
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy -Accounting
6
T
MOFrN -
Y
PUBLIC WORKS CLEARANCE LETTER
FOR ., t
t c CUSTOM HOME LOTS f
t .fi � ..'-t�;� ` �.-ir. �•i-: 23,E � ,y.-
Prior to issuance.of a building permit, you will`tie required to obtain clearance from the fr
i
Public Works Department for one,. or more, of the following
�7
1.. -Verification that rough grading is complete, and the pad elevation 6e;
ertifications, n
w prepared by a licensed surveyor, or engineer; are on file in the Public Works`-- Y
rte { �"
Department: L k > > r s
-rk�Y
2: Verification that infrastructure improvements and other required tract Improvements t-5 ra j
are complete, or sufficiently advanced to warrant building permit Issuance 3�N
.. .. ' _ t T n ",L 1` ,1 4, 4 , r K-. k -in #•3_> "i # } i,A'i jIF- `"-'a
.3. Prepare an engineered grading plan that provides for.on lot storm water retention,'
.and have it checked *and approved by the Public Works DepartmentYn
- s 4 x .:r„ty )p ri�vk7.s til4'-i
• Tract 26524 (Estancias)
x K 14
i
.. ,• h Y t'vA�,v ' -moi � ' ' +.
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building pad grading
accordance with the existing soils report and tract grading. plan, _ and have it�
Td
-Y4
checked and approved by the Public Works Department
• Tract 28034 (South Valley Estates) -r=
Y
. . . F S A b. Y`5+ .f �•ti�
• . � A'. . F x ^i 3
e
! r •Y li�
FOR WTERNAL USE BY PUBUC WORKS DEPARTMENT-.,-*
TRACT: ` GI 5'2
L�(T: t v e&
PUBLIC WORKS ACITHORIZATION DATE
F:%PWDEFnDOCS%FORMS%PW CLEARANCE LETTERss
COMMENTS:
:.i
4
} 4
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