9909-143 (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
Professonals Code, and any License is in full force and effect.
"t_4cense # Lic.. Class E p. Date
Date .' `iSignature of Contractor
OWNER=BUILDER DECLARATION,'
I;hereby'affirm.under penalty of perjurythat.I am exempt from,the Contractor's
License Law for the following reason:
as owner'of the property, or my employees with wages as theirsol.e
compensation, will do the work, and the•structure is not intended or offered for
sale (Sec. 7044, Business&' Professionals Code.).
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:
() 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
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.-,
�U—NICARR NS, CO.4 r .ySli5��3 X4.4 bW°ti Q
(This section need not be complefed 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 t4at if I should become
subject to Te Yorkers' compensation provlslonsf of S ct n 3700 of the Labor
Code, I sha�forth i h comply with those p�ovlsions. ��
Date: . 11 J � Apvkc nt
Warning: Failure to secure Workers' Compensation coverage is unlawful'and
Shall subject an employer to criminal,penalties and clvil,fine§•up io,$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 Bwlding.and Safety,
for a permit subject. to "the 'conditions , and 'restrictions set foort h• 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 buinta; 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 informationis
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 ippection purposes.
Signature, (Owner/Agent) ✓ Date//
T_
BUILDING RERMIT :. PERMIT#�N1
DATE VALUATION _ LOT ?'?'�'�`4
TRACT
,
JOB SITEAPN
ADDRESS 7P,030 WAFLORENIM
I.,
643420-002
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t,.L'X.t`if�;.l,AA 1 QQ �..°t'.J3. FAVI '1. - . ..
'�...It^1INAD;YL �i� & �.YS{��PANY
BROOKHe3LLO,W MME, SUIITF3 209
1570 13R.00K O T.C:}W DR.:[VE, ,SUn . 208
S.A;fi(TS1l,ANA f'.A 92. 705
SiVTf.A ANA
-C.A.
9V05
USE OF PERMIT
`, VA e ` V "oklV f 1 114(,
_
3F.D - i.OT M PI.AN R4 A, 'PFRN-q d`DOSS NOT 3T1Cti :g.Ola .L L CK WALL
'
CJ.12.:f'M
i
-75�!a Puw cHum, F F kwIs'CTIi' w o,,71.'3suAN:: rs o.F mu':i. [PLE PLAN '
TRA r C014S'I'#ai:C"•'i10W 3.079M SF
,
PORr"i3�A.I f 7 SSQ:tD4 S.�' -
.
GARA.CIVE GARPfJ;< r 65.5.0 SP
. 0 7•!'a�AM i( 0ag.+ tva)s:B,1 00!^ 'CON 91. R�4I+t�YrllaJN
.d37�oi49�4. a0
PERMIT SEE SUM"Y
-
00.1dS'%RIJCI'IONFE'E 01I -000-41W, 0 - S947-51)
P1,DIY CHECK FEF, Al- E1`v'G-439.313 $195.45
•
��a-11A�aiCat. ��' : : • ., ..•1.01,-UC2�-�?1-•1J1b1[ :�,'• °' . �s�.:��
11,EC TR.ICAL FM $1,93 .3
�
PT.UMBfl4QP,P8 101-000419-00 $Ia6.5fl
4
"a I
ST tc�l:�v1x,e31'r.rl >s,lra 101-000-241400S.73,�.
GR:tADINCi ifs ,10i-000-42,3-000 $70.w
4i
rt.•
ART $21$.36
rw;
• .�....
l.�t V� CI'AE'RIWAAM,.�C�I.. _ Sol 00
�rt�
f •�,4c`'
FEE DEPOSIT
ttft�...q
5 -T-' OTAL CON SIRIJU110IN 1aA[D MAN.GFiE K
3,`75.41
Las Pim-PAILIFF S
-�'t 3Ct.ftO
OTA PERNTMFEES DUE NOW
RECEIPT
DATE.
BY
At
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs '
Forms & Footings 10 11 75
Underground Ducts
Ducts
Slab Grade a - $
Return Air
Steel
Combustion Air
Rom Deck L — S
Exhaust Fans
O.K. to Wrap/ �y-�
F.A.U.
Framing —/ —GNU
Compressor
Insulation fr 2,57 --oz.)
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
O
BLOCKWALL APPROVALS
Final
C
POOL5 -SPAS
Steel
Set Hacks
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 rr[
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral i-
Sewer Connection �7'�
Pool Cover
Encapsulation
Gas Piping —p
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lara Voltage Wiring 1110,
Fixtures
Main Service 000,
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Building _](/C/��� t JQ
Address / 9j / LJ �/
Owner
woodN
P.O. BOX 1504
78-495 CALLE TAMPICO
l`? (Q ��oLA QUINTA, CALIFORNIA 92253
0. -
Mailing f ]
Address "'1 t- O 7 O
City t Zip Tel.
T 917 8n /c.l- 56?-g9yb
Contractor
Zip
Sate L
&tCla self. S -! � 1 5 `� I Licy#g �s
Arch., Engr.,
Designer L. A�
lJ M O
Addressf 06(
Tel.
{9 t0
City"'' Zip r�JSlate
�4 Qj'r E �� �O X3ic. k
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
p
e
rmit 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 the alleged 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 (8500).
I.: I, as oner 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.)
11 1, 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(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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.)
1 certify that in the performance of thg 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, 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.
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
APPLICATION ONLY
BUILDING: TYPE'CONST. Ot'.C. GRP.
A:P. Number -t ,J
Legal Descriptions �
Project Description
Y1 C.'M l , Y1 CQ`
q.t
Sq. Ft.?f
Size 3 (
No. NoDw.
Stories Units
New,'2�- Add ❑
Alter C1 Repair ❑ Demolition ❑
s�i�,mA i;:�"Sur—
I-7 1 - 1636
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
I
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eno,
Infrastructure
TOTAL
REMARKS
y
s
ZONE: BY:
` Minimum Setback Distances: t=
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setbackfrom Center Line
Side Setback from Froperty Line
FINAL DATE INS'ECTOR
Issued by: jum 3 e IgMate-Permit
Validated by:
9 SIT
ValideflonV r) : a ai
✓ Y tl x -.- d.
YELLOW = APPLICANT
PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA.92253
760-771-8515
CERTIFICATE OF COMPLIANCE -
Date 9/21/99 APN # 643-120-002
No. 19351 r Jurisdiction La Quinta
Owner NameCanaday & Company Permit #
No. 78-930, Street Via Florence Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 3079
Type of Development. Single Family Residence No. of Units l
Comments
Lot 230, Plan
(cashier check for 6 units - $34,830.71)
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 feeti 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
11.93 X 3,079 or $ 5,942.41 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By cc/First Security Bank/Robert Walker Telephone, 760 771--9636
Name on the check h
By Dr. Doris Wilson ,, 4•
Superintendent
Fee collected iexempted by Olivia Aguirre Payment Received $5,942.47
Check No. 0216003
Signature r
[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 identrfied
bove will begin to run fromthe 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
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
Z• Iry
OFTN .
PUBLIC WORKS CLEARANCE LETTER '
FOR
'CUSTOM HOME LOTS
Dear Builder: R
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following; • .
1. Verification that rough 'grading is complete, and the pad elevation 'certifications
prepared by a licensed -surveyor, or.engineer., are on"file in the Public Works
Department. r
Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to Warrant building permit issuance.
Prepare an engineered grading plan that provides for on -lot storm water retention,
and have .it checked and approved by the Public Works Department.
'• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
Prepare an engineered grading plan that provides for building pad grading in
accordance with the. existing soils report and .tract grading plan, and have it
checked and approved by the Public Works Department. "
• % = Tract 28034 (South Valley'Estates) ;
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT r
a'
s 2
TRACT:,
"LOT: �a3O,a31,3a ,
au $ ayce
PUBLIC WORKS AUTHORIZATION DATE
F:%PWDEPrDOCS\FORMSkPW CLEARANCE LETTER.SS '
1910 S. ARCHIBALD AVE., STE.'N. • ONTARIO, CA 91761 • .BUS (909) 930-14E6 . FAX.(909) 930-1468
. 1
AND
DEVELOPMENT
DESIGN
CORPORATIQN
August 23, 1999: .
JN3065.
City of La Quinta
-Building: & Safety Dept.,
RE: Lots 229-232, 245, 246
TR 26152
' Rough Grade Certification
Dear -Sir,
- This letter certifies that the above mentioned site has been graded in substantial
conformance with line and grade as shown
on the approved grading plans. '
The pad elevations are as follows:
„Lot 229: 59.40
-
Lot 230 `60.20
r
Lot 231. :60.20
Lot 232
Lot,245 . 60.30
Lot 246 59.90
•
1 t�
Sincerely;
pSp`
a�A��.�+
lit h`o. u5P,53
-+
Dennis C: Farnsworth
LIC. EXP. Fr
RCE 31653, Lic: Exp. 12/31/00
1 x(31
_ PLANNING
CIVIL .SURVEYING
1910 S. ARCHIBALD AVE., STE.'N. • ONTARIO, CA 91761 • .BUS (909) 930-14E6 . FAX.(909) 930-1468