0001-012 (SFD)1 fir: LICENSED CONTRACTOR DECLARATION
.1'. er6by'aftirm 6hdq;-* Penaity of perjury tha�i:l am licensed under provisions o
6 Division 3 of the Business �ncl
�1! l`_ Chapter 6 (commqn`�cliplq 0
with Section 7000) of
force and effect.
Cf) and my License is in full
LU Prcl�ion'Ni - Code, a
bceris�-# f-, Lic.Class
C4) Exp. Date
LO O:V31�2,
Lu
l, r Z r-- DateKolsi6nature of Contractor
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, I i- , _ 1 :1 - . x.t . " � '
_ I
r-0 OWNER -BUILDER DECLARATION'
L) to
UJ LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Q -License Law for the I following 'reason:
U)
Z 1, as owner of the property, or my employees with-wag6s-as theY sole
compensation, will .do,the work, and the structure is not intended or offered for
'Sale (SeQ, 7444, Business & Professionals code).
1, as owner of the propeirty,,am.,exclusively contracting with licensed
contractors to constructthe project (Sec. 7044,'bdsiness & Professionals
Code). A
CY) O I am exempt under Section B&P.C. for this reason
LID
C\F
C\1 Date. f Signature of Owner,
0
< WO - RIKER'S COMPENSATION DECLARATION
CL
C)
< C1 I hereby affirm under penalty of perjury one ,of the following declarations:
LO
— l.- 0 ( ') I have and will maintain a certificate of.congent. to self -insure for workers'
X LLj Y= _compensation, as provided for by Section 3700 of the Labor Code, for the,
0 _j _J performance of the Work for. which this permit is issued.
<
< have and will main'tain' workers
s'compensation insurance, as required by`
0
0 S&tioi`3700 of the Labor Code, for'the performance of the work for which this
CL U) I.- permit is issued.' My, workers'', compensation insurance carrier & policy no. are:
Policy No.
Carrier Iq
ti
0D 1.111ON' Llli
A 5 G_ I
0
< (This section need not be completed if the permit valuation is fol' $100.00 or less).
_J 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 provisiohs of Section 3700 of,the Labor
Code, I shalt f6 bwith comply with thoseproves *
Date: <5 /I ("I Applicant— 40,
Warning: Failure to secure Workers' Compensation Coverage is unlawful and
shall subject an employer to criminal penalties and civil finesupto $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 whds&behalf this al5plication is made & each person at
whose request and for whose benefit, work is performed under or pursuant to
any permit issued as a r4sult.6f�th.is 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 this7application and state that the above information is
correct. I agree I to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
t the above-mentioned property for inspection purposes. oses.
'e n
Signature (Owner/Agt) Date
PERMIT#
-BUILDINGPERMIT
DATE VALUATION L TRACT
26152,
JOB SIT .1 E
ADDRESS 78-935 WIA -FLORENCE TAPN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
V�, AY k%
'A D
-!,jiXJA 1"N A V- Q r,
t. 0- k,
-KHOI'Lowapuw" Suln')08
.,BPC)
lj7OOIOLLO�1,4PP,!Vr--.,.SLUUN
NXINTA. ANA' CA 92705
SANYA, ANA CA 92705.
(7 OWN -4485
USE OF PERMIT
5T,'D-L01'i68 PLAN 4A. 1',10MUT DOES H4G-AbEJ3L0CK- WALLS Ork.
POOL. 75% PL 'AN CHETICK RI&OiXf IUNF-014
7 MAC MIN 3-,
'NARCHAIATIO qr,
655,OOS F
iol-0010418-000
K A MCNECK FIST, 101;000439r -3t8
N' MANUCALTU,
EL WiPRICAL 7EM:
P.f.UYBJf NO FhEE, 101-00040-000 $162.50
$J15,09.
GRISIDINO F01 10x-0.4:3-42~3-000
DENFIOPER O&ACT Hifi
AR3.'LNPUbLICPLACHS KF.SIL 701-000-2,55-11170 $127.19
Y -'h- 13f") S Y T
SL$-?'JT.A L CONT -MVC -TION ANO PLA N CHF40K
LF -PAID FEF�
SS PRE
2 5 01. (W
TOT M, P E KIM I 1NDUE"NOW
T FCC
$3.7
RECEIPT DATE BY,�- DJTf lltEZOO INSPECTOR
Oro
.1
. _V V L
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set hacks /
Forft &Footings <
Underground Ducts
Ducts
Slab Grade ,—/,� G
Return Air
Steel
Combustion Air
'Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing — -oZ� ,g�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath Z Z—tam dam.
Drywall - Int. Lath
00,
Final !
BLOCKWAL APPROVALS
Final
POOL -
o >
. PAS
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 -(p --
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralPool
T
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test rp��
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
Utility Notice (Perm)
'—
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Building
Address
Owner
Mailing
Address
City _T`
Contractor
Address
4
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
7"L/ I(VIC/1 �" 17- 106
^ , '
zip Tel.
A ---foe-(/ 9 a
Zip Tel.
State Lic.City
& Classif. 59 I S Lia a L/ (495
Arch., Engr., 1 Nobe\ t
Designer J\j
Addr, Tel.
city --T
Zip State
--t- i' "1� (10(p 130
�` 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 thathe 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 ($500).
I7 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 soch improvements are not intended or offered for sale. If, however, the building
orimprovement 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 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.)
0 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
(] 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 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. It, after making this Certificate of Exemption you should become
subject f0 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.
1 certify that I have read this application and state that the above information is correct.
1 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 applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE"CONST. OCC. GRP.
A.P. Number 7 [
Legal Description -tc- z o — Ld f 0-7/o,?
Project Description
rf?_
Sq. Ft.�`•" T
Size o /
No. r
Stories
No. Dw.
Units
New 19( Add ❑ Alter ❑
Repair ❑ Demolition ❑
n f►T � ��
^ 1 0
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Q CX
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
Issued by: Date Permit
Validated by:
Validation:
t
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DI%dsION
Desert Sands Unified.School District
47-950 Dune Palms Road p
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 3 -
CERTIFICATE OF COMPLIANCE
Date 2/15/00 APN # 6437140-045
No. ° 20039 c Jurisdiction La Quints
Owner NameCanaday' & Company ' Permit # 000,-012
No. 78-935`. -Street Via Florence Log # -
City La Quints - Zip 92253 Study Area
Tract # 26152Lot # 108 Square Footage 2507`,
Type of Development Single Family Residence ' No. of Units. 1
At the present time, the Desert Sands Unified School District does not collect fees on ga`-ages/carports, covered
-patios/walkways", residential additions under 500 square feet, detached accessory structures or replaaement 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 )e issued
Fees Paid By CC/Washington Mutual Bank/Robert Walker Telephone,,'-1&0471 9636
Name on the check'
By Dr. Doris Wilson-
Superintendent
ilsonSuperintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received $f- 938 51
Check No. See Comments
Signature �g t
FE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90day approval period in which you may proest the fees or otherpayment identified 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 Districts) onto another public entity authorized to
t them on the Dlstrict('s)(s') behalf, whichever is earlier. "k
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
Taw
9
Public WorKs uepartment for one, or more, oT Tne Tonowmg: r
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. i
2: Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance
'3. Prepare an engineered grading plan that provides for on of storm water retention,'
and have it checked and approved by the Public Works Department
.qj.y
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building *pad 9 radin9it
fiy
accordance with the existing soils report and tract grading. plan; and. have , '4 r
checked and approved by the Public Works Department. M ,
• Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
pt
TRACT:
LOT: J09 5
UBLIC ORKS AUTHORIZATION t I DATE
F:IPWDEPT%DOC.SIFORMSIPW CLEARANCE LETTERss