The URL can be used to link to this page

9909-142 (SFD)LICENSED. CONTRACTOR DECLARATION I,hereby'affirk; under penalty of perjury that I am licensed under. provisions of 'Cfiap er Ocommencing with Section 7000). of Division 3 of the Business and Professbotials CoM, and n License is in full force and effect. Lic. Class Exp: ��Da__te__ 1 5,d `� „ate IMM Vdate —Signature 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: ( ) 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 wan ltcens�a 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.'My workers' compensation insurance 'carner &'policy no. Carver Policy No. (MCA'E INS 00 :S1'754.1193.14179 (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 shrill fo hwith comply with those.prro`Islons;r .ti y Date: Applicant—'-. Warning: Failure to secure Workers Contpensa•tion coverage,is. unlawful and shall .1subject an employer to criminal penalties and- civil fines up to $100,000,' in addition to the costof 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' df 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.. [.,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'inspection purposes. .) Signature (Owner/Agent) -r --f -Date BUILDING PERMIT PERMIT" DATE �. ` , VALUATION tOT�}Sjt.;�l�Z TRACT 229 JOB SITE - ADDRESS APN 7&440 0 VI 111.0'RUNC:E, 643-12"01. OWNER j CONTRACTOR/DESIGNER/ENGINEER bkNA.DAY,&C'0MP',rtlN , C:.. NADAY-&CC?.MPAaVY 1,00 208 `iiSiF• 208 1570 BkXALt-1OLLC)W DR.11aJ.E, SUM 208 SANIA A _1"Ni.t ,, CA 92705 MNT A ANA QAt 9270 (7:14)751-,)15ji CKA 4485 USE OF PERMIT 8 - LCYT 229, RAN4. A. PEAMrr DOES 140T INI-M DE BLOCK WALL OR. r•M, TRACT CONSTRUCTION 3,079.00 Sr, POPICEF PAT` O 550.00 FI gtfQ e't „/v(^��,y�• gyp �• �P �•' y �•Q/•�� !L'.+DTIMA•1'KA) l.K.a,�Db OF v,�.�1�S�,.C��l�/Y:1ON yq�q� t.M �p 187.3• V10—' P1~RM1T 1'E>s. SUMMARY MMAR CONS rRUC31,0N FEE 1014k10-418-0109 5947.56 Pi A14 IC-HEOI'L FEE 101-0.00-439-318 $793.81 MECHANICAL FM . 101-000.41•14tDti Lxl:, 'C° 4 #fit P►1 } t31. -b0 -�1 -I10t? . S11603.37 i"%;tMMINGF'EFs 1Gb1.00i?-�19�=i3Ut1 �1f1P.5i1 r. i ; _ TtROhtt3MOTi0'trT..M- .RE;atL). 101-000-24U.000-, GRADdlvOVIEE.. 10:1-000423-000 $20..00 ART.i:N PUBLIC tPT..A�. -8 - P... 11 701 -0(W255 -00D 12118 Mi i t7 FFE UEPOSU'r lis > t -439-3i 8 -1250.00 DEV'E1 OPM INVACr FEE, . $0117.04 SUB -T rAY, CO. rKUCU0N AND FLAN CHECK : $41,370.77 3101172U, .PFIDT IMILS DUFi;NOW S4y210.77 - tit RECEIPT DATE BY ? D FIN ED60. INSPECTOR N INSPECTION RECORD .fir OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts SlaLfGrade ?W - Q 7 Return Air Steel Combustion Air Roof Deck y - Exhaust Fans 0.1,&' . to Wrap _ _ f— F.A.U. Framing /g--► �� Compressor Insulation�� 2 j/ o -o ��— Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final O 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 c' Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral �! / 7 `� Pool Cover � Sewer ConnectionZ.;--27 Gas Piping v Z -C_W Encapsulation Gas Test Appliances Final COMMENTS: ' Final 1 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) i„,,.r�-. ;.lrJ .. .. ry.�►- -jam,�.<.+`4ayt.•.,v..!`"rh'r',,..ti,.,df-.r,.r�1....,,,. L.+.'.-:�:-...,.*`�....« r.-,.,.+....y„";,'F.�.'s"�"�: i,;•y�v�i zryY.ryyn_, n' Building .... _ Qcin a40.4 . Mailing Address 1 1 1 Ko C t City C Zip r Contractor A f C Address 4 sQ& Ttty/ &49kZ 7 `�• z zq P.O. BOX 1504 APPLICATION ONLY 64,V2 / �C 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 41 to Tel. 8U 71 - lo? -,-m State Ljc. S ) b I City 9b 5 8 ateClassif. �-1S 1 U Lic. # t - Arch., Engr., / NJ Designer Address Tel. t +�dn I (a)1, - sl -(4365 City Zip State �`! �1 f nC ,3• 3 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and elfec 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 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). is 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, Suisness 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(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. 8 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 r'7 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., It, 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 a0plicant Date Mailing Address City, State, Zip BUILDING: TYPE'CONST. iA.P. Number ,Legal Description Project Description s� CCC..GRP. F �nAA . i?g 5r vi ce- Sq. Ft. 2�7(' No. ' No. Dw. , Size . J � Stories Units New.2--' Add ❑ Alter ❑ Repair ❑ Demolition ❑ C;ot\AG c Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. r'7 S 15 ' Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fron Center Line Rear Setback froir Rear Prop. Line Side Street Setbadk from Center Line e Setback from Property Line FINAL DA All INSPECTOR Issued b6LIhL. 63 Date Permit Validated by: - LA OUIN WHITE = FINANCE 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 # 643-120-001 No. 19350 Jurisdiction La Quinta Owner NameCanaday & Company Permit # No, 78-940 Street Via Florence Log # City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 3079 Type of Development 4 Single Family Residence No. of Units 1 Comments Lot 229,pan (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 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 3,079 or $ 5,942.47 the property listed above and that -building t , permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By cc/First Securit'Bank/Rober Walker Telephone 760 7714- y Name on the check r By Dr. Doris Wilson Superintendent, Fee collected /exempted by Olivia Aguirre Payment Received $5,942.47 Check No. 0216003 Signature - f.b.v.. TICE: 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 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) onto another public entity authorized to llet 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