0001-013 (SFD)LICENSED CONTRACTOR DECLARATION
affirm un�d penalty of perjury that I am licensed under'provisions'of
C+ zr 9 icommencing with'Sectlon-7000) of Division 3 of the Business and
.P, essionals Code�and my License is in full force and effect.
'License # Lia Class ' Exp.. Date
X,- <.- ii1/3ii2N
'_.
Date j1i 1 % Ali�_�Sgnature of Contractor" " `'U
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;Rfor
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). • .
O 1 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
Seytlon 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.
(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,
"Tshall not employ any personin*any manner so as to'become subject to the
workers' compensation lauds of -California,, and agree that if I should become
subject to the workers'.compensatlon provisions of Section 3700 of the Labor
Code, I shal forthwith comply with those'provisigns., ,
Date:? (h�/ K)Applicant•
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. w ; }.lV�
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:
-`l 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 -inspection purposes.
r u 1 b
Signature (Owner/Agerit)� � � �-{ Date��
BUILDING PERMIT ' . PERMIT#
DATE { t VALUATION LOT ' � TRACT. X16
109
}; 4 ..
JOB SITEy
ADDRESS 75-94+!51 AVIA $1 � O'Wt?1�$. '
APN
643,446-046 .•
OWNER " "
CONTRACTOR / DESIGNER / ENGINEER
t:aAINII1` DAY & C_GN4- a.2JY
_ r'-.M4ADAY A., COi1VA91."
1570 E"s:aZ60KKOLL iW DIMS+, SIMM 208
i57G I3RC3OKkiGLUDW DRIVE, S't.Jii">: 208 `
S.ANlAANA CA 92705
CA 42705
�St1NTAANA
f' CKiX# 4685
USE OF PERMIT
' T,D-LOT 10 PLAN 3C. Ph -RI IT D09S NOT NCLU& 13laom WALLS OR • ; '
s�%i',�i � i�/b MtrA13 (:, iQ i4 i3fg�UL."i'1ON f''O i�+1f1i.2'f§°i f~ :sSLIIiNCGP:
t
`
n ♦
48.00 SF
_ Ca�114ACi4%e: Ori f' 61l0,00 Sd `
i
ESMINATEI D iCOST Ot C'UNIST;`YUS'T.%:.NN
.!316.'724.20 '
PF RWIT 1` a+;
C( NS`CRUC.1110N Fa-; 101-000,418-M $769.00
' . *. '
1
tai, r I
1 1 U.! lmm"AL Fm `1(014)004'20% W^0 &164Z
!�1 tIM1S1IV6r}'ts6 101-000-419-000 $142,00
!STRDNC IL40•iFC7(.I. rFM; - t,E ESTI?10j-M0-2A1--000
1/�n1r /�� @SIt13.,(67
f111A.3l�If 1`121 1.01 -000'•42? -000 520.0
riis`l a.Gp.t:R
ART IN PUBLIC PLACX8 - .IE-&swl 701-000-7 55 -OW
wt±.c nth err!°
101 -000 -439 -31R -f ?Sn
SUI.3-nt"C.1-A.1: CONSI72UC'1,'T0 WiD P1,AN l;'M (::K
Y,euSS FEEL.
$27i.Cir�
• "COT Al,"il"ERA1.I14 FC98 ,11M]E `@fl3W
•
f<,
,- . - � . � -mow -
RECEIPT r
DATE
BY %,` , n
D
T FINA
ED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—G -Z,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
o
Compressor
Insulation
jaarj—d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
c
Drywall - Int. Lath
—L •- Cao
Final
Final
1g(o
BLOCKWA
-POOLS-SPAS
L 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
7 U
Heater Final
Water Piping
,�-'--cq�'j
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
019
Pool Cover
Sewer Connection
aCoe Ge
Encapsulation
Gas Piping
Gas Test
,X' v`
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)
P.O. BOX 1504
Building(}� j 78-495 CALLE TAMPICO
[
Address $ l s 1 tcA JF'ri l ti ([- LA QUINTA, CALIFORNIA 92253
\�LAFTiS lt1JN\ -1.1 -Air
Mailing
Address
City Zip Tel:,
11 S i q -7 5 q q
Contractor
Address
r
Zip
State Lic. City
& Classif. :51
, � (_ � � Lic. q
Arch., Engr., tt 4,n 4 t' 1
Designer f � ILj )� I ,n ,
/l 1 tA0 1l LJi ,4 J "t Z
City Zip ++ � State
q' bc� Lic. fr
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencingwith Section
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.,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 live hundred dollars (8500).
l: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"I 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 or property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
i J 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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] 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 permif 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 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 L__.
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 1 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 applicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
it
APPLICATION ONLY
TYPE'CONST. OCC. GRP
Number /
I Description -R - Z G 1 S-1 "' { (9 C D 9
Ict Description
Sq. Ft. "} NO.
Size e,( Sto
New Add ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
, AMOUNT
a
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setbacc from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
a
.h
YELLOW = APPLICANT PINK = BUILDING DIVISION
j! vt krn34 n7.a4 hi°:
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
No. • 20040 Jurisdiction
Owner NameCanaday & Company
No. 78-945 Street Via Florence
City La Quinta zip 92253
APN # 643-140-046
La Quinta
Permit #000-013
Log #
Study Area
Tract # 26152 Lot # 109 Square Footage 2286
Type of Development Single Family Residence
Comments
No. of Units 1
Cross Reference with Certificates 20036 to 20040.
Certificate 20036 to 20040, are paid by 2 different checks.
Check# 656651658, for $14,100.99 and check# 656654660, for $9,400.66=$23,501.65
w
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 repla=ment 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 2,286 or $ 4,411.98 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
01
Fees Paid B _CC/Washin on Mutual Bank/Robert Walker 7 `
Y gt Telepho`ne ` 760'=771-9636
Name on the check .y
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Bora Payment Received$4,411.98
Q /f A 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 protist the fees or other payment identified I
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 ?o 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 all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt, Copy - Accounting
. � � t � n" r r v •. .
J
-. PUBLIC WORKS CLEARANCE_ LEOF
TTER
CUSTOM HOME LOTS Y Y
,_ P ' t t ,t +t„y g y -sem a z ti_c _�•W,�.,•N h v q .� .c-'
p Dear Builder.
Prior to issuance of a building permit, you will be required to obtain clearance from 1
Public Works Department for one, or more, of the following k :r
1... Verification that rough grading is complete, and the pad elevation certificatic
prepared ,b a licensed surveyor, or aerigineer, are on file m the Public Woi
Department.
2: Ver cation that infrastructure improvements,and other, required tract improveme
are complete, or. sufficiently advanced to warrant building permit issuance
' � a t .: r )' 'x• u t r, � - .� v � .+r d .. F ' � t �'•ft'rY< .?s3.i'-.' 't
'3. Prepare an engineered grading 'lar 'that provides for -.on of storm water retenti
.and have it checked and approved by the Public Works Department L
.Eqv'
• Tract 26524 (Estancias)
s
• Tract 26769 (Mountain View Estate)
,a yr
4. Prepare an engineered grading plan that provides for :building pad gradinc
accordance with the existing soils report and tract grading . plan;,; and . hav
checked and approved by the Public Works Department.
't f
• Tract 28034 (South Valley Estates)
tir ry
9
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT'c.
TRACT: `261 S2
LOT: (o - g
Unrzcol-
'PVJBUC WORKS A THORIZATION DATE
F:7WDEPPi1)OCSIFORM9PW CLEARANCE LETTER.cs
COMMENTS: