9807-016 (SFD)LICENSED CONTRACTOR.D_ECL RATION
-1 hereby affirm under penalty of`per'ury that I am licensed under provisions of
'Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
-Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
P16Y Ji3ir'01
/ate Signature of Contractor 41 -A -11A
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 following declarations:
( ) I have and will maintain,a certificate of consent to self-insur.'e 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.
( ) 1 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.
MITICAIM TINS CO ti00-1 MT -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 wor7 ers' compensation provisions" of Si ction 3700 of the Labor
Code, I a fort it .comply with tho�e � ov(ru ns t
V1Date: Y 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.
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 r preventatives of this City to enter upon
the
above-mentioned property for, ns�ection pure:,6.
(Owner/Agent) /� Date/ h
r
PERMIT o
CONTROL#
t tBUILDING PER
Jr'tf.) 7-014 ,�H � }'�
DATE i VALUATION LOT TRACT. ,.
MS-01874.2111110�! ;
JOB SITET,�
APN '
ADDRESS 7:I-9 SS VIA A N L{ RENCE?
"3440447
47
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Y. 0, rIt-Ii,,t11 A #qV
i {K. • •. JI 1 44 i a
Tyr
�' i.�r ri.DA lr & COIN4i�A" i.
\...0 t t
i376 iirtUi ai i i jf.i 0 i�iiti.V1;', 5i11'd los
1370 FjROt.oiR H0,i,iuOW DRIVE, E, SUr..rF 209
StAhrrA ANA K CA 92705
SAaI'AANA. CA 92705
fi141i'�'1-3451 S'13[.'+`� 5
USE OF PERMIT
I
"Al) • 0LM41 '1A.11 WOW]. tX-A5S 1,. 4 f..INCLU`b4 bI.0C"`K W 4.d.S OR f4a)t:IL
,!
�a'.t\i`ir�.l'�t"it.i�i�`�ii�i.°IF;.u3.f}0 SI"•
POIIKk lf'PATIO 189.0 S
19tAGT (70NSTItW110N ?,507.06 Soy
ESTIMATED COST OF COOTS 14;Ut"I'HIN'
150.144"114,20
PERMIT f ,4ET SUNI,;► AkY
FP'E M2,110.4111 (014*0-439-318 4450,00
4'1.AN r`tIR` ►{ FIFFit?i-17IK)-d2 -118 $A9.4 S''i
C OINS't'tttTMONI'TH 101-000-4118.000 $318.00
1<EclilikNICt;L FCE 10 AO -421 SW5.00
ELL t'tzlCAC FRE 101 -NO -420-000 $472.73
P4.{f? U -11r4 !'X17 JP -0004194% $ae:2.511
S i_WNC WTI 01-4 FEL - RES ID 1011.000-241-000 515.09
f1.4tr'1iJLfdC FE'f' 101-"423-0000 S'z0.t)fi
CPVF'RAN'1'R.1JL'YU11E FET. 22540100443-342 S-a,33S..1.1
AW1" IN I't1FAVC-., P1:, ACI +S - C701-000-255-000
;:i.q3_'1'qrAL,CC N4,TMU+ ONANDPLAN 01[EC1
LESS PRE -PA) D rLR S
.250.00
TOTAL r8i1RMYT II'F N1 D,iib"'JNO
`RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksNOY
Underground Ducts
Forms & Footings
Ducts
Slab Grade
L tyReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
_p
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath9q
Drywall - Int. Lath
Final
Final
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
�i
���/�_
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
.Z 3 Q
Appliances
Final
COMMENTS:
Pre, 9,< a.=S-Qt!
Final
•��-psj
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
t
Final
ERility Notice (Perm)
_ _
X_A ( / Q� S_
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 78-9555 Via Florence LA QUINTA, CALIFORNIA 92253
Canaday & Company/LLQ, LLC,
Mailing
Address 1570 Brookhol low Dr., 1#208
City Zip Tel.
Santa Ana 1 92705 714/751-9151'
Contractor
1570 Brookhollow Dr., 0208
?Y07 -0l
APPLICATION ONLY
ILDING: TYPE'CONST. CCC. GRP.
1. Number 643.140047
Description Tract. 26152, Lot 110
It Description Single Family Detached Residence
City
Santa Ana2705
Zj
Tel.
714/751-9151
State Lic.
& Classif. . 5915561
City
Lic' # 4495-
Sia Ft - 2 *507
No.1 No.UniDw. l
Arch., Engr.,
Designer Len Nobel Company
New ❑ Add ❑
,
Alter ❑ Repair ❑ Demolition ❑
P.O. Box 16606
Tel
City
Irvine
112713
State,
Lic. a
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,Susiness 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 lila 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
forie 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 (S500).
f: 1, 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
Estimated Valuation
-
-
PERMIT
- AMOUNT
Plan Chk. Dep.
00
Plan Chk. Bal.
Const.'
Mech.
.
builds or improves thereon and who does such work himself or through hisown employees,
provided (hat such 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
ofproving that he did not build or improve for the purpose of sale.)
Electrical
Plumbing
I') I, as owner of the property, am exclusively contracting with licensed contractors to con-
'strucl 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 I am exempt under Sec: B. & P.C. for this reason
S. M. 1.
Grading
Driveway Enc.
Date owner
Infrastructure
' WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of
Worker's CQ�1R. ns�do0 I $yr nc�j lle% flied co thereof �e.Q 38$Qr,�lo�boq ode.)
Policy No. JL�U� 1 �7��diP-an• PY Vl/lliai C l�s•
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL.
' CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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, after making this Certificate of Exemption you should become
subject fo the Workers' Compensation provisions of the Labor Code, ,you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. tine
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
IN=SPECTOR
Lender's Address�-
This is's 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 slate laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Issued by:
Validated by:
Date .Permit
MA IM
Signature of afiplicant Date
_
Mailing Address
Validation:
APR 2 919%
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIV.SION b
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 J
CERTIFICATE OF COMPLIANCE
Date 7/15/98 APN # 543-130-047
No. 17335
- Jurisdiction La Quinta
Owner NameCanaday & Company Permit #
No. 78-955 Street Via Florence Lbg #
• City La Quinta v Zip 92253 Study Area
Tract # ` Lot # Square Footage 2,507
Type of Development , Single Family Residence No. of Units 1
Comments
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
`qtir 12, ♦ ,
1.93 X 2,507 or $ 4,838.51 the property listed above and th'Atbuhflding `,o'
;A•
,� .
permits and/or Certificates of Occupancy for this square footage in this proposed project y cw_9,e issued
Fees Paid By City National Bank/Canaday &CompanyT euhone x+",14 75.1-915;1
Name on the check -Z
"
� a
By Dr. Doris Wilson
Superintendent,
Fee collected /exempted by Juanita Green Payment Received $4,838.51
Check No. 01058491
Signature
NOTICE: Pursuant of As mbly Bill 3061 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may profsst the fees or other payment identified
above will begin to run frft the date an which the building or installation permit for this project is sssued or on which they are paid to the District(s) or I. 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 w2ivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
W. cr7p-O
ancyff CCUp
a�
_Cit of La. Quin.ta
Buildin and Safet Department. ��of
g Y
-
:
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 78-955 VIA FLORENCE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9807-016
Occupancy Group: R-3 Type of. Construction: VN' Land Use Zone: RL .
Owner of Building: CANADAY AND COMPANY Address: 17480 EAST, 17T" ST. #106
City:` TOTIN CA 92780
By: STEVE TRAXEL
Date: 08-03-1999
Building Official