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9704-050 (SFD)
V LICENSED CONTRACTOR DECLARATION",', I hereby affirm.underpenalty of p rJury that .1, am licensed under provisi6nsof i1chapteir 9 (66m-mencing with Section 7000) of Division 3 'of the'Business I and Prof6ssi6nalg Code, and my License is in full force and effect.' . License Lic. Class Exp. Date B 13.119$ ignature of C'.�nt r Ae_,:_:�// �0 A ::OWNER -BUILDER DE LARATION, I hereby.affirm under penalty of; perjury that I am exempt from the.Contracto'r's License L ' aw for the following reason: 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,'buSiness &.Pr6fessionals Code). - 1, as owner ;Xo.fthe property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,, Business •& Prcifessirirals Code). O I am exempt under Section B&P.C. for this reason Date. 'Signitu'r6 of Owner WORKER'S COMPENSATION DECLARATION r, 14 hereby -affirm. Urider peiFialty of , perjury one off the following cleclaratio"ns: O l.have and will maintain alcertificate of consent to self-insu're for workers" compensation, as provided for*by Section 3700 . of the'Labor Code, for the 'pdrformance of the work for which this permit is issued. ly�l '.I haveand.will 'maintain workers' compensation insurance; as reguire6by q0tion.3700 of,the Labor Code,*for,the perforimance'of the work for which,this permit is issued: -My'vyorkers' compensation insurance -carrier policy no. are: Carrier Policy No.. 6, LVICARR. IMS CXY (This section need not be completed if the permit valuAtion is for , $10U00 or less). I. certify that in the performance of the work1or 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' compensationi prov�,dions of Section.3700 of the Labor Code, 11,sha fo with. comply with those provis Date: pplicnnt J Warning: Failure to secure Workers Compensatioin,c6verage is unlawful and shall subject an employer to criminal penalties and civil fines up to,$1.00,000,, in. additi6n to the cost of compensation, damages as provided,:for,.i.n.*.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 uncley�or pursu I ant" any permit issued as a- result of this. applicaton agrees to, &*Shalll in e & 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 pe I rmit to,candellation. r le 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't'o the.building" construction, 'hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes/' Si nature (Owner/Agent) ek 'A/ Date r/S * ` I lAnentl &Z�Da PERMIT# CONTROL# BVILDING PERMIT 5 1 J DATE VALUATION LOT TFIA6. -130 112 "'N .7 JOB SITE � 4 VIA KOM ,ADDRESS OWNER CONTRACTOR DESIGNER ENGINEER ANADY CIOINIIPANIT, C MY &COMPA GAMY 2,09E . on tlwo ouo 90'119.1#8', SAI905 .S . NT, A. NN A CA SAMIAKN-A CA 9270'; 1 7 (714)75,1.915 i 446 USE OF. PERMIT i OR t 100 AN -wa S L. -PL IlUiLl' CONSI' UVI yiN.00,SF WN, - 'moo Wt Io- 0 14M t A(SiVCA RPDX'J N I , AM#, IM N CIJNJti1, k 110 IF[ iF.1 _0 pij� <it�tf7cic Fri, 11 lic 1. vi 141c i N 1 � I ? Vqi 0 t -000-4Q, 1,000 Jf- .11, !Ert cliM .)tit 1 -ow J f 'i tqa- k. Iry V, i (IN UNTR 1!� R f" 113 2�00 T� -v) 0 1) (]_141 tu i a $3i"I'm 'M ARX IN r11J33.JC 11.4s - OR! v, 70!. 000.1ss- o 4 v RECEIPT DATE BY FIN ALED, INSPECTOR [DATE INSPECTION RECORD OPERATION DATE INSP CTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. f LGrills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath I .41Z 14Z Final Final 7 "Gv BLOCKWALL APPROVALS POOLS - SPAS 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 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 Appliances Final 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 11W7 1-97 Utility Notice (Perm) COMMENTS: 1 ✓ T4 ht (4" P.O. BOX 1504 APPLICATION ONLY Building % c,� 7&105 CALLE ESTADO Address ! _ _ V / 4 0%�A OUINTA, CALIFORNIA 92253 CA-VJ p� Z" Owner J Mailing /S©1 Address City Contractor ct/ t G h L C, 4 t., y vi Co"13 ISP-OC2410`ow 4'> zip2 70s� T��7 d ;o y-, ty lZip I Tel r ntl r 1104 - 0 S BUILDING- TYPE CONST.II OCC. GRP. q 7'C A.P. Number �-� -4 10 Legal Description L. TR- State 2 State Lic. G City �) & Classif. / �+a / JLic.# Arch.; Engr., f Designer �< �� h Address -rel. j 3�Uy City State C ^� J. 2�oT Lic.# �7 0� �7 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, after, 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). 17 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. 11, 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.) 17 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 17 Copy is filed with the city. O 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: 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip BUILDING DIVISION Project Description 7 C. Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure i FEB TOTAL REMARKS ;fN OF 6A, ZONE: FM BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setbac from Property Line FINAL DAT Issued by:— Validated by: Validati INSPECTOR Date Permit CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. PO. FT. @ $ 2ND FL. SQ. FT, @ POR. SQ. FT. @ GAR. SO. FT. @ CARP. SQ. FT. @ WALL SO. FT. @ SQ. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 1'A c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBLTOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB, BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND, REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CU. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District 82-879 Highway 111 , Notice: ;• ,. Indio, CA 92201 Document Cannot;Be Duplicated 619=775-3500 ' CERTIFICATE OF COMPLIANCE .; Date 5/13/97: .` APN# 643-140-049 No.. 15511. Jurisdiction La Quinta Owner Name.Canaday & Company Permit# No, -78975 Street Via Florence Log # City La Quinta Zip 92253 Study Area. 123 . f Tract # 26152 Lot # 112 Square Footage 2591 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 mobileholries. It has, been determined the above-named owner is exempt from paying school fees at this rime due to the following reason: i EXEMPTION NOT APPLICABLE ,, t This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 X 2,591 or $ 4,767.44 the property listed above and t'iat building permits and/or. Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By cc/Pacific National Bank/PNB/Canaday &Company Telephone , Name on the check 1 ,( By Dr. Carol McGrew Administrator in Charge {: Fee collected /exempted by Pauline Pearson Payment Received 14,767.44 Check No. 67456 Signature 1 0 16.1 n 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 identified 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) Dr to another public entity authorized to collect them on the Districl('s)(s') behalf, whichever is earlier. - d 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 y