9909-147 (SFD)LICENSED CONTRACTOR DECLARATION
n under penalty of perjury that I am licensed under provisions of
mmencing with Section 7000) of Division 3 -of the Business and
po
Code,'ang my License is in -full force and effect.
RL _:; , '' ' Lic. Class Exp. Date
,! �d3I 03!314201
Date �� � ��9^�sSignature of Contractor�J
.r.
DOWNER -BUILDER. DECLARATION
I hereby affirm under penalty of perjur y. that- l -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 isnot intended or offered for
sale (Sec. 7044, Business& Professionals Code).' a
( ) I, as owner of the property, ;am 'exclusively' contracting With licensed
contractors to'construct the project (Sec. 7044, Business'.& Professionals
Code).-
lam
ode). Iam exempt under Section-B&P.G.. for this reason
Date 'Signature of Owner`
WORKER'S COMPENSATION. DECLARATION'
I herebyaffirm .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
S�CUon 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 L Policy No:."",!
UNICARE-INS'CO 79:
(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 permi0s..issued;
I §hall not employ any person in any manner so as, to become subject to the
.workers' compensation laws of•California,`and agree that if1 should become.
subject to the workers' compensation prbVislons of'SeEti n 3700 of "the Labor . .
Code; I shall ort kith comply with•those,pfovl�sioons.
Date r�a`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 37.06
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 'arid.`restrictions. set. forth,. on'his
application:' .
1'.-Eachperson 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 (if La Ouinta, its officers, agents,and employees.
2. Any permit issued as a result of this application becomes null and voidif
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. •1, 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) f� �-- . t -Date
BUILDING PERMIT PERMIT II
DATE VALUATION LOT 9"9441 TRACT
OW22199.9. S18%849.0- 246t.`
JOB SITE
APN
ADDRESS
. 47-710 VIA.MOlY'1'IGO _ .
543-124-019
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CANAD,k . COMP Al'{ Y
'' NADA Y & COMPANY
_
1370 BR(7D1C.1-1O DRIV*g,::IJI`TE 2013
1570-BRQ0KH0L..L0A DRIVE; SUIT 2-08
.I.LO"
SANTA. ANA CA '92705
5.AKrA ,ANA.
CA,
922705
f71 i1 .I-9'15!
CBLN
4495
USE OF PERMIT
••'1.OT 2,1,6, .PL AN R309:PF"sttlyiIT DO .03 'N6T INCLY SDE.' I OC '1N,",L
OMMI,
TRAG1'` C6NS7•k0,'i; t ION 3,018.0010-F
Pt31'e01:Ula.ATIO 3.0,048F.
G.4;i?tAGEfCARFO1%;C
V
II;�k`�`li��Ik.r to C' ';i OF t`�3to'1'tua
'�1q 1'I' PEX &1J:NM4,tlT. t'
CON3T1i,11'C°C10Nl�f� 101-0010-41",i 3 $51°2:.dls)
a`r
"el,f,w eac.m ru 10.1 -000,-430-318 37'77.11
Lw" � `4
KT,A�,4A,-1CA_I,. FEF. l.(3.1 tlSatl°�l I Vii) $92,00
; , �
3.t � I`E2tGAL:'kl ?`` '• - ` dl.t Y$> 2(1-t1t20 190:97
PI C7.talBif► Af(33t)
{ o .
TRONQ MOTION FLE. RESRY .e.01 -GW 24U,000
t34@�g13it*dCn t' % 01.000-423.'000
1
((!? yy
f',11.''J2Y I�LI..IC ,.R'.14%.,8 t/�,a11�t "t}.l-wli�R�-. i.liiJ'1
'DE,I>�l.0F'fzf+%.i�,aALT.IE'~
r 1?'1 U DEPOSIT 119:1 i3QU E9=111a 425040
'LTVrO�°3't':L t O)NS`x'RI;JC' ON AND KAN C.;:iEC.K.
LESS F'1'a:-RAID 1<E IS
- ,0,00
'1'O'FA 1°E1�1�IT YORKS 1AT, + NOW
RECEIPT
DATE'
BY
(�.` .
D ENA
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Backs Underground Ducts
Forms &
Slab Cra
Steel ,
Roof qe,
O.Y. tb%
ace T.O.
Wall Insulation
Wall Firewall
or Lath
ill - Int. Lath
LM
Ducts
Return Air
Combustic
Exhaust F;
F.A.U.
Compress
Vents
Grills
Fans & Cc
POOLS - SPAS
Gas Test
Final
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Low Voltage Wiring
Fixtures
Main Service
r Sub Panels
Exterior Receptacles
r• G.F.I.
Smoke Detectors
Temp. Use of Power
I Final
Utility Notice (Perm) T
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
Water Piping
7r
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans/
Sewer Lateral
{U /
O.K for Finish Plaster
Pool Cover
Gas Test
Final
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Low Voltage Wiring
Fixtures
Main Service
r Sub Panels
Exterior Receptacles
r• G.F.I.
Smoke Detectors
Temp. Use of Power
I Final
Utility Notice (Perm) T
9
Building
Address
Owner
Y �Ii��Ij1,IGV
r _ P.O. BOX 1504
I (a /o I rn� l� 78-495 CALLE TAMPICO
J LA QUINTA, CALIFORNIA 92253
Mailing
Address'
City /, ,) h
Li
c. State c. 511 5
& Claate Lf.
Arch., Engr.,
Designer L
APPLICATION ONLY
0-406
! 10 UBUILDING: TYPE'CONST. OCC. GRP.
VM Pri V1
Z l� Y 17 I - '16(,, A.P. Number
Zip Tel. �- j 1 1 � 1
a%go 71t �- ���� �/y (-/d Legal Description 7 `+l
Project Description
�j'r
Zip Tel.
r
Lic.# L1 y�5 Sq. Ft.
Size
Addre;ii f ���p SIM 5 59-735
City 1t h Zip��` State
! �L �"� 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 Profess16ns Code, and my license is in full force and
effect.
SIGNATURE L 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 ($500)•
1.: 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.)
1'1 I, asowner 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.)
i7 I 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
n 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�su h 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 it 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
WHITE = FINANCE
{/ No. No. Dw.
D Stories Units
Newry] Add ❑
- Alter ❑ Repair ❑ Demolition ❑
\ ,wfiAo
Estimated Valuation
PERMIT
:. AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.-
al.Const.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
t
1
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances: r
Front Setback from Fenter Line
Rear Setback from Reai Prop. Line
pa�N P%e ode Street Setback from Center Line
} Side Setback from Property Line
FINAL�VYv INSPECTOR
Issued by: Date Permit
JValidated.by' @s, 1
M
Validation:
PINK = BUILDING DIVISION
YELLOW = APPLICANT
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 9/21/99 APN # 643-120-018
No. 19355 Jurisdiction La Quinta
Owner NameCanaday & Company Permit #
No. 47-710 Street Via Montigo Log #
City La Quints Zip 92253 Study Area
Tract # Lot # Square Footage 3018
Type of Development Single Family Residence No. of Units, 1
Comments
Lot 246, Plan
(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
f-
1.93 X 3,018 or $ 5,824.74 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
Fees Paid B cc/First Security Bank/Robert WalkerTelephone'` ^
Y Y 760 7T1, ,963.6'
Name on the check a '
By Dr. Doris Wilson f ..
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $5,824.74 r, `
Check No. 0216003.
Signature
NOTICE: Pursuant of Ass9mbly Bill 3061 (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)'or to 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
f
ti
r
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Dear Builder:
Prior to issuance of a building permit; you will be required to obtain clearance fr`orn the
Public Works Department for one, or more, of the following:
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.
Verification that infrastructure improvements and other required tract improvements
are complete,, or sufficient) advanced to warrant building permit issuance.
P Y 9
Prepare an engineered grading plan that provides for on -lot storm water retention, .
and have it checked and approved by the Public Works Department.
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates) ;
Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report.. and, tract grading, plan, and have it
checked and approved by the Public Works Department.
• Tract 28034 (South Valley Estates)
FOR INTERNAL.USE BY PUBLIC WORKS DEPARTMENT
TRACT:
a� aye
PUBLIC WORKS AUTHORIZATION DATE
A
F:\PWDEPT\DOCS\FORMS\PW CLEARANCE LETTER.ss .
Certificate of Occupancy,
City.of.La Quinta
ow
Buildin and Safet De artment t.,�o
g y pF•��,
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building. 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: 47-710 VIA MONTIGO
Use Classification:-, SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-147
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: TUSTIN CA 92780
By: STEVE TRAXEL
Date: 05-05-2000
Building Official