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9909-146 (SFD)LICENSED CONTRACTOR DECLARATION' We'rby affirm under penalty of perjury that I am licensed under provisions of (commencing with Section 7000) of Division 3 of the Business and ''pnals Code, and my License is in full force and effect.' Lic. Class Exp. Date ;Date .1 1 / Signature of Contractor ' OWNER -BUILDER -DECLARATION I. hereby affirm under penalty of perjury that.1 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). ( ). I, as owner.of the. property, am exclusivelyleontracting "with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O.I am exempt under, Section B&P.C. forthls'reason Date Signature .of .Owner WORKER'S'COMPENSATION DECLARATION I hereby affirm . under, penalty • of • perjury one of _the following declarations: O 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 4he work for'which this permit is issued: O 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:ins' urance: carrier &policy_no: are: Cairier PolicyNo., " i,NICARE INS CO SWO-1..19&-:.14179 , s (This, section need not be completed if the permit valuation is for $100.00, or. less). O I certify that in the performance•of the work.for which this permit:is issued, I shall not employ any person -in any manner.soas to become subject.to"•the Workers' compensation -Iaws.of California;, and agree that if I should become Subject to the' workers'compensation provisions of, Section 3700 of the Labor Code, I shall(�o�rth It,,��,,comply with thoseprovlslonsj Date: (�Cr.Appllcant` ; '--%``..Y` i • - �. 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 notcommenced 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. l agree to comply with all City, and State laws reiating to the building,, construction, and hereby authorize.,r resentatives of this City to enter upon the above-mentioned prope y for. inspettion purposes. ' (Signature (Owner/Agent) Date BUILDIf4G+PERMIT PERMIT4 DATE, VALUATIONLOT _ TRACT I<8.�il2lf:i�� 117,;aI9�.7t� "?.=35 .. • .. . JOB SITE APN ADDRESS 47-740 VIANONTIt�'`.sO OWNER CONTRACTOR/DESIGNER/ENGINEER t;AA:_�1i5AY * t i°ill+:Y T�A�AY6' COMP ANY 1570 F3Rt3C?KHOLL6 l3#trVE, S`br °6 !68 1.570 T31't00I;.401 L0W D1RJ.W, SL71'fi7209 SANTA ANA, CA 92705 S.A,NTA, JU-JA CA 92705 Cd:11.,# 44485 . USE OF PERMIT ''. qi : (I1 , . FA 4 :.:y `wr t. I'A n 75% PLP"N i'"IMCK 11M RIEDUCTION i.>N MSUANCE OF tr<IM:.° ALE PL N Uf".tM CNARA✓,/RO l,t;ON 3,079M I r �U+Ji� P�eTiO- 550.00 .'H':, f,7AR ACs&CARP 31fU 6,55.00 ST' . 4 FI S�T31V.1N"FED COST OF CONST RU MON ... 187,342.70 PE>3YhU'lt'• F'.EE Sg1MMAk !/1{�3,&i-it1(1� flFt?U'. 39-47, St Cy�O/N!,3i�'`>iZJ1�J,CT.ICDNyFE )t{0�1 .. IYE.AN.0NE(,,i�.,I? L.V;"liifVP 3S 3I .-. t..•. ®.,1,J0..� •'.ir,�. ^� y iYfWI ANIC f.I$FE . d4)& -d +42I S�Of3 : $yS.50 . ;w 3DI-i3tt�-4�104100 i76:IJMSYNG FEE .101 W- 410-000, S'TIi.C)NG Rq!DTCi�I� F`. '• l�.E.'�Cl'� ! C11,.430il-?Q) �CJ� � tR:7� � � . 4 w� a :. GRAAdNLt 11s• OIT000-42340 ART IN P€ -81;10 `.P,LACES - RIFI SID 1131 -m -b51,001 fi:t?:1'!;10:ID X13'=3.1:F4-StISf2:f?f1 "" O' 1isT.OF'kR 111f3, e' "1' 1 tI UW7.00 SUB-TIM*AL CONS RUC110N AMP1AN CHECK $V/75,4 TOTAL • PERAHT-FZE1 DUE NOW S3,525,41 - RECEIPT DATE BY glAT71FINAL INSPECTOR INSPECTION RECORD :RATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set (sacks Forms & Footings /�Underground �/` �% Ducts Ducts Slab Grade a —/,t- Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap lB;9 f 4!5, F.A.U. Framing / -3/— oo �' �_ Compressor Insulation Vents Fireplace P.L. ! Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath l%a Drywall - Int. Latht�Za / Final 0,2 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 Water Piping C T l Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Gas Piping _ Pool Cover Encapsulation Gas Test Appliances Final COMMENTS: - Final _ P� Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fodures Main Service Sub Panels Exterior Receptacles _ G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Building k Address Owner Mailing Address City 14 Contractor Address T. 4 P.O. BOX 1504 �} - 78-495 CALLLE TAMPICO V l q �� -� �1 li LA QUINTA, CALIFORNIA 92253 Zip U7� 7i,+Pk- el y/�J 1 Tv Zip Tel. State Lic. City & Classif. i) Lic. # L`/ 95 Arch., Engr., Le N Iv abe I Designer Address i nl e\J✓ T' tob7i(' F S�1 City State 134 I'lple &Z�� Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70X0) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE _r DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors 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 rile 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 live hundred dollars (5500). 1] 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 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.) F1 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.) i 7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure, or acertificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company (7 Copy is filed with the city. 0 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 (S 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 ame 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. 1 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. y Signature of applicant - Date Mailing Address City, State, Zip 78-1 30 14, Fhv,, � tA11V f' } APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number -7 Legal Description` Zf�� L1�C. a YS J�'►�� X4413 Sq. Ft. C No. l No. Dw. Size �Gt , Stories J Units New Add O Alter O Repair O Demolition ❑ tstfmatea valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback'fTom Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Sid Setback from Property Line FINAL DATE INSPECTOR Issued by: to Permit Validated by: - e WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 # 643-120-017 No. 19353 Jurisdiction La Quinta Owner NameCanaday & Company Permit # No. 47-740 Street Via Montigo Log # City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 3079 Type of Development Single Family Residence No. of Units 1 . Comments Of245,.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: 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 permits and/or Certificates of Occupancy for this square footage in* this proposed project may now be issued Fees Paid By cc/First Security Bank/Robert Walker Telephone 760 771-9636 Name on the check', By Dr. Doris Wilsons Superintendent Fee collected /exempted by Olivia Aguirre Payment Received $5,942.471 '" S Check No. 0216003 Signature NOTICE: Pursuant of Ass mbly 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 ident�ed 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 NOTICE: 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./ApplicantCopy - Applicant/Receipt Copy - Accounting 0 oZ Iry OF.:TN� z I Y PUBLIC WORKS CLEARANCE LETTER FOR t CUSTOM HOME LOTS, Dear. Builder: Prior to issuance of a building permit, you will be required to obtain clearance from 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. t Verification 'that infrastructure improvements and other required tract improvements are complete, or sufficient) advanced to warrant building permit issuance. p � y g 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: LOT: �9 i�30,o�31i J� ,,. ail $ PUBLIC WORKS AUTHORIZATION DATE F:%PWDEPTXDOCSIFORMS%PW CLEARANCE LETTER.ss Certificate of Occupancy City o fL a Qdin ta Building and Safetjr-;D-'epairtme''ht r. 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: 47-740 VIA MONTIGO Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-146 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17T"1ST. #106 City: TUSTIN CA 92780 By: STEVE TRAXEL Date: 06-26-2000 Building Official