9910-162 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm'under penalty of perjury that I am licensed under provisions of
Chapter $.(commencing with Section 7000) of Division 3 of the Business and
Professionals Q000, and„my License is in full force and effect.
License # Lic. Class Exp. Date
If
A
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affir, i 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 W 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 conserlt 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
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:
CarrierPolicy No.
'lP tet ,LRE alfi rryy �•{**,,R(A� q aalio} pp
(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 workers' compensation:, provisions of Section 3700 of the Labor
Coyle, I'sh7ll f?rt'with comply with those proviSL9QS- —_
Date: r! (' 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT�910 40
DATE VALUATION IS 4M 42.70 LOT S it TRACT
JOB SITE 42,440 VIA tAdO'Xr,b, SrA,'
APN
ADDRESS
w O
OWNER CONTRACTOR/DESIGNER/ENGINEER
t4 A -PA A 71 A'Vi SL (" )-A,1 11 AAaX- i 1 610 A n %r LN r +t )t,4 rnf
4 hLi 7.! lith L A %W iAGL 41y,W C A GSA 7i1Y, l.i"1 'I. 1i4 4. ddA f t'i f
37013ROOlti.HOl,,i.OV11 1570J3N.(j0KH0LL0%V .i3RIV , 51 MIT, 2W
S,A.{ T, ANA Cain, 92705 SAIN'I'k ANA CA. QTbC
USE OF PERMIT
53 t)i..AWt34�•Xd� 1� 1 �,i) 1 hJt(1n14 fhJ
i1lM,L (IR. !K XX .
TRACT MZ SIF
PURC&PAIK) yStl.frU aI<
0A}.tA(JJ001,tiF'0AT lv i-4yt9 iii'
11:41{ri IM t5FID MINT i0l'8�.'''A
CON:it'JKUCTION k -W, t{{i.4WO, "49) ��3:a`T 11,0)
{ �03.R1
PLAM ("!'CK l"f*i� f O{yl siritfr�ir�Z
;
3t9- p1D
3�IlKrs°IR¢�rvltYtAhc d EE' 11i losJ�E=•�G� iH)7? 4t :�i.jfit
,:
i1 X`TRf..t..Al. FLlf
PLUMF3l.l`s(3 FEE t0l fN�)•�i')-{'dU(? 118tf,*4
'
t�A`t�€ t�.a=:� Si�7pi; 1OIL 000 , 3 000 $) 0.00
J5— 06 �12110J,36
A1'L•t' Jy1.#i1JB J.k1' PLA •Iiti — t\11L 701 `�.�160r MLr
�)/ e^
�iCYf�;-'{1�('i�,,gt:"4�1V�i!'[i,(tt:":1_'�t.r'+t.,�hfr°I�I..AhC.'j�E?�t•'
'�.l?1"t �"'
..ESS 3'!',.E®!'AID UFFS
$21W,00
11•lYfAll 3EIR_rYlfteY, FE US DUE NK)•vA
�i7`Iy.ii ti Fgr� /
tr
RECEIPT
DATE
BY %ft
DTE FIOALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Bacl s ,,-� _.
f�/C
Underground Ducts
Forms & rouurigs
r I [
Ducts
;slab Grade
-6 - G 57'
Return Air
Stir`
Roof Dkk
/ ip-
Combustion Air
Exhaust Fans
O.K. to Wrap
-—o?r
F.A.U.
01
Framing
% - v n
Compressor
Insulation
3— /S mU .6'l
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
--��
Drywall - Int. Lath
2_ 7--�a
Final �r�}
Final
/J �
POOLS - SPAS
BLOCKWALIL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
Sewer Connection
/0
(1��-�D� �l
Pool Cover
Encapsulation
Gas Piping
Gas Test
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 LA
Temp. Use of Power
JIV
Final
Utility Notice (Perm)
f i
f�)33 P.O. BOX 1504 APPLICATION ONLY
Building �� h J . 78-495 CALLE TAMPICO
l
Address LA OUINTA, CALIFORNIA 92253
Owner
�I
Mailing (,k'CA BUILDING: TYPE'CONST. OCC. GRP.
/, /�
Address V ' OlAA.P. Number (O W-5 — G-0City 11' Tel. // ) 11 f /
�� c>� � '71(,]_ �. 4 qo Legal Descriptionl bl Sed- ' U-4 P 33
Contractor Project Description
Address C J T U
City Zip Tel.
Tl
State Lic. City a
& Classif. Lic. # Q Sq. Ft.Q No. No. Dw.
Arch., Engr.,
I Size X07 1 Stories Units'-'
Designer NewN Add ❑ Alter ❑ Repair ❑ t `, Demoiition ❑
rAi �Ai6e.� �
AddressP o '.��) � ' G b 0�0
Tel.
City �tvl� 1 Stae
Zipq) W3 Lic.t#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
lot 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 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 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 hundied dollars (8500).
I] 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
doesnot apply to an owner of property who builds of improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
I') I am exempt under Sec. B.'8 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 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., 11, 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 Address
City, State, Zip
>timated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setbact from Center Line
Rear Setback from Rear Prop. Line
Side Street S3tback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR I ,.
Issued by: Da -.e Permit
-,V_alidated by:
i'
Validation:
5
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
r - • CERTIFICATE,OF COMPLIANCE
f r
Date 1'0/21/99 - APN # 643=120-005 -
No. 19491 Jurisdiction La Quinta
Owner NameCanaday & Company - Permit #
No, 47-133 Street Via Montessa Log #
City La Quinta Zip 92253 Study Area
Tract # 'Lot # 233 Square -Footage 3079
Type of Development Single Family Residence No. of Units 1
Comments Lake La Quinta 1 ,
1
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 f
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 Uat building
�Sy
permits arid/or Certificates of Occupancy for this square footage in this proposed project may mw besued '3
Fees paid By cc/13'of A/Canaday & Company Tele tone' r :
p :a771L9636
Name on the check`
By Dr. Doris Wilson
Superintendent
. Fee collected /exempted by'- Juanita Green Payment Received $5,942.47 "
" Check No. 2016297584 .
Signature "
NOTICE: Pursuant of AIV.mbiy Bill 3081 (CHAP 549: :TATS. 1996) this will serve to notify you that the 90 -day approval period in which you mey protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Distrlc$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 _
Dear Builder:
/ I �
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
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 adicensed -surveyor, Ior engineer; pare :'on file n,the,,Public Works z r,, ',
A c Oat Uzi
Department �y }-�
a `4 _4,
,Lr '.Abd' +y��,..,7'c t n ti•,' Y•
�',!+,M=;.I+K;;r.?C�'•S+^.L`ik'-'t7'i',,....{:y"rifl ,t.
1��°.£� s,.f::?�2� r,Venfcation;ihatanfrastructure,irn rovements�and�other-re uired'tr.-act�,rr�rouements�a-�:��.
``S�..t�•�i...'�.�,,w�R"'.--�%.��c�f+;'n'','5.,�...»cne'�-'da�A"'..«.k'r:"..:'dT:�`:1'�a..•...��ar',"�:, r:'"''7r'.}'vrl';"t.►� d.:�:..�`S'"-,�'';�t'l:e.:,�.�,`TP.t"�rnyr.+et�>_,..CY�*.: +„}T'
� � �.-�;�*,�- � ��.". ,;are complete;�or suffrciently,advanced�ti}owyyarrant;buildtng�pe mit�i5suance�`.� �� `': x r �. a�
.. - u_i. .,' . rr '1I:.t�,1,gt,.^''D`ik;?t�w.,.h,�,y'v'?�^,ia,!"'�..�� ,�,�i';fii'g.'�•�i'Sw",,.. �:;���'" ;:a -^Y
3. Prepare an engineered grading plan that provides for on -lot s.orm water retention,
and have it checked and approved`by the Public Works Department . '
a Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates) -
4. Prepare an engineered grading .,plan that provides for building ,pad grading, in
accordance with the existing soils report and tract gradir:g plan, and have it ..,..r-
checked and approved by the Public Works .Department. ry
•• Tract 28034 (South Val ley kEstates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: h,
LOTS 13`� ZEv I�
i4;z7 , Zbo Z-0 i
Lezm 9�
PUBLIC WORKS AUTHO IZATION CATE
F:IPVJDEPTIDOCSIFORIMS\PW CLEARANCE LETTER.ss