9704-142 (SFD)LICENSED CONTRACTOR DECLARATION
I h&reby affirm under penalty of perjury 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
/Date—;//3/97 Signature of Contractor /
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).
( ) 1, 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 -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
Se, tlon 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.
UNICARE IN'S CO �14501 1% 14 179
(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 14*fiould become
subject to the workers' compensation provision of Se Ion 700 of the Labor
�pode, Ish I f rt wi comply with tHose
ate: Applicant !
Warning: Failure to secure W�kers' 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 aY
whose request and for whose benefit work is performed under or'pursua to�
any permit issued as a result of this applicaton agrees to, & shall, inde�ii�
& hold harmless the City of La Quinta, its officers, agents and em , leyees.
2. Any permit issued as a result of this application becomes null and V, d'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 s City to enter upon
the above-mentioned property
for
iinnsspe io�,DateS)
e
Sig01
nature (Owner/Agent) ,4MI/ 1" '` 9
BUILDING PERMIT PERMIT# CONTROL#
y IIr4.142 5126
ltili,l
DATE .qw VALUATION �tZ f�7i1.31i LOT, TRACTJOB
SITE
ADDRESS 47-815 VIA i•RIESTE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CANA.DAY&COMPANY
eAa"dADAY&CU:>,fPANY
15707 b'RWKii0f.WW I)R. 5l'i. 208
1570 BR(X)Kf40LL0W DRIVE, SUM—* 208
SANTA ANA CA 92705
SANTA ANA CA 92705
(714)751-9151 C131A 445
USE OF PERMIT
S11)
:10) - PLAN 2 - PERMIT IK)� 1401TNCLOI)b 01.010K W.N,1.3 OR fACK)L.
I tRi►.li• CONSIRUC. T1e' 14 Z011010i 5F
1K71 t'fi� r�fto 40.40 SF
GARAt'11%t'AR11t: 10' 599 0) .1W
MATED c.Y: ST OF C'ONs�tRUC;'t�ION
12N.573.30
(( ff =;ss ■■ gL, L + ,y`A6 yil�:.�"i,'
i"�1� R&I- t f Re EF, wt:11� MARK'
.
C*0N-V1'RtJ(."t'K1N Flus 101-t.M-418•-W
en -AN (14VF3r#: iZEIR sig9.,tI
MliCHANICW, ! l4i, 101. -000 -421 -ice iGfi.Sti
ELF'C.lIRICAL 3 .11i mi-1.)fi0- an.,000 3fas �w
41t,t_+r P"NO srt:1= 10;_W_ ..11u-1116 VM 00
IC7�11'3,, l liI. - IZUS31) 1111 Q01i-2=11 tTM1: $12, to
CH1DIN(i Ho,' S2
ii3l..u;^tA7)
1--1(1X(Wk!)--4�42'1-.3tfi4)tdf
)INFRA1010ii(It't 11013 E'A" i1,{4)5
•r 2,
ART IN )'13tH N II .vii; • R3 511: 7of -rN1. ?55 oun R51 91
t ,
i
SUB "►UFAL, COM it UC TION AND PLAN t''1lECK
$4,474 M
LESS f'EiUMIA10 07ES
. $2 S0 to)
'tT)TAI, PERMIT N'1± KS 014, NOW
54;22401
RECEIPT
DATE
,BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
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.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVA S
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
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
Temp. Use of Power
Final
Utility Notice (Perm)
Building
Address ZY
Owner
�� h c
Mailing
Address 1S
City • w
JG. - 14 I -r^ G
Contractor
C4s'Ne-
q7-1,P.O. BOX 1504 OPPI ICOTIAN ANI Y
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
!Gy d ram c
11104/ s/e- 20&
Zip 52-70s- T
e7/ / 7J-1 W >/
d W ►r.4
City lZip Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer m 6 rVV,tr�
Address OrTel. !�
//>�-,JuP? ele-1-;&0 31v/z//
City / Zip State `� State
4�i.., I A. 0. l `1 ��6,T Lic. #
Jr LIC&SED 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
1 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).
I 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.)
II
I, 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.)
I 7 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. ❑ 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: 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
ct)nstruction, 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
BUILDING DIVISION
BUILDING: TYPE CONST;_ OCC. GRP.
A.P. Number f64 � - i 3(D - (�
Legal Description 4h ZiP `J 7 -
Project
Project Description
Sq. Ft. No. No. Dw.
Size 377 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
��/G rt .2- Z U / 7
Estimated
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 from Center Line
k from Rear Prop. Line
0WN WSetback from Center Line
Side Setback from Property Line
FINAL DATE R 2 9 1997INSPECTOR
Issued by j,.,_Permit
Validated by:r
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SQ. FT. (ty
POR. SO. FT. @
GAR. SQ, FT, g.
CAR P. SO. FT.
WALL SO. FT. 0
SO. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
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
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID p 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R 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 APP./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
InArC4 !vn J AIUMM1UM=J nl 11 0
GARDEN WALL FINAL I _
Notice:
Document Cannot Be Duplicated
Desert Sands Vnified'School District
82=879 Highway 111"
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/13/97 APN # 643-130-048
No. 15507 Jurisdiction La Quinta
Owner Name Canaday & Company Permit #
No. 47815 Street Via Trieste Log #
City La Quinta zip 92253 Study Area 123
Tract # 26152 Lot # 48 Square Footage 2013
Type of Development Single Family Resideice' 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
1.84 X 2,013 or $ 3,703.92 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/Pacific National Bank/PNB/Canaday & Co. Telephone
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received
Signature
Check No. 67456
$3,703.92
tOTICE: 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
ibove 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
ollect 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
�il,iel,;1 Ouiuta Arc•I�i1rr1�„•„► �'',,.,,...:�.�,.,.
Date: i�997
Re: ' Lot No:�
Address: '
Your request fur .-lippruval of
Has bee►►:
Approved
Subject to:
Denied
Reaso►► for de►►ial:
airy f Architectural Committee
1
r
CITY OF LA OUINTA `
BUILDING & SAFETY DEPARTMENT .
777-7012
INSPECTION F9PckE4 iJ 1A Q(Jjj1jTA
m-7153
owr1Of CANADAY&COMPANYMAY i 4 1997
Contractor CANADAY C COMPAUX ,�„
Permit Number
9704-142 114MME LJLP I.
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-815 VIA TRIESTE
SFD DOES NOT INC' .UDE WALL OR POOL
C
7/96 TURN ON LftILITIES OR OCCUPY WILDING
Ets",iv