9704-145 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
°t— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O Z M License # Lic. Class Exp Date
C) 1 0 1 x,► ► 14� i 10'18
cr l�� 7 . .
Z r" /Date '� Signature of Contractor - f �
r 0 rl�
U rn OWNER -BUILDER DECLARATION
LU LU (0 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
EL
U) License Law for the following reason:
Z_ ( ) 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 to construct the project (Sec. 7044, Business & Professionals
Code).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
CL
z
WORKER'S COMPENSATION DECLARATION
o 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as, provided for by Section 3700 of the Labor Code, for the
O � JQ performance of the work for which this permit is issued.
m Q C) ( I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
2 U-) H permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No.
°,�° C) 1JUiCARE 1145 01 58SUI 1961417)
J
(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,!d agree that if should become
subject to the workers' compensation pir 0 Secti6 3700 of the Labor-
Code, 4s9-$6 hyyi� comply with pr�p,fyf Isl, oyJ��
✓ Date: ` 1 Applicant !/ C/!/'/
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 authoriz7rVresentativ s 6f this City to enter upon
the above-mentioned property for sf�ectio%�p .rises.
Signature (Owner/Agent)�li !% Date
BUILDING PERMIT PERMIT# CONTROL#
47404-445 5125
DATE$113107 VALUATION $1.16,724.20 LOT 101 TRACT )o 152
JOB SITE
APN
ADDRESS 474500 VIA 1 IVIii I:
OWNER
CONTRACTOR/DESIGNER/ENGINEER
(',tir:< 1 1 : �:3:�:i' ;r: '
f `11.rAi3Ar &Z C()M1'A1'.Y
1570713.1 O(AlfuLIA)W bR. 91'E. 208
1 +i0 iiiti.3c;)f HOLLOW 1AIVE, SC.ifI""fi; 208
St1fV'1'A ANA C'A 02'70S
SA N'I'A ANA. CA. 42705
t71,417%1-9151 C'fiifi.# �11R�
USE OF PERMIT
104)
191, 1) - t&(.AN 3 J IS10 (,1JES t itO SE) - t"HRMI t t *.t. S t u i ilvi;l.U01.,
111,(.X.X WA1.11.8 OR Pt,x 11,, FLAN tJ11:C *K 1+1% KR tX'F0 HY 7"0 bOR
M1JLTIPIX ISS( iAW.TiUFS SAlkItiPLAN
GARA0[VCARP0H:r 1**
i'i.iR�.'itfi'tt"1'1Cy dg.1Nf t,1�
9'1t.At."1' C`Ol�i':3'1'1tiJS'7'1c�N 2,�8n �J►1 `t1�
ES'1'11> A'1'ED COST OF C0N1N'.r1Z ri."f10, N
136.724.20
[ ERM11T FEC NVAIMA110'
PI..AN 003C% % 1^'1.1i 101-tM-4' 0-318 S 1613 79
c'CaNSlltztt"TFQPf1a4 ? If -000-4184.0 $7fiq.tltl
XLE01-W41(:A1,14X 101-000.421-000 Suti.SU
El.l.C."!'RICAi. HiL lot.00.0420-()00 x004.71
PLUMBiNO FPli 101 -0(1C► -414• Xl10 5142.10►
STCONCFMOTION Pi1..-RF 810 191.(! -241-W S11.67
GRADING FRE 101.4100-423-000 $20.00
tNrRA&rRUCf'(JR6 Phi-. 225-000-443-342 S3.1J61.9;
ART 1N 144.11:0,11C PLACES - NSS1tr 701.000( 25541041 191.81
�a
,4tiI3-1Y)TA1, ("ON:i#RW7110IN ANY) PT •AN CIMCK
$4,49041
' LESS PRE -PAID FEES
$0 400 ;
TOTAII, eERMIT 1,051 DITE NOW
$4,+11101.41
l
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
,t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE 7
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footing
Ducts
lab G
Return Air
Steel
Combustion Air
Roof Deck-71Exhaust
Fans
O.K to WrapF.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. Vf
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAL
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
aste Lines
Heater Final
Water Pipin
Plumbing Final
PMMYin-g Top Out
Equipment Enclosure
Shower
O.K for Finish Plaster
r Lateral
Pool Cover
Sewer Connectio
Encapsulation
Test
Applian
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
Utility Notice (Perm)
COMMENTS:
P.O: BOX 1504 APPLICATION ONLY
Building 41 C) 7&105 CALLE ESTADO
Address / 7 5 5' ��F / '�f rS c LA QUINTA, CALIFORNIA 92253
Owner /
G h 4 jey d
Address/S
n%rJ
C'ty Zip Tel.
h � 41 70 3r' 7/s
Contractor
Address
s4
City lZip ITel.
State Lic. City
& Classif. Lic. #
Arch., Engr., at
Designer �/ W/ A &rvo;
Addressl Tell..
_ S / ///�' y
e -i 740
City l / Zip State
i�.. Jor iw S 1 �J,1.2 & Lic. # C S .� 9; 7
t ICENSED 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, 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, 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. 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.)
fl 1 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
F) 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 (8100) 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 Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. OCC. GRP.-
A.P. Number /
,Legal Description LoY /w, �Q. Z.i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING
rk,
1ST FL. SO. FT. @ $
2ND FL. SO, FT.
POR. SO. FT. p
GAR. SO, FT, ®
CAR P. SO. FT.
WALL SO. FT.
SO. FT.
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
ROUGH PLUMB.
NOTE: Not to be used as property tax valuation
HEATING (ROUGH)
FLOOR DRAIN
FORMS
MECHANICAL FEES
ROUGH WIRING
WATER SOFTENER
ROCK STORAGE
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
HEATING (FINAL)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
TEMP. POLE
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
WATER HEATER
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
BOND BEAM
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
=$
COMPRESSOR HP
POLE,TEMIPERM•
LAVATORY
FRAMING
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. c
BATH TUB
VENTILATION
SO. FT. c
WATER HEATER .
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR @ 3/ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
GAR. FIREWALL
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.IEOUIP.
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
1Mare,1 VM J AIUWA 1 UMCWIMI IALJ
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500 '
CERTIFICATE OF COMPLIANCE
Date 5/13/97
No. 15508
Owner Name Canaday & Company
APN # 643-130-060
Jurisdiction La Quinta
Permit #
No. 47850 Street Via 'Pmts _TR t c_,STE Log #
City La Quinta zip 92253 Study Area 123
Tract # 26152 Lot # 101 Square Footage 2286
Type of Development Single Family Residence
Comments
No. of Units 1
REVISED COPY. Street name changed om Via.Florence to Via riests per Greg Butler
City of La Quinta.
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 payschool,fees, -at -this time"'due to the following
�,.:. i
reason: _
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 2,286 or $ 4,206.24 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
Signature
Payment Received $4,206.24
r ,Check No ,67456,,
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90-da`y 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
lot
Naol
CITY OF LA OUINTA
BUILDING & SAFETY DEPARTMENT
777QVVY OF Lid C UINTA
INSPECTION REQUEST LINE
777-7153 Ni rad ; 4 1997
Owner CiAN.4DAY.&COMPANY
Contractor CANADAY .& C'OMIFA NCE DEPT
Permit Number 9704-145
(POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL' APPLICABLE. SPACES.
JOBADDRES& *-850 VIA TRIESTE
SFD DOES NOT INC'LUDF WALL OR POOL,
TYPE OF INSPECTION DATE INSP.
FOUNDATION A SETBACK
FOOTING STEEL v�
MAM GROUND SYSTEM 4wr _
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL AL A OV N�S BEENSIGNED
.CONCRETE SLAB n �. '•
JOISTS & GIRDERS
ELECTRICAL GROUND WORK -
DO NOT POUR'CONCRETE'UNTIL ALL ABOVE HAS BEEN SIGNEO
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS &GAS TEST f
HEATING & VENT - A/C
FIREPLACE
ROOF �� Y
.BOND BEAM
O.K. TO WRAP
GROUT D 4' O 8' ,
FRAMING u(
INSULATION
PRis-ROOF ._._�.,...._ .r _._........�__
_ COVER WO WORK UNTIL ABOV H S EEN SlGbWD,,V
ALL INTERIOR.
EXTERIOR LATH _
POOL PRE PLASTER
POOL FENCE & CCATE
SEWER SEPTIOTANK
FINALS
FINAL, GAS TEST
HEATING. -A/C'
HOUSE NUMBERS .
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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: 47-850 VIA TRIESTE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9704-145
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: CANADAY AND COMPANY
Building Official
Land Use Zone: RL
Address: 17480 EAST 17'" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 03-31-98
POST IN A CONSPICUOUS PLACE