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9803-135 (SFD),i LICENSED CONTRACTOR DECLARATION I hereby 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 Eiip. Date 41 ,I t. b n ate 'S Q 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). ( ) I, as owner of the property, am exclusively ` contracting_ with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) 1' 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 Sedition 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: Carver Policy No. 0=1 INS co 5�50�1197-3=11 i'�"" (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 provisioof Section 3700 of the Labor Cede, I sh I forth Ith comply with those pro on ons ©ate: s %Applicant ✓ . � « A Sr le, 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, indemnity & 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 con§truction, and hereby authorize representatives of this City to enter upon t 2 above-mentioned property for insp tion purposes. gnature (Owner/Agent) Ag, Date PERMIT# CONTROL# BUILDING PERMIT DATEl VALUATION LOT yi TRACT :. f8*, 9 7 4 tt ` `t�"4` C y y� JOB SITE' 17-'9405 ADDRESS 7 '9405 VIA ��,.�(3 ESI a:. � � � _ APN L+�;�•^9..►L��;l� . OWNER CONTRACTOR / DESIGNER / ENGINEER Cr•:;�IADA:Y & t:OI IPANY, iA9`JAf31-' Y 4z; COMPANY . :t5 0 BRUJ,KHOL LOW DIUVE, Si ME, 208 1570 BROOK14OT.,.LM DME, SUMP, -1.08 SANTA - ANA CA 92705 SAN'T'A. ANA CA 92103 USE OF PERMIT SPO , .ISR) - PLIOWIT DOEa NOT 114CLi3U1 131.oc* wi%LLs OC< PCjuil'fi.AN C'#�!"'•C�•: d�:Rk;C.9i,JCED k Y 7 4°4'6 FdYF2.1VlULTITIL1- 1 S RJe1,1�fP.;'l I'.l..tl JF 3AM �?�� MAR 2.7 1998 TRACT ti -ONS` RUC'I`iON Z591.00 Si POR1 -UPIATRt0 43.00 SC vIT T F LA 0UINTA �3,(3ZA�ivi:i(;tt]�CaFi�f` b.it�.�3(► �E' LSTAIMATE"' COST OF � GINIIS 5111 :Irl N .1153,.'Z85,70 CON' STRLJCi10N FR7 101-000.41N-000 PII IV CltrC K FEE '101 000-$39-31X, S 1175 29 ATICSGVNII.IC.AL P'EZ1 1.01-000-42.1-000 t ZEC1 UCALT-, 101.-00C-420.000 4115.3 6ALUN1.t33a4Ct• FEE 101-0001-419.000 .'ti`?'RON01 MOTION FIR: - RE: `e.3K) 10 t - OW -2/$1-(()00 05115,33 C.1Itj'kDLN0y FRP; 101-000-423-000 INFRASRUC T VRE FEE 225-000-443-342 531'434. AWI71N Pcn? <iC PLACES ,12f:Si_•I:, 70.i.()00-255-000 1533.25 F1 's!?1r!�Cai1'!' 10L��t00 3��315 4250.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $S,Ow?.tJ3 LESS ['1.a1'=1'.A D%L;ES -$250.00 • TOTAL-4110.10117p'8413IS,Y,Y[I.l?"No6'9 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs A rlUnderground Ducts Forms 8 Footings Ducts Slab Grade Return Air ,Steel Combustion Air Roof Deck / /2j Exhaust Fans O.K to Wrap F.A.U. Framing p 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 S 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 PLU BING AP/PR VA Gas Test Electric Final Waste Lines Heater Final Plumbing Final Water Piping 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) ? S 7 ELECTRICAL AP ROVALS 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 r . t Final Ql 61" S% Utility Notice (Perm) J, ,� `f: - 4 Citi/ of La Quinta . - .:. .:. I . I.- Bu lding S Safety Division I A . ..:. .. t P:O: Box -1504 . • Per_mlt #.. - f , , ., 78-495 Calle Tampico . Y . 1.La Quinta, CA 92253' - .. •a.'>>1. Building Permit Application and Tracking Sheet Project Address: 7 / Q S' V�'A - f ,-ir j! c Owner's Name: `�G',., ` 4 .4 t',O! A. P. Number:• COT 3 /300 .57/ ' Address: / S70 %j r00 v// -J �v W -200 Legal Description: Ciry,ST,Zip:'-f4, 111 /1it� cq Co ntractor. 4' C o� Te I hone: s Address: 15-70 o Ot.+' r T•�'Qi0J Project Description: r. ,26 Sot- Zo / �1 o .Cityk:Zip: 5r_rT� h4 .6 /�70� LG KC z4 QUrk1� L� 4>(,,"�'c �4- . _ Telephone: 7� y / S �� ::: .. . ..State Lic. # : <-q S�I S6� Ciry Lic...#......... y... 2 411 �J CS'llt. J IJ4. rI Arch . Engr.. Designer:. Ni k r /)% <ov610 Z 4 .. . - 1. Address: ' 1-2. 0, 13 e> x 75' ' City. ST. Zip: .O,J(i-1 /yOT S r,.. t e� , Tel le h ne: e o •o P 60 �� to 7 3 • Constru coon T e: Occu anc -3 P Y YP n V N t i StaeLc '.. I ne : Ne w Add'n Alter ' Repair Demo P ro'ect e � circ e o ) P J type Name of Contact Person: 1304. � 11lc.� _ Sq. Ft.i a 5.9 / .' # Stories: / # Units: ' _ Telephone # of Contact Person: / Q , -1 - . .. , , Estimated Value of Project:. �,:;;;::;:;;;>:<.;;;:.:;.>:;.::;:;;;;;;:;<:;;:.;::.;:;:;:;:.:. 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I . �, - f , , . •• . . . . . a1 k ' 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 ollowing. BUILDING ADDRESS: 47-905 VIA TRIESTE Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9803-135 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CANADAY AND COMPANY Address: City: l-�&'t-X Building Official 17480 EAST 17T" ST. #106 TUSTIN, CA 92780 By: STEVE TRAXEL Date: 09-27-99 POST IN A CONSPICUOUS PLACE I;