9807-011 (SFD)l 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 # ti Lic. Class Exp. Date
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).
() 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.
(t�) 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. ares -.<
Carrier Policy No.
Co
(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 wo1kers' compensation provisions of]Section 3700 of the Labor
Code, I shall forthwith comply with those,,provisio s99.
�Dafe: /f�f • // Applicant;1 / VZ/
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100;000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code interest and attorney's fees.
t .
IMPORTANT Application is hereby made to the Director of Building'and Safety
for a permit .subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit:issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and�State laws relating to the building
construction, and hereby authorize representatives of this.City to enter upon
the above-mentioned property ffo�(inspection purposes. yry
Signature (Owner/Agent) </I / Date i
V`
t BUILDING PERMIT PERMIT# ,jvnLjrlL# _te,
t
DATE VALUATION LOT TRACT •'
JOB SITE
ADDRESS 47-944) V I/(► TRIESTE �
APN G
4i+$a�`��'�?�.7% .;•'
OWNER
CONTRACTOR / DESIGNER /ENGINEER
.:( A,NA:l::'�'-VY& CwOMPANer.�'AN,�.E
AY&!,y'C�flI"NAN1
t.5'it'r713Rii+.fKHl:3L : J'dVi:+ld S E; 2109'
15-70.ORClf 1i'04"OLLOW DRSVEU!`IR 208
AWA AN A CA :x17()5
SttWA t1: A CA 92705
7t ' s►-ay5'� CfWt: 4485
USE OF PERMIT.
-WIT
Si --D • :iILfiN Wo, P91 BOE WALLS, OR POOL
t v t w
r-
iZe�*l . i �v}iv'Sa`.i!`3h i ivs4 2,377.00 uF
GAKAPIUC:'AR ORY 600.00 8
ISIIARATIED CONST OF CON' 10-INY
,C*01NS1',R1.fiQ110N EY, i.t).l-1?IK••4.tt4•-tX11} - s7�ti,So
`
,I,.A�vi Gl-1i�'* iS.'rF,1, _t.. ({�1�f�(if!•"rl ili-]l S60.21
1°l; !ll:f^•a,•ltil i+ i-�'y�t).ttli
Mtit:.! M41C AL 'l7.I.L l f ft -006-423.-000 %98.50
F LEECITMC,AL VIFE IM -000--0-000 X10 70
r'd,iT(�hliR4`ffi ['i?d? ffli Olf4)��#la�t){}(,1 $lht„^S
NfY;.X40'MOTTIONT.-;01', S ,afL} .1.Oz••:iij.O-2,41-0$14.1.6
'�
(0�j0
0i\A•la/ZKO' F.ke-,
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}1!'3' I-Ndytlf.(i,;tt P!,AfM!,,s-,s-1-C 7014W, -255-0f),() �l.lii,94..
r[ tli "i'i7'CtL., +'0 "!'It,UC!'_T.E )1ti: �� l '1 P1.11 N (,Jy} •C :?
` "tt'Q:� i:.t��, Q' @.$ `✓i' : ''bj':4+,°+t 1)1j (ii, N(.)�%r
841,9W.96
/ori-:A.ts
RECEIPT
DATE.;
BY f
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
BLOCKWAL A PROVALS
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
Waste Lines
V
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
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) s/�y199L
COMMENTS:
. 98'07- 0!l
4 4 "
i P.O. BOX 1504 APPLICATION ONLY
Building 47_940 via Trieste LAQUINTA78-495 CCALFORNIIA92253
Address
Owner
MailinCanaday & CompagyAL0, LLC BUILDING: TYPE'CONST. OCC. GRP.
Address643-130-057
1570 Brookhol low Dr,, 0208 A.P. Number
City Zip Tel. Tract 26152, Lot 981 ---
Santa And 92705 1714/751-9151 1 Legal Description
Contractor w w Project Description Single Family Detached Residence
Address
1570 Brookhollow Dr.. #208
City Zip Tel.
Santa Ana 92705 714/751-9151
State Lic. City
& Classif. 591561 Lic. # 4485
Arch., Engr.,
Designer Len Nobel Company
P.O.
Box 16606 7714/559-4305
112713
State
Citryine Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 o 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 thealleged 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).
U 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
orimprovement 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.)
l l 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.)
17 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 acertificate of
WorkPolicer's Cybrtitp No rys�tiio„n sfu�ncl pr fy�gytIfied copy thereofrdn i carob 1oyns I
F] Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WO R KERS' 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 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, alter 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 it 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
ateMailing Address
City, State, Zip
Sq- Ft. 2,507 No.
Size Stories
New ❑ Add ❑ Alter ❑
n
1 No. Dw. 1
Units
Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL:
REMARKS fC;
y
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback fro Property Line
FINAL DATE
fNSPECTOR
Issued by:
Date 011nils
Validated by:
Validation:
998
OptA
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 7/15/98
No. 17331
Owner NameCanaday & Company
No. 47-940
City La Quinta
Tract #
Street Via Trieste
Lot #
Jurisdiction
APN # 643-130-057
La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 2,377
Type of Development Single Family Residence
Comments
No. of Units 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
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 2,377 or $ 4,587.61 the property listed above and that bbildiing
permits and/or Certificates of Occupancy for this square footage in this proposed project ma_N'_Jhow'be lssuedUA r'
Fees Paid By City National Bank/Canaday & Company Te'lgp-o` ne 14-7-T51-91�5'1r
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $4,587.61
ki
Signature
Check No. 01058491
NOTICE: Pursuant of Asse bl 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
above will begin to run from (h 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') 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
r
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
47-940 VIA TRIESTE
Owner of Building: CANADAY AND COMPANY
Building Official
vnd
Bldg. Permit No.: 9807-011
Land Use Zone: RL
Address:. 17480 EAST 17T" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 05-20-99
POST IN A CONSPICUOUS PLACE