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9807-018 (SFD)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. Classxp. Date ,/Date j w Signature of Contractor r i 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. �) 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: Carrier Policy No. U ICIARFs INS CO SCC."_- I tri - 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 I should become subject to the workers' compensation prov. ions of Section 3700 of the Labor ?ode, I shall forth ith comply with those pfovisions.. ate: �� Applicant /-�^�`)s Warning: Fail 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. 6 y!_ Signature (Owner/Agent) Av ` Date % BUILDINGPERMIT PERMIT# CONTROfl`# DATE VALUATION S1"R1 LOT fit+ TRACT 011 t r 1_ "i - ADDRESS ` &M.; SIA. TjrZ[cs- c OWNER APN CONTRACTOR / DESIGNER / ENGINEER "3-138-im CAN ADAY & COMPANY CA.NADAY & COMPANY 15770 BROOK.HOLLOW HIVE, SUM. 208 1570 :BROOKHOLIAW ©I3. VE, SUfTE 209 SAWA. ANA l -'A 92705 SAN'T'A. ANA f'..tq, 92705 t�J 4751-4151 CB11 9484 USE OF PERMIT SFDti VV 3FD - PLAN 4A. F' "IT DOES NOT INCMUIYE, BLOCK WALLS OR PC� PIAN CHECK 1 -TE ItMUILID 13Y 7544 FOR MU1.'I'IPIli ISN'UANCFs ! W :dA%4E PLAN TVK_ � { ARAvf'sr•L.'A WR.T 624.00 SIS PORCH)PATIU 1803.00 S.[• TRACT CONSiRL,C110N :.51.17.00 SF 54 f);-1�.) t A?, l'4 )A1S'1 R17C"F InN .'P1f� F'1._�N CgiCf'K LIESS PRE -PAIL) FEES RECEIPT I DATE 1•0TAf, PERiWIT F CF.S 10111+, N CAV 11-;k. DATE FINALED I INSPECTOR S2"'o M Wi'MATED COST OF CONSTRLICT aN 1'L+'RMtT F1~✓ESUMMARV FiM f T(_)SI P 101-000-439-318 -3250.. Pi. AN 0WX,,'K F[T 101.04f7-434-118 S171,71 C.`•01111STRUCTI.ON F131.1 te1-000-418-000 S818.00 MFA'f 1ANIC:A1.,FU- tG 1-G00- 421-E?E,f, $10.5.00 fs�.t*l'3dtil."ihL 3'7 's 101 -000 -420 -WO 3171.73 M 11.f"11 W11°"1'?, 141-W.0419.000 3142.50 STRONG 114,7110N FEC .RESIO 101-M)-241-000 5!5..09' k.;Ikiw11` 01° fi1i 1014)00-423-000 320.00 INR A;3'IRI.K" rL.FRE VDi M-000-441;-342 53,34,11 ART !N PlItIlAr PI _hCFS - RF'41r 701 W053-000 $I 37 14 54 f);-1�.) t A?, l'4 )A1S'1 R17C"F InN .'P1f� F'1._�N CgiCf'K LIESS PRE -PAIL) FEES RECEIPT I DATE 1•0TAf, PERiWIT F CF.S 10111+, N CAV 11-;k. DATE FINALED I INSPECTOR S2"'o M 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 p 1119 5p 9 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 BLOCKWALL A PROVALS steel POOLS - SPAS 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 ConnectionEncapsulation Gas Piping Gas Test jFr 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 t Final trltility Notice (Perm) SIr COMMENTS: 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 APN # 643-130-056 No. 17327 Jurisdiction La Quinta Owner NameCanaday & Company Permit # No. 78-885 Street Via Trieste Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 2,507 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: 0 EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 2,507 or $ 4,838.51 the property listed above and,ihatbuild>?q' '►.., permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued, FI Fees Paid By C1 National Bank/Canada & Company `} "� ,i City Y !'i`elephorle 71 x:751-9-� 51 Name on the check* By Dr. Doris Wilsont��''`"� Superintendent's Fee collected /exempted by Juanita Green Payment Received $4,838.51 Check No. 01058491 Signature NOTICE: Pursuant of Ass¢obly 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 frorff 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 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: 78-885 VIA TRIESTE Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: Occupancy Group: R-3 Type of Construction: VN Land Use Zone: 9807-018 RL Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17TH ST. #106 City: TUSTIN, CA 92780 Building Official By: STEVE TRAXEL Date: 07-30-99 POST IN A CONSPICUOUS PLACE