9807-015 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F� - Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV UU LProfessionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r- dLO 8 7
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oZ pate /. t Signature of Contractor
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to 0 i
J U C) OWNER -BUILDER DECLARATION
W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ i1
N 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).
co () I am exempt under Section , B&P.C. for this reason
LID
N Date Signature of Owner
Q N
C)
a- Q WORKER'S COMPENSATION DECLARATION
C) Cr I hereby affirm under penalty of perjury one of the following declarations:
Q () 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
m� Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
Q L Q Section 3700 of the Labor Code, for the performance of the work for which this
11 0) F- permit is issued. My workers' compensation insurance carrier & policy no. are:
I'* Z Cartier YY Policy No.
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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, and agree thatlif I should become
1 subject to the workers' compensation provisions of Section 3700 of the Labor
!`•77 Code, I shal'fort with comply with those prpvisi hS. 7 --
,Date: / pplicant sem. _e
Warningf Fail re to secure Workers' Compensation Ion 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 ins ect'ion,porposes.
,Signature (Owner/Agent) ��� Date_v&A;
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION �� � LOT �4t TRACT d✓
JOB SITE i
APN
ADDRESS 7''1. 1,; �`�Xi C 'Z �'� �, ,
0111^ A0 �M)115
OWNER CONTRACTOR / DESIGNER/ENGINEER
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USE OF PERMIT
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I'M, PAIDFFIFI�1)
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
t OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
_Set Backs
Underground Ducts
Forms & Footings T
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
-Framing ,Z-J� — Q
Compressor
Insulation j -S
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 PP OVALS
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:
pr
ow 6ty
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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P.O. BOX 1504 APPLICATION ONLY
Building 78-495 78-915 Via Trieste LA QUINTACCALIFORNIAALLE 9
Address 2253
Owner Canaday & Company/LLQ, LLC
Mailing
Address1570 Brookhol low Dr., #208
Santa Ana Zip 92705 714/751-9151
Contractor I
Canaday & Company
1570 Brookhollow Dr., #208
arta Ana
'42705
14/751-9151
BtClassif.
591561
LIC. LIC. q 4485
ArchDesig ergr
Len Nobel Company
Vdte,ssBox
16606
TI114/559-4305
"Irvine
242713
Lict#
LICENSED 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 rile 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 intenCed 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.)
1'1 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. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's C ati6ngd9U�anCE4ja Ified copy thereo��6J 38 ab fffg9.
Policy No. — 1 17/ �o Pavy 7 Viilt.�fC lll��
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
employany person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: d, 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 aOplicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. O/CC. GRP. AA
A.P. Number 4'3` '3• (01AS " `4 V — 00S
Legal Description Tract 26152, Lot 59
Project Description Single Family Detached Residence
Sq. Ft. 2591 No. 1
Size s Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing.,
S.M.I.
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation: l
APR 2 91999
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION _
:gym s Y 0F LA 0Ui[I��
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. 17330 Jurisdiction
Owner NameCanaday & Company
No. 78-915 Street Via Trieste
City La Quinta zip 92253
Tract #
Lot #
APN # 643-140-003
La Quinta
Permit #
Log #
Study Area
Square Footage 2,591
Type of Development Single Family Residence 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
1.93 X 2,591 or $ 5,000.63 the property listed above and'`liat building L'
permits and/or Certificates of Occupancy for this square footage in this proposed prcjecf may'now: e issued
y V �;
T"eRMephoneFk714Fees Paid BY City National Bank/Canada & Company -'51-91r5 1
>
Name on the check
By Dr. Doris Wilson
Superintendent
)Fee collected /exempted by Juanita Green Payment Receive
Received
Check No.
Signature
$5,000.63
01058491
NOTICE: Pursuant of %jb ''embly 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
will begin to run (pm 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 Dis rict('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
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