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9807-182 (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. Class Exp. Date 591561 B 3/31/00 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. (() 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. tlr4111,, i , frits CO 3C50-1197-14179 (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 provisions of Section 3700 of the Labor /Code, I shall forthwith comply with those prove lonsl, Date: (2 ! o I/' 1 Applicant— Warning: pplicant 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 i, 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-4, he above-mentioned properly -for inspection purposes. Vr� , fi "� 1 r qI J! f Signature (Owner/Agent) -- +- Date BUILDINGPERMIT PERMIT# CONTROL# 9907 -INN DATE } , „ VALUATION -44 TRACT �tf s� :�:z ,7dr . � 27, 5 6 ` ,;, JOB SITE C_ ADDRESS 78 9.25 VIA TRI 1e TE A APN ' 64135-1404 04 OWNER CONTRACTOR/DESIGNER/ENGINEER C'XNADA.Y & CO rfE'IVIVYC��i+dA[)/i'Y & f;'©*VfR,,1.NY 1570 BRCK)KHOLi.LOW 0R1VE, SLT11E 208 1570 BIWOKHOL:LOW DRIVE, Si3FFE 208 SANTA ANA CCA 9:1705 SAN'F.A. ANA CA. 92705 I'71 751-9r St CBL # 4454 USE OF PERMIT SINGLE !AMI Y DW8,111` 1Wi � SPD - PLAN 313 0 -- PERMIT DOES NOTAINC:LUDt BLOCKWALL OR POOL k TI A T 0ONSTRUMIC1N 2,591.00 SP PCgZCWP,r'il:10- 45,00 Sr GARA0FJiCAR'P0 Zf 518.00 SY p ^�+w���g �[+qryy /^�y /°y� ` ��x C yy t . ,Y PsTISi,t,AmT� DCOS. \I'Et �..%�Q:3�iL.lvV•YivJ� CONSTRVY,7 ION FK6 10.1-000-.418-OtIO 101-000-430-3:18 EGE DUE 7!0�.51T 101.-000-439-3111 4250,00 bir'sc,iiRT31CAT; :k -101-000-42 i -ftl 585,50 IM- F.0 ,RiCAL F R 101 -OW -420-000 $175.39 PLIL4"INP 1; FH $160.00 `i'J'!t(?NG 1Lf01UGN FE E, -R:E,WD 101-000-2.41: 0 $15,33 ORAr '�xs rEri 4.6J - -42 TNFfZiW.RLrL'%'URF FEE .225-000-443-34- $3,434.:56 ARS' 4NU#3j t :€�? ,AC ;� • 1'�Is:fr.701-000-2."00 S133.f 1 SUt3=?l MAL CONIM',RUC TION AND PLAN CKC'�. LESS P1tP.-PA1C F ES 425101,00 PERMIT E4� A.1✓ 9C : rS DUE NOM"$5,3 o -w 4 RECEIPT 1 DATE BY qJFINA7 bb INSPECTOR . r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ Underground Ducts Ducts Slab GradeT ReturnAir Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -/Z $ F.A.U. Framing <:Z�C) C 1 Compressor Insulation — Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 57 Drywall - Int. Lath (— — Final Ir -7; BLOCKWALL APPROVALS Final 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 Water Piping Heater Final 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 Final4;01— 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 1 Finales✓%0�� Utility Notice (Perm) COMMENTS: I Building Address 799 Owner Mailing Address (� 4 u�l'ItrGu P.O. BOX 1504 78-495 CALLS TAMPICO APPLICATION ONLY (--'(\ e STe LA QUINTA, CALIFORNIA 92253 -\ C6 - l BUILDING: TYPE'CONST. OCC. GRP. onk"Inl oo Al,` 02 A.P. Number Tel. �• -70_� 717: -J. f . 1) l Legal Description co Project Description T7 `R/ IaL \lid Tr i'r, City Zip Tel. State Lic, h & Classif. .59S� �"-� JJ City p� Lic. # 4 � Sq. Ft. Size No. No. Dw. Stories Units Desjgnengr (s C), \ � Ne Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address --�0.V Tel. � �13d? r City � k) i V) Zip a 2) State Lia # c. LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I a�S'licelised under provisI s of Chapter 9 (commen I with Sect n 7000) of Division 3 of he Bf ness:an` ,Protea qLs Code, and my lice�s is h full force j effect. / 23 SIGNATURE/AT 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). l'! 1, 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 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.) Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing I'I I, as owner of the property, am exclusively contracting with licensed contractors to con- strucI 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. 8 P.C. for this reason S.M.1. Grading Driveway Enc. Date Owner Infrastructure 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 n Copy is filed with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (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 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) t "• Side Street Setback from Center Line back from Property Line Side Setback r Lender's Name t, FINAL DATE INSPECTOR J U L Z J �v r`�Date Permit Issued by: Validated by:, - 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. 1 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 a0plicant —Date— ate Mailing Address Mailing Validation: APPLICANT PINK = BUILDING DIVISION City, State, Zip WHITE = FINANCE YELLOW = r 1 Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 6/28/99 No. 18944- owner 8944Owner NameCanaday & Company APN # 643-140-004. Jurisdiction 643-140-004 Permit # No. 78-925 Street Via Triesta Log # City La Quinta Zip 92253 Study Area Tract # 26152 Lot # 60 Square Footage 2,591 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 2,591 or $ 5,000.63 the property listed above and,that L;uildmg t permits and/or Certificates of Occupancy for this square footage in this proposed project fray now j,be issued Fees Paid By cc/CA State Bank/Lake La Quinta Communities T .ephon� 771`9636 r Name on the check "T By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Signature Payment Received $5,000.63 Check No. 51152 NOTICE: Pursuant of Ass(fnbly 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 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 tolled them on the Districl('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