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9807-180 (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 3 .t t,1 •13 3111100 Date Signature of Contractors � 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 l 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'bf 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. 1.VIC;AIM rNS CU t"�','•.50-I u�7-14179 (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, t shall,�'pforthwith comply with "those proLs ision Date: t''�'` // Applicant \..\ F4- = "- 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 ' 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 ,pu�rposes. Signature (Owner/Agent)"- Date' um PERMIT # CONTROL # BUILDING PERMIT>��i,..>If�) DATE VALUATION ap,�y LOT TRACT C i , n� 71 y �. z gAVP.7. ! R7 2111 G.I JOB SIfE ADDRESS '1:dj+a�y��2�%1. APN g�ll OWNER `uY.u'?tiiI lDUVO it, lC..011'{P2L1•;iY 1 tii0.8PLO Sl .HOLL0, MUM, & .I1 iM 20 SANIA ANA -- CA 92705 USE OF PERMIT SFWA 1? FANCLY CONTRACTOR/DESIGNER/ENGINEER CtLilnaYi.al.A & .r.,i.1+54PAN C . 1570 BROOKHOLLOW DIU Vi:. SUM 208 SANTA ANA CA 92XI5 (7t4)7s1-9151 �:C3l. 4985 .S�i •- i%Lt�i 3E1 C; - t''.E:�tivif'i sGti + NvTI1vCt.Ul31~ .�S1.GC;<'�Ji�L% G 1"�-�i?i'....f�'Lt\Lir C"•.h1T:{.3ti" }'isl')ik,�?t1�`i�3 "75�'0'�"1�t.2.IVf1�1: CWI.d? lStit)A1�C;� (,s<:' 8Ai4' ULAN TY -PE. TRACT CONSTRUCT MN 2,591100113F PORCii&AT10 48.00 Sr t3ARA_GE1CAfU;10RT '610.00 Sk 153,W, 70 Sii13�7C3T��'e,'�1r.'�.ND1�LANCHECK $5,026.89 L:?SS RMPA[D FEES -$25t0.0^u� 'OTA@. F"E.RlVl';.WT FMS DirE NTOW S4,776S9 RECEIPT I DATE I BY INSPECTOR l.Slff MMX 0 COST OF CONS UCTI GIN 1'I! iit11 T .FEE Si1r0 MARY C0NS7I'P:t3Crf0N `FEE 101-000.4.18,({)O $828.50 PLAN CMCK FEB 101-000-439-319 $174.40 ME :DEPOSIT 101-1104.439-11 S .$2.x,0,00 (EC:i: N;1CAL FEE 101-M-421-000 f35.50 ELECTRICAL F6E 101.000-420-000 SI75.39 PLUMBING EE 101-000.41.9-00() ilF,fi.00 N1',R.0'N1'G M1, Pi N:3N ITTE - RESID 101-(}W-241.000 $15.33 CrrwM'i t"UI 101-040-423-404 INM:6LASTIYI.fc"i URE FEE 225-000-443-342 ART .IN PLY81AC" PLA MX , V--,,59; 701.••000-T 5-000 fi'333. 1. 153,W, 70 Sii13�7C3T��'e,'�1r.'�.ND1�LANCHECK $5,026.89 L:?SS RMPA[D FEES -$25t0.0^u� 'OTA@. F"E.RlVl';.WT FMS DirE NTOW S4,776S9 RECEIPT I DATE I BY INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Back ; Forms Footings ,Underground round Ducts Ducts Slab Grade - 1(-91? Return Air Steel Z Combustion Air Roof Deck /7 p Exhaust Fans O.K. to Wrap /o .•e Z Qf 57 F.A.U. Framing 0 Q7 S 7 Compressor Insulation _-Q 57 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath -Z2 — _ Drywall - Int. Lath Final Final 6'42--- BLOCKWALL APPROVALS POOLS-SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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 Pool Cover Sewer Connection C ,2 t -, .7 Encapsulation Gas Piping Gas Test Appliances Final Final���v Utility Notice (Gas) Fa 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 Final Utllilly Notice (Perm) COMMENTS: • Building Address Owner ' Mailing Address ,City Contract Address City d T4,!t 0 4" P.O. BOX 1504 78-495 CALLE TAMPICO (� iPta n LA QUINTA, CALIFORNIA 92253 APPLICATION ONLY ILDING: TYPE'CONST. OCC. GRP, ICiaJ ' A=%%_1011A.P. Number 7 co— IJ 0 Legal Description L t!t State Lic. City & Cla sif. S-1 S6 I K I Lic. # L 0 g J =ngr., L.. \ c) ��� i (o �,6 Cs� T lu S�`I CityZip State r-1 .1 � vt 0 . Q -,, r Lic. # �LICEPSED CONTRACTOR'S DECLARATION I hereby affirm that I art licensed under prol(gs of Chapter 9 (cc 7000) of Division 3 of the Business.anq Piofessio s�Code, and my Iii effect. l i7 / / If —a -V OWNER -BUILDER DECLARATION 11 Ihereby 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 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 oner 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.) 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.) 1-1 1 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 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. ❑ 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 employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, atter 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 a0plicant Date Mailing Address City, State, Zip Description I —7 9 IN 11�_ \) 1 of T(fe Sq. Ft. No. No. Dw. Size Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side,Street Setback from Center Line t= Side Sack from Property Line FINAL DATE INSPECTOR JUL 2 i9s-R Issued by: Date Permit Validated by: - Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 921 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 6/28/99 APN # 643-140-006 No. 18946 Jurisdiction 643-140-004 Owner NameCanaday & Company No. 78-945 Street Via Triesta City La Quinta Tract #- 26152 Type of Development Comments Lot # 62 Permit # Log # Zip 92253 Study Area Square Footage 2,591 Single Family Residence 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 i3,L ]'ding permits and/or Certificates of Occupancy for this square footage in this proposed project;inay'no*'be.issued Fees Paid B cc/CA State Bank/Lake La Quinta Communities By Q rT'Nlephone 77t- 9636 r q..'t %7— r Name on the check r b `T 7` By Dr. Doris Wilson's Superintendent. Fee collected/exempted by Juanita Green Signature Payment Received $5,000.63 Check No. 51152 NOTICE: Pursuant of A,rmbly 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 identfied above will begin to run f m thedate 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 LICENSED CONTRACTOR DECLARATION PERMrT#,' CONTROL#! ei� 'Npirmunder penalty 0 pe c0p B f perjury that I arn'llcensed under provisions of UILDINGPERMIT : I ;.,. - Chak, j commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT TRACT % . . w . . - 2 CO) S S1531235.70 Pr6fedebrials Code, and my License is in full forc6 and effect. 04, Ul - :. . .. . . . . Lic. Class Exp. Date .Ucens JOBS E APN CY CONTRACTOR DESIGNER ENGIN OWNER B 3/31/00 ADDRESS 78-945 VIA TRIESTE W z r- ate Signature'of Contractor COD. CANADAY & COMPANY OWNER -BUILDER DECLARATION CANADAY&COMPANY 1570 BROOKHOLLOW-DRI 1570. BROOKHOLLOW DRIVE. 9= 208 W 1:11liereby.affirm tinder. penalty of pe.qury that I am exempt from the Contractor's .'CA 92705; SANTA ANA .:.*CA 92705 License Law for the following reason: SANTA ANA (714)751-9151 CBL# -.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). USE OF PERMIT 1' -..as owner of the,property, am *exclusively contracting with licensed contta . ctors to construct the project.7044, Business & Professional SINOMPAMILY-DWELLINO- (Sed. a ;ode) SFD PLAN 3A G - PERMIT DOES NOT INCLUDE BLOCK WALL OR I am: exempt tinder. Section B&RC. for this, reason K)OL.- PLAN CHECK FEE REDUCED 75% FOR MULTIPLE -ISSUANCE OF l kr Signature.. of Owner 41-z; Date. SAME PLAN TYPE. WORKER'S COMPENSATION DECLARATION of the following declarations: I. hereby -affirm under penalty of perjury one Q,, a: Lo < JUN .009 1999 I have and will maintain a certificate consent to self -insure for workers' TRACT CONSTRUCTION Z591.00 SF LL X, W compensation, as provided for by Section, 3700 of the Labor Code, for the PORCH/PATIO 48.00 SF rto f the work for this permit is Issued. e 3wce o GAPA(WJCARPORT 610.00 Sr. < L)! d 11, maintain workers' Compensation. -Insurance, as required by OF —i 1,1,have.an will, .01TY :Section 3700 of the Labor Code, for the performance of the work for which this .-Is• Issued.. My policy no. are: 'pernift workers' compensation Insurance carder & PolicyNo. -order ESTIMATED COST OF CONS! 153x83.78 4 r` OSCSO- 1 197�44179 , CONSTRUCTION CTION UNIdARE.INS CO: s000n. need n: o't be completed if the permit vaitiatloh is for $160.00 or lase). PERMIT FEE SUMAL4JRY'., ][01-000.4 8-0W Aw that In the performance of the work fdrwhIch this permit -Is Issued, .50, FEE 1 1 shall not, employ any person In any. manner so is to-be6ome subject to the: i�-.$174,40 PLAN CHECK 101-00("3511-318 FEE DEPOSff 101 000-439-318 workers' gomp. rki brisatloh laws of Califomla,'and agree that If I should become Slone iubjbd to the workerW compensation. 1?fouL of Section 11700 of.the. Labor . Isogn . a." 0 FEE 164 -400 -421 -OW M Code; a 11 ?J�vlth'dornply w Ite. P 71 Date. b111*5_ Applicant.: i -J, PLUMBiNQ "hiiirtj:� Failure. sectir:e' Workers' FEE 101.4)0.0419-M 5160.00 to ompensation Coverage Is unlawful.. and : :1 C MA RES I ID shall slubjectan employee to criminal penalties And civil fines.up to $100,000, In r:ST�01�0.wxrio.N FEs,--.' 101-000-Z41-000. -415.33 n FEB iddltI66:.to*the cost of compehsatlon; damages as proy!Oed'for In Sectio 3706 'W. 2 25 -OW -03-342 --,:!,.4i43k$6 of the tAbor Code, Interest And attorney's fees.'. INFkASTRUCTLIM FEE 4., IMPORTANT Xop*llcatloh Is hereby made to the Director 'of-blillding and Safe -.-AR-1r-.jN�pMIC.j! CESi %Ai 133.21::. ty MID _subject . to; the Conditions . and . restrictions. -set -forth on. o.0 a... . permit - ApplIcatq :60on--whote behalf.th. isapplicatio i4mqo each person at ' I E*ch, pqMn oss requeislandni t:work Is 0666 rider or pursuant. to wh -for.whose'be efi rmK:14 I agrees to;4,81hall, indemnity ONANDTLAN CHECK x5,026.89„ 0 . x, •- TAL k" B ,any,pdrmft Issued as -a result of thisiapplitatoi -T(Y -CONSTRUCTI IT' V- 5 rz 6! 440 $250 W Id and -4m0IOyeeS.7`,-`J :hold `CI off ,PRE*PAID {RES" ', '+'r An' rtnifaasued as -a result of this n�;becomes:nul .'AndyoId1*iffy -,. m date S4 E isnot commenced lwit If I .. " ssuah 8.,bf do TOTAL R Cancellation, .r} 'fi pr, ha aw to.. subject ' 1.80 - d -p don y caseation?"permit, or of Wo -PERMIT FEES.DU -N t on and t above Info .a reA h ,a .11 -s 4 to. "VI W1 City;. bu I with Cl. relating 9 lid! ve th I an t a a r 0. m yw 6' - _ . . . g p 0 ere y ou reprose h b o a n.- .n n PA 4.'�:j, v4, t..