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0007-089 (SFD)LICENSED CONTRACTOR DECLARATION �w hereby `affjrm 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 5915111�4B - Dat" 1 �" ignature of Contractor 49' - rOWNER -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 constructnthe project (Sec. 7044, Business & Professionals Code). O I am exempt under Section's B&P.C. for this reason Date -Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty 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 FREMONT COMP INS Policy No. 8100.119900.1,4170 (This section need not be completed if the permit valuation is for $100.00 or less). gr ., ( ) 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' compepsation laws -of California, and agree that if I should become subject. to -the workers' compensation provisions of Section 3700 of the Labor Code,shall forthwith comply wit Ahose provlsl P ns. Date: 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 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 pur olges`) Signature {Owner/Agent) ate BUILDING PERMIT PERMIT# - DATE VALUATION LOT ����`�'� TRACT ( N/, $145,X46.1171 67 26152 JOBISIT APN ADDRESS , . ,m riF ' 643-440-011 OWNER CONTRACTOR/DESIGNER/ENGINEER - CAWMAY & C©10A1,Y CAA PMAY& COMPANY 17480 E 17TH ST. 0166 17480 X 17M ST. x#106 '1`IJS'17Nf CA, 92 780 i'U.ITM CA 92 780 (714)50€ 4440 CTE 4485 USE OF PERMIT MGM FAbfiLY 17'' & LLI7t. SPID. PLAN 10A. R. LOT 67 PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL 75% KAN CHECK FEE k3EDUC'irION FOR 1SOLIANCE, OF SAME PLAN TYPE TRACT CONSTRUCTION 2,422.00,5F PO1d.CI•ifPATIO . 378.00 Sir 0ARAOFJC.1 RPORT (Nt) %604.40 9.17 -MUM) ) COW or C011MUC71ION 145,146.49 PELiAUT MI SUAGdARY CONSTRUCTION FEE 101-000-418.000 $800.50 PLAN CHECK IEE 101-000439-318 $166.58 FEE DEPOSIT 101.000-439.318 4250.00 _ MILCHANICALP'EE ;, 101-000-421-000 $93.10 R1:T CTR.ICAL M, ti ;k 4101 x000-420.000 ' l 14; , S PLLlMFI1Yaa FEE J 01-000-419-000 � �1�9.'Y3 S7'R.O140MC'dTION PEE RE,S"ID 101 000.241.000 $1441 GR AD1NG D >; 101 wa40 40th $20.00 , ly, DEVELOPER IMPACT FEE. � � r $1,907.00 AUG 14 ITY LA SUB -TOTAL. dONSMICTION ARD PLM' C.MC%` X3,2"/4.29 LESS PRE-PAID:lFM -$250.00 "TA.L FEEW 1l' YERS DUEE NOW 9JAa9 RECEIPT DATE '� BY DATE FINALED INSPECTOR i INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR ' BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade A? /�r Return Air Steel t� Combustion Air Roof Deck// - Exhaust Fans O.K to Wrap / -/ F.A.U. Framing 6' Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Z=/6 - _/ -Drywall Drywall- Int. Lath_— _ Final _ Final Z� - — POOLS -SPAS BLOCKW� 'L AP' ROVALS 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 ���01— Pool Cover Sewer Connection Encapsulation Gas Piping Gas Testa/ Appliances Final COMMENTS: Final f 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) 1 - Certificate" -*- ,-City of La uinaa Q Building and Safety De'p-artMent -This Certificate issued:pursuant to the. requirements -of'Section 109 .of the UniforM Bui/ding 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�fo/%wing: BUILDING ADDRESS:- 78-995 VIA TRIESTE Use Classification: SINGLE FAMILY. DWELLING Bldg. Permit No.: 0007-089 Occupancy Group: R-3.4, Type of Construction: VN Land Use Zone: RL . Owner of Building: CANADAY & COMPANY Address: 17480 E. 17T" ST. #106 ' J City: TUSTIN, CA., 92780 - By': GARY HARTMAN Date: 6/20/01 Building Official a POST IN A CONSPICUOUS PLACE L 0 ..