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0005-299 (SFD)-LICENSED CONTRACTOR DECLARATION 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 Professional§'Code, and my License is in full force and effect. Li�.nse # s Lic. Class Exp. Date 61 03131;W Date e�� rGN 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). ` �.t... �,y a O I am exempt under Section B&P.C. for this.reason r, Date Signature of Owner • WORKER'S COMPENSATION DECLARATION I hereby affirm -under :penalty, of perjury one of the following declarations: 4) [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 pe ormance 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: CarrierPolicy No. FRBIV1ONT OOMP 1114.9wT O -i 19900-1,4179 (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, J .shall'not employ any person in any manner so as to become subject to the "�t orkers' compensation laws of California, and agree that if 1: should become subtect to the workers' compensation provisions-of5etionn-3700 of the Labor Code, l s`hal fd hyv h comply with those.provision^ ^� ~ 'Date: / zro Applicant t r 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 1.80 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 forinsp4ectlon purposes. (, Signature (Owner/Agent) C a l>1J a ±ti-� ~~ Date BUILDING PERMIT PERMIT# DATE VALUATION LOT • ONS -299 k' , &.154,471.70 85 TRACT JOB SITE't ADDRESS 47-1845 VIA 7iPA°1.M. APN ?� 1!/ 7�= ! t! i✓ � ll e/t OWNER CONTRACTOR / DESIGNER / EN INEER CANAD A1C & COWAXY CANADAY & C:OWANY 174$0 r, 1?Th 9'F. 'm 0E 174801:" 17M 33T, 010£ TtJRM CA 92780' MUM CA 92780 .714)508 40 ..... CBIJ i. .4485 . USE OF PERMIT SWOLE F.AWLY-DW�.d.11tiTG ' SPO. LOT 85 PLAN 2OB-PERMIT DOES NOT INCLUDE HLOCX WA 111.13 OR. 1064 76% PLAN CHECK FE ,R.FDUCT10TI FOR. MULTIPLE ISSANCE OF ; SAME' PLAN TYPE. TRAC;`T CONSTRUCTION 2S.PS.00 OF PORMP10110. 393.011 :e`P C3ARAGE(C';ARPORT (OAS 8110,60 EST A=3 COST Or, CO^P AUC -00-7 .1-54,471.70 71.70 My21WYETLl<Id�il t.0140TRUC:TION FEE 101.000.418.000X838180 PIAN Ir.HECK bZE tf?i-Q(f0'439-�I$ $1� 14. ` FEE DEPOSIT 101.00©-439.31812%99 MECHANIC.A,L. FEE 101-000-421;.,060 $105.00 ELECTRICAL FEE 101.000.420 WO 8147,83 PLUM51"FEE 101-000419-000 $12aas MONO FEI - RE91D 101-000-241-000 ORADINO FELE 101-000-423»000 DWELLOP�11:'IMPA^CT YEffi1,9D7,OD :; 2..,' • i)' -4 SUB-TOTALCt7MMUCiTOWAND NCIMC-TL $3,'3213:019 { LESS PRE-PA[D MIS -$250.00 +1,+'S DOB NOW RECEIPT DATE BY' s a >,� y D I ED INSPECTOR i�i INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR f` BUILDING APPROVALS MECHANICAL APPROVALS Set backsUnderground Ducts Forms & Footings Ducts Slab GradepsJ Return Air Steel Combustion Air Roof Deck ���� Exhaust Fans O.K to Wrap _� ZZ 2� F.A.U. Framing/•- _ Compressor Insulation _ -D 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 BLOCKWA/—L APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I 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: 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 3 6 Temp. Use of Power Final Utility Notice (Perm) ,:..¢,,�.r.-.,� .._=.,.,w.+st:yr.--._.�. .s:-�. ���. .www:wa.--4-r•�sl,; �='x:xv.�nl,gs .s.•�:"^+:.^•x��ru-�a�v..,� -�::" s�.:3f::e•.x�;+Ir'..i»T.•-a.-,3,,,.:.iav5v+r^�s:wY-ra...�–� :,. ,�,•,� ,,i �_ �-� . .., Tit* QuiCt P.O. BOX 1504 APPLICATION ONLY Building (� / �`! ' + 1 �� f �C 78-495 CALLE CALIFORNIATAMPIO Address / ��JJ I e.- LA QUINTA, ORNIA 92253 Owne �� ��' C�� 1n .q BUILDING: TYPE'CONST. OCC. GRP. Mailing Address i L.) a`' �, �i '�"_�Q ! t1 v A.P. Number Cityj Zip �g (,` TeL 1� .41 / L1V �_t q 'Legal Description Contractor! x Project Description Address' r .•.. City. Zip Tel..; -'."i. !' r Lt ; State LicCity r . , & Classif. (� ! Lic. q C-, qg5 Sq. Ft: �' '. No. " • No 'DW. i , i + Size. �' .� Stories Units 9 Arch., Engr.; Designer New Add ❑ Alter O Repair ❑ Demolition ❑ Address Tel. city-- Zip State ~�"``(VI�Q Lic.# 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 - Estimated Valuation 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 islicensed.pursuant to PERMIT' - AMOUNT 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than live hundred dollars (8500). - - 1: 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Ch..k. Bal. do. the work, and the structure isnot intended or offered for sale. (Sec. 7044, Buisness and Const. 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,' Mech. - ' 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 oElectrical ' f 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. Plumbing Strutt the project. (Seca 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 S. M. 1. such projects with a contracror(s)'.licensed pursuantto the Contractor's License Law.) . •i7 I am exempt under Sec. Grading 8. 8 P.C. for this reason - .. 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. • ❑ Certified copy is hereby furnished. - TOTAL CERTIFICATE OF EXEMPTION FROM - REMARKS - WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (E100) valuation or less.) - I certify that in the performance of thgwork- forwhich 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., If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop.,Line CONSTRUCTION LENDING AGENCY. Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name— Lender's ame Lender's Address—,FINAL DATE INSPECTOR This is a building permit when properly filled out; signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that. the above information is correct. Issued by: Date - Permit 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. Validated by`. Signature of a0plicant Date g� Mailing Address Validation: City, State, Zip . r WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION }' Desert Sands Unified School District z ` 47=950_ Dune Palms Road Notice: ,,• La'Quinta, CA 92253 Document Cannot'Be Duplicated,, _ 5760471-8515; L CERTIFICATE OF COMPLIANCErr f <Irk ; Date 5/31/00 i '�' ` ` �. APN # 643-140-029 <•_• e � ,< .3 =k"ra- Y'/ Wb•µ . S�•• , ,. No. •20497 as+ 7 '. Jurisdiction'-,' •La. Quinta",' r Owner NameCailadaye& Company` ` ' y ,r `�� ; ; Permit #0005-299 - < • .. . 1.. + c Vie. T .. 5•,� No. 47-845 > Street .Via Zurich: �i•" Log # _ .; City<La Quinta `.r Zip 92253 -Study Area' , Tract # 26152 ; Lot #_:,85 " ' . Square Footage -2595' a 1 Y - . moi- + "'•' . .. '� t . i tZ`• •!•;, � t' "4. y ` • . ° T . rr • . <,'Type of Development Sing le'Family Residence' •'' ;No. of Units 1 . . is ,Y. • • ..: ? - .. - + ��4 . .. - + Comments', At the pr t: k ' -t • patios/walkways, residential additions under.500 square feet, detached accessory structures of 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_ f, 411. This certifies that school facility.fees,imposed pursuant to 'Government Code 53080 in the amount of 2.05 X • 2,595. or.$_ 5,319.75 5` #" the property listed,above and that building permits and/or -Certificates of Occupancy for s square footage in this. proposed project may now be iss ed. `.• Fees Paid By CC/Bank of America/Sue Pelletier x " '' . Telephone .760;771-9636 :,. r. Name on the check By Dn, Doris Wilson Superintendent Fee collected /exempted by -Mary Ann L. Borja Payment Received W`715,319.15 rte, Check No. ' - • 2004888073' ; Signature NOTICE: , Pursuant of Assembly YII 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 collect them on the District('s)(s') behalf, whichever is earlier., Collector: Aitach,a copy of county or city plain check application form to district copy for all waivers., Embossed Original- Building Dept./Applicant - Copy, Appltcang[teceipt Copy -Accounting k < .4 ter.