0005-296 (SFD)LICENSED CONTRACTOR DECLARATION
F"� by affirm under penalty of perjury that I am licensed under provisions of
^ter 9 (commencing with Section 7000) of Division 3 of the Business and
rofessionals Code, and my License is in full force and effect.
License # Lic. Class ? Exp. Date
Date L� 'Signature. of Contractor
1 -
OWNER -BUILDER DECLARATION
—1 hereby affirm under.penalty of perjurythat 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). ^ ,
O 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:
O 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:
CannerARM�?NT dGMP INS . Policy No. gSO-1Il�OQ=241 %9
(Thissection 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 sous to become subject to the
workers' compensation laws of.California, and agree that if I should become
subject to thew • rkers' compensation provisions, ofISe ao r 700 of the Labor
Code, I shallo y�Ith comply with those provision .
Date: �y Applicant,,`
.�_..
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 compensatiorrdamages 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, a d State laws relating to the building
construction, and hereby authorize reprejentatives of this City to enter upon
the above-mentioned property -for inspect' n urposes. a °
Signature (Owner/Agent) ---J " - Date
BUILDING PERMIT PERMITk
DATE r --� VALUATION LOT OOOS-` -96 TRACT
?� �R4�,14tir3d3 62' 26152
JOB SITE
ADDRESS 47-W V7.AZfWC`rf'.
APN
W 1 J" -6
OWNER
CONTRACT( R
CAMMAY CSG dfV.6r1C'd'. N i
7.
{,ii' )gADAY & COWANY
17480 E, 17TY�_ M, 4106
17480 L. 17'511 f'1; f1106
Tug= CA ' 92780
TUMN CA 92780
(714)5084440.. CBIA 448.5
USE OF PERMIT
;3WO1. R Ffil&[. Y DW1a, 1:1NG
31?1 � LOT 32 PLANJOA.PFAMI`P Oi: X3 MYT NCLiJDE k4LDC)t-IVALLS OR
P001 '
TUCT CONNTRUOIION ?,4 2,00 8F
PORCI3/PATIO MOO Sl;
OARAC#1BfG?lYlt'.1OR (8F) 8,6114,+40 .
XS'rMA'iD C0ST.0F CONS"G''PdCM.-
145,146.40
PERAff1 T' S1MMI.2
COUSTRUC1'ION FEZ 101.006,418-000 g0t'D gU
;PLAN CHECK M8 1 �i1-r30Ca �k39-� 11� �CcS�.93
2DEPOSIT 101.000.439-318 42SO.00
MECrLA?IlCIiLMI; 101-000-421-000 $91x:50
'"Pf.
ELECTRICAL Imo: 101.-000-4204*0 $142.05
PLONIBINciYEE 101000"419-000 $1ZS79
* r
MtRON)MOTION FV, - RC'SID 101-000-W-000
ORADI N91'??2 101-OOf"23-000 $3't1,00
r K
bi?9ELOPER NPAC'T :F'8E �1,90700
..
I Alf
SUB-TMA1'., CONSIMUMON ANLi PLM Crk*Y C
IBJ PRF--P.ALD FERS
4251100
TOTAL PERM-ITY-PTS DATE NOW
i .,�f Lys..«.•%*5 rµ8
'
RECEIPT
DATA;!
'��
T INA •.
INSPECTOR
4✓
y T a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ _�_.
Return Air
IZ
Steel
Combustion Air
Roof Deck'
�B
Exhaust Fans
O.K. to Wrap
_ _ ��
F.A.U.
Framing
`
Compressor
_
Insulation
/ '
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /Z
Drywall - Int. Lath
/
Final 3f—A�
BLOCKWALI APPROVALS
Final
POOL - 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
5vL
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
Temp. Use of Power
Final
Utility Notice (Perm)
.,�„ ,. iT"- .-r'r - �r .>.. � '� .._ _. - ..ti. s t�•F _..y .. _->�.: - :r�7h+' �r.x.� �,r�': r ..�.. ., Y *. .' r r'
P.O. BOX 1504 APPLICATION ONLY
Building { g(�. i } `� 78-495 CALLE TAMPICO
Address `T LA QUINTA, CALIFORNIA 92253
Owner r
l 7 BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address ( CI �`t"Q �f��
A.P. Number --� r
City^. , 1 Zip . Tel. + ! 1 t '. -e G 1
LI L `Y 0 . Legal Description
Contractor Project Description '
Address
�1
City Zip Tel.
State Lic. City _ti Y
& Classif. f" j ;� Lic.'# L ` Sq. Ft.' `, No. No. DW. ,
.� . Size �- Stories Units 1-7 ,i-,,
Arch., Engr, yI
Designer (�J dtt New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address . Tel
City J Zips, r State
Z. 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 Contractors 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 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� ry
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. !J' IT
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
t7 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk: 881: -
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and "Const.
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, 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 Electrical
of proving that he did not build or improve for thepurpose of Sale.)
I'1 I, as owner of the property; am exclusively, contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law .
doesnot apply to an owner or property who builds or improves thereon, and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 Grading I am exempt under Sec. ' B. & P.C. for this reason' '
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION - -
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 .($100) valuation
.,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..
Date Owner
NOTICE TO APPLICANT: If, .alter making this Certificate of Exemption you should become ZONE: BY:
subject to the , Workers' Compensation provisions of the Labor Code,' you must forthwith . '
comply with such provisions or, this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY -Side Street Setback from Center Line
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 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 1 have read this application and slate that the above information -is correct. Issued by: Data 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 applicant Date ,
Mailing Address Validation:
Cit State Zi
Y. P
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
''47-950'Dune Palms -Road r
Notice: Q „nA92253'+QuitaC
DocumentCannot Be Duplicated•76771-8515
d
: `
s CERTIFICATE OF✓COMPLIANCE
Date. 5/31/00 t' ,z APN # 643-140-026 N
" No. 20494 �ti' t Jurisdiction ° La Quinta
Owner NameCanaday & Company- y F 'r Permit # 0005 2 6
A, �,
No. 47-880 ' Street'+ Via Zurich r ` ;{ .: t t`.• 'tog#
-City. La Quinta `` �, '"° �"� , Zip `92253 LStudy"Area,
Tract 26152 c �' = Lot # 82 '' T ' Square'Footage "2422
5
. y.•.aj• - r4. .4. -r}•,.: l }^'1 .',ril it'd.. * •. .i. �� ti
Type of Development Single Family Residence`' is ''' No. of Units 1
Comments
'r
7
F
,r
T' a
At the »present time, the'tDesert Sands Unified School, -District. does, not, collect tees 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 paymg school fees at this tirrie due:fo the following`reason:
r
• �.,.. a - , f `1 rx',1 -f �,f 'L . � . Ste. ) , r - .
f EXEMPTION NOTgAPPLIC"LE-
.
This certifies that school facility fees imposed pursuant tori Government Code 53080 m fhe amount of
2 05 _ b ! ' jC- : 2 422 ( ` or $ J" 965 10 .. a;
` t_he property listed above and,that building,
- permits and/or Certificates of Occupancy forthis square footage in this proposed project may now be issued
.Fees Paid By CC%Bank of America/Sue-Pelletier 4 Telephone `760-771=9636
' Name on the check
By Dr..DorisVilson
Superintendent4'
Fee collected /exempted by Mary Ann L. BorJa Payment Received $4,965 10
��.. Check No` '2004888073" }r`
Signature ; i
x
• NOTICE: Pursuant of Assembly 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
collect themonthe District('s)(s') behalf, whichever,is.eadier..,
Collector: Attach a copy of county or city, plan check.application form to district copy, for all waivers.
Embossed iOriginal- Building Dept %Applicant + +Copy - Applicant/Receipt' , Copy Accounting