0005-301 (SFD){{f LICENSED CONTRACTOR DECLARATION
I hereby.affirAunder•penalty. of perjury that I am licensed under provisions of
Chapte��91commencing with Section 7000) of Division 3 of the Business and
Profeg.;ionals Code, and my License is in full force and effect.
Licceensb # Lic. Class Exp. Date
Date 479) i IcAr" Signature of Contractor
ff
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). ,..: .
O I am exempt under Section B&P.C. for this yeas o
Date Signature, of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm-underfpenalty 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. ;
_X " 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:
Policy No.
Carrier .pftl?Yddt)Ali tr`GAAp'INS ;9Fh3U-1.39j3A0 14#�
(This section need not be completed if the permit valuation is for $100.00 or less):
O I certify that in the performance of the work for which this permit is issued;
l 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,o� Section 3700 of the Labor
Code, I salloftllwith comply with those provlsiofjs'
Date:((tl. v! (, Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compe gtion 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 tc enter,
nter . pon >
the above-mentioned property for�inspection purposes.
Signature (Owner/Agent)d.Y Date ( •f1 ��'
BUILDING PERMIT PERMIT# '
DATE `` VALUATION LOT 000-303• TRACT
Ya S� A4471.70€17 26152
JOB SITE
ADDRESS. 47-W5M ZI C%H
APN
OWNER
CONTRACTOR/[ / EN INEER
CANADAY & COMPAN'Y
CAWADA:Y' & COMPANY
174Q01... I 7TH U . 6106
17480 E, 171JI iI'. 0106
Tt%TIN CA:, .$2?s30
i{7:YPi 7 ' C'Fi 927R0
..(7J4)508-44.40-.. CBVI 44,85
USE OF PERMIT
�y1^�� yyr p•�, qty �P 7+,q�p�• p �,�qPe`
i?.L.[V \:r9.:sCi d�'ADS�•+'• -J..L VYl:•A.�I�fJ.tl ti... ."v t '
sro..LOT 87P1..A 120.AR-PZkM1T 00=NOT INCLUDE SLOtaK WALLS OR..
;11,00L.'i4°,G PLAN CHECK F-WR,EDUCTION 1+012 MULTIPLE ISSAN`CZ OF
SA PL" TYPt. '
TRACT CONSTRUCTION 2.595.0 SF
�
POROi• PA:T°IO SP
-
OARAQrUCARI'ORT (S1)s,' �a49.6l1
Rsm, xD C4e's'i' of coNrinuanC?m
154.472..70
.tea 'RM"T FFE SUMMARY
CONSTRUCTION WE 101.000=4113.000 $832,00
PLA14 CHECK FEE 101.000-43:9-318 $i rd.54
rtU DEPOSIT!' 't 01.000.439.31€i 4230.00
Mf`-CHA141 ,ltL PER 101•000429-000 $193.00
1+��
v&w. T.RIc 101,000A42(Y-000 $147,81
PLUMHINO PEE 101-000-419-000 $123.25
�� r
STRON(1 MOTION FRE, 3tESM 101 b400-241.000 515,45
U1 AL1?dQ ]E 901-000-4234-100
NJ
DEVELOPER IMPACT _I4;
SUB -I IAL CO1491RTl' M,1O1; AND PLAN CDFCX
$3,323.09
LESS PRE -PAID FM
4250.00
T01ALPERW-f ITEMS VLWIP NOW
RECEIPT
DAT/�
,E .
BV' .der ''�
+may
FINALE
INSPECTOR
> fY,
y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
:.~. BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
. Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_73•a
Exhaust Fans
O.K to WrapItzs--,41C)
7 app
F.A.U. or
Framing
6 .
Compressor
Insulation/
�(
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final ?j2
Final y�(�
POO S - $ AS
BLOCKWALL APPROVALS
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
/�
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
— ZyZ/-F
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
_ _
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
('"'
Y+°•._-'l`^i: �hn .f'11�: "'YYYA%.T:,:>;."Q}^ry'a:�,
Building j /� /0 a
�"'f
Budding `" 1
Zip
�re b ,
Owndr
fx1c �o
c i) t
Mailing
Address "� (J
�r�;
t—
Ci_ty--- t t
Zip
CityZip
State Lic. �� r� ,
8 Classif:
Arch., Engr.,
Designer LQ ti
Address
0/,).
i G
i':Ir;?tii�"•.� �y-s!'.(;i•�t+so,^•;k•..i`w!3iF•.,.�•..><j� .,;.)-. ��,�x;.�.�1�F�1%«..�.�`.A. �.�i: �«.. - �,�r;=�, �... �, F. y: ,_ ..—
P.O: BOX 1504 APPLICATION ONLY
'r- 78-495 CALLE TAMPICO
{� LAt QUINTA, CALIFORNIA 92253
`,� VN'M C.0 ' BUILDING: TYPE -CONST. . OCC. GRP.
A.P. Number
Tel.
.Legal Description
. Project Description ;
Tel..
y
Lic. # Sq. Ft.
Size
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
City '��
r►
Zip
�re b ,
State'
Lic. fi
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
• I hereby affirm that I am exempt from the Contractor's License Law for the.following
Estimated Valuation-
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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'
•PERMIT/tel./r
AMOUNT
( -�_ i+•
p plan Chk. De
/�/)
y .
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).
t"_ 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, Buisness and
Code: The Contractor's License Law does not apply to an owner o/ property who
plan Chk. Bal.
Const.
Mech. - -
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
Electrical .
er
or improvement is sold within one. year of completion, the owner-buildwill have the burden
' Of pioving that he did not build or improve for the purpose of sale.)
Plumbing
I'll, 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
S. M.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
11 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
"Infrastructure
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
(7 Copy is filed with the city.: 0 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.) -
Icertify that in the performance'ot 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.,
-
-
NOTICE TO APPLICOANT.,, N, after making this Certificate o/ 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
Ihereby 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
This is•a building permit whenproperlyfilled 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.
FINAL DATE
Issued by:
•INSPECTOR '
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:
Signatureof applicant Date
Mailing Address -
Validation:
City, State, Zip
WHITE = FINANCE YELLOW =
APPLICANT
PINK = BUILDING DIVISION
Desert Sands -Unified School District
' t 477950 Dune Palms Road {. ,
Notice: -La Quints, CA 92253 s
Document Cannot Be. Duplicated 760-771-8515
• - .. i' Via• -. _. - _ - - ..y! v.; 4.. � s r•. _ '' y1�
CERTIFICATE OF,COMPLIANCE '
YDate 5/31/00 _
� Y ,��'` � .. ° Y � ;APN # ;643-140-031
No. 20499 ;, �-� Y f.: Jurisdiction t La,Quints
Canaday '& Company Ft . • .
-Owner Name `' '' °� .Permit #0005-301 •
'
_'N 47-905 , :Street . Via Zurich:Log #
-� City. La: Quinta s
r Zip 92253 r - Study Area
Tract # 26152. - . z r Lot #, 87 Square Footage 2595
Type of Development - Single Family Residence _ >' -'No. of Units k l
E Comments
.4
At the pi(
.r
a f
L
4
f
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: .
t
+ EXEMPTION NOT: APPLICABLE
M a ti a�
This certifies that school facility fees imposed pursuant to Government Code 53080; in the amount of
.. 3 ..
q . 2.05 X:,= 205 ' . or $ 5,319.75 ` }the property listed above and that building '
permits and/or Certificates of Occupancy for this square footage in this proposed'project may now be issued ' • r
Y
Fees Paid By. CCBank of America/Sue Pelletier �< f Telephone' 760-771-9636.
�. Name on the check'-`
By Dr. Dons Wilson'
a t Superintendent
Fee collected /exempted N Mary Ann L: Bo' ja _ Payment Received' 15,319:75 .�.
Check No. "'2004888073.1 'F
Signature
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 Districts) or to another public'entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier. t
Collector: Attach a copy of county or city plan check application forni to district copy for.all waivers.
Embossed Original- Building Dept./Applicant . Copy -,Applicant/Receipt., Copy = Accounting {'"