Loading...
0005-295 (SFD)LICENSED CONTRACTOR DECLARATION affirm under penalty of -perjury that I am licensed under provisions of Irtler.9 (commencing with Section 7000) of Division 3 of the Business and nals Code and my License is in full force and effect. License # Lic. Class Exp. Date 1.91561 B t' o3/.31/2( Date - Signature of Contractor •,�_� OWNER -BUILDER DECLARATION of perjury that I am exempt from the Contractor's I hereby affirm under penalty y 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';piope'rty, am exclusively contracting with licensed contractors 'to construct .the .p'roject (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 ' .F I hereby affirm under penaltyof perjury one of the following declarations: ( ) I have.and will mairftain`a'ce'rtificate of consent to self -insure for workers' Compensation, as provided fo.r 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 Se 4on 3700 of the.Labor Code, -for the performance of the work for which this ' pe Itis Issued, My workers' compensation insurance carrier & policy no. are: Came%, �0,, TVOMP-M9 Policy No, u 30-l19gi9-341 o- (This section need not•be completed if the permit valuation is for $100.00 or less), O I certify that in the performance ofr the work for which this permit is issued, (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 f Code, I shall"fgit it comply with thos prow ioni��• Date: !r Applicants 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 authorise rep esentatives of this City to ente[, upon the above-mentioned property for inspect n purposes.. j Signature (Owner/Agent) l'�a Date `; •" BUILDING PERMIT PERMIT" DATE /• /• VALUATION LOT' ,; owsam TRACT JOB SITE APN ADDRESS •.1'7-91()VIA. .�i T,QXCU !' OWNER CONTRACTOR/DESIGNER/ENGINEER CAATYOAY & tOW. ANY C.el•1'ADAY COWANY .17480 R 17TH fit #4 06 1.74801_ 17111 U1', 0106 CA 92780 1I°t7ffm ;CA 92790 l (7.14)508-4440. CB14. 4485 USE OF PERMIT NF1"H WT 91 MAN aOBuPERRix DOING ;1O`1' iNC1X1' X BLOCK VJAL.LS OR POOL ' r ' TRACT CONSTRUCTION -' - " Z591.00 3F - PORCHIPATIO r '.39�.flQ SP GAR AOUC,ARPOR7 (811 . 044,611 1vSTMAW.0 (709T OF K:ii13S.TRX7'C ..ZON PR.IDJUrFILM 6RIMMARY CG' NST1i3OCT19N THEE 101.000.418.000 $833,0 PLAN CHECK VE9 101 -000-439-318 $690..16 FEF, MOSIT 101-000.435 ^318 4250100 ` MIMkIANIC.A'11PrIM 101=00-421 -000 $IDS.00 , ELECTRIC, L."ME, 101.000.420000 $147,83 v -, PLt3MBIWO FLS $123.2 « * F S T RO1•lci Ml'S't IPWi , PEX - R13S.1U 01.000r 141.060, $15,45 ORAJAII(3 ftt 101-000-423- 00 $10.60 � � T r DEVELOP"—IMPACT'PE8 ,-� irk t " LES"U .PAR-PAiE,3.I' J -$250.00 JO—AL. PIMMIT MIS DUE 1Y(.)W RECEIPT DATE / B,Y--ls ti ,,... I A D INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs �/l Forms & Footings 8:T Underground Ducts Ducts Approval to Cover Slab Grade ���--�—d Return Air Equipment Location Steel Combustion Air Underground Electric Roof Deck Exhaust Fans Underground Plbg. Test O.K to Wrap �_ �—p� F.A.U. Gas Piping Framing Compressor Gas Test Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Sewer Lateral Sewer Connection ,,rt,�. _ U Exterior Lath ps) Gas Piping` Gas Test Drvwall - Int. Lath Final �l3__d./ Final POOLS - SPAS BLOCKWALIL APPROVALS Steel Set Backs Exterior Receptacles G.F.I. Smoke Detectors 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 Sewer Connection ,,rt,�. _ U Pool Cover Encapsulation Gas Piping` Gas Test Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole I Ilr Fixtures Main Service Sub Panels _ Exterior Receptacles G.F.I. Smoke Detectors _ Temo. Use of Power Final Utilitv Notice �5 r:.:Y�<:."y`/f1::v�:�.l%;..��.'r.:;a,�!%rt¢,z•:;.Yi+�f�'��'",S''K-�?'.�:�+1 �td�.''•,r;l .-'.+T:;r�"4'tSt'i Tr�si"�- ::wi.;ty; .:�s'��;�""'�%�'a'` 'f{: f�n,.+wi�l+' M'M " �si+r'7.`!,-• Building Address V Owner Mailing Address City 4 P.O. BOX 1504 78-495 CALLE TAMPICO tit? LA QUINTA, CALIFORNIA 92253 APPLICATION ONLY % I BUILDING: TYPE'CONST. OCC. GRP. 0 to A.P. Number / f Zip Tel. '�� • Z � � S� " 1 � '�� 9 4-m 1-7 ! q 5()&,,14 (4C) Legal Description Ar,_X Project Description City Zip Tel.. - = State Lic. City � & Classif. jC� i C, Lic. # Sq. Ft. � w - No. No. Dw.;' �y Arch., Engr., � Designer !J V zA Size '� y Stories Unrts ' b�"Y s New Add ❑ Alter ❑ Repair p� Demolition ❑ ., �,:� �`'� �..J Address ('j _ �.�Cs` 1` ` � � �J �� i V� Q�?Ga ✓ I''�� .J✓ City �' Zip, f State "C �� Z 10? 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 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 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 PERMIT AMOUNT Plan Chk. Dep - / 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 notmore than five hundred dollars ($500). V-11 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 of 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 or improvement 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.) ' Electrical Plumbing I'1 I, as owner of the property, am exclusively contracting with licensed contractors to con- strucI the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law doesnot 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 Seo. B. & P.C. for this reason S.M.1. Grading 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.) , 1 Policy No. an Com P Y n Copy is filed with the city.. O Certified copy is hereby furnished. TOTAL REMARKS 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., 8, after 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 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 Lenders 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. FINAL DATE INSPECTOR I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof . this city to enter the above- mentioned property for inspection purposes. Issued by: ' Validated by: Date Permit Signature of applicant Date Mailing Address Validation: ' City, State, Zip -- -' WHITi= = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION " , E Desert Sands Unified School District ' �. 47-950 Dune Palms Road • ' ' Notice: r Va,Qumta CA 92253 -E Document Cannot Be Duplicated- t 760-771-8515' •-, *'` :,'CERTIFICATE OF -COMPLIANCE',. r Date 5/31/00 ' w .� 3 . APN: 4 643-1.40=025 ya - *` • _ ..� No. ' :.20493• ;La - i' �t f .:; + r " .4 , ' � • Quinta � �` _ • �, [ Jurisdiction. S4 A tOwner NameCanaday & Company ` , ! ` ,. Permit #0005-295 ' -N0. 47-910 Street Via Zurich4 `• r` _.. q Log # City La Quinta F� ' ;Zip - 92253 Study `Area F _ . •• j � b+ s � .y.t ; F •. '1 . • : , , ,, Tract # 26152. ' L oto# 81 -Square Footage 2595• Ix' . r . r Tily -Type Single Fam.Residences°1y'' 'No.ofUnits 1 A ''Comments J " ' !At the present time, the, Desert .Sands Unified'School District !does.•not. collect tees on garages/carports,, covered patios/walkways, residential additions under 500 square'feet, detached;, accessory structures or r`eplacemenf mobilehbmes. It' has been determined the above-named owner'is exempt from paying school fees at this -time due to the following reason: � «., -�• ,fry. ^` � -a, � '♦ f A { , • • EXEMPTION NOT APPLICABLE 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=a - *; { .the pioperty listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed proi "ectmay no*_ e -issued. ,. + al ,p Jr Fees Paid By CC/Bank of Ainerica/Sue Pelletier ~r *. t "� + Telephoney 760-771-9636 3 Name on the check IN ". i ♦ Lry w By+ Dr. Doris Wilson .'�a , .w� t� :,4� " Superintendent �" -` 'tk' ckp r1• ` , u � s t.ti::• .. > >`'. ,3'-`�1i.;-�. �.♦ •�� .lye/:., > a Fee collected/exempted by Mary Ann L Bo a" Pa ent Received" E Y111 $5,319.75 E 4..♦ "k , "Check No. 2004888073 , _ Signature 'x r a "" r § •, - 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.sssue_d or on which they are paid to the District(s) or to another public entity authorized to tolled them on the Distrid('s)(s) behalf, whichever is earlier. - - ' < t 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 - Accountiggr 7.