0005-286 (SFD)CENSED CONTRACTOR DECLARATION y
er penalty of perjury that I am licensed under provisions of
c cing 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
591551 3112(
f.,�
Date f' r3 ', 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 A 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 rpenalty.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
pert mance "of the work for which this, permit is issued.
( I1have 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:
CarrierFRZMONI'tif:,AaPh43 Pblicy.No. S�s0-11AS+tl9.1Q270
(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,
�t
I 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
Code, I Shalt forthwith;comply with those�orovisiot
Date:/!"( (�iiJJ Applicant) Y✓� f?xt-; '•=
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. ;
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and 'restrictions set forth on his
application. '
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is,performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &shall, indemnify
& hold harmless the City of La Quinta, its;'officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation. r
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the buildings
construction, 'and hereby authorize representatives of this City to enter upon
the above-mentioned propertyfor`inspecti n purposes.
Signature (Owner/Agent) - { ^' J Date a �)b,
BUILDING PERMIT " PERMIT#
DATE VALUATION LOTTRACT
(b S1180=7SL70 80 25152
JOB SITE
APN
ADDRESS '
OWNER
CONTRACTOR/DESIGNER/ENGINEER
3
CJ`iNADAY & C 0 AW t
CIAWADAY.& Ci7b1'PMY
1 e4801,' t 'S1 .l",X146
'17480r-, ITVH ST, 0101 "
TUX M." CA 92180
Tu MIN CA 92780
w �w
(714)508-4440: ": CBL# 4485
USE OF PERMIT
✓:' X01)- LOT Fitt., 1,AN 30AR-PER1JT DOES NOT1ATCLUDE 81JXK: =avALIS OP.
iPc3ci1. '
TR40T CONS7`OCi' CN 3,034.00 SF "
PORCHIPATTO 275.00 S {
MRA0FJCA1tP0kT (SF) IZXI&00
EM'"1710 COST OF. COTIMUC'non�
..
1 od5l.70.
P00M FEF SUAWARY
CONSTRUCTION FES, 101.000.418'-000
PLANCFiWK F919 10g-OQOPe�j$-32�, 7G.14
FEE DEPOSIT
AAEC33 ANICA1, FEE, J 01- 0-421-000
FUC`!'1i.1mFFz 101A.000-420.000 $167,29
PL'UM.131Ne PEE 10"-1-000-4i MOO
�1
STT -0-00 MOTION F99 e 8011) 101.000-241 x000 II8,bi3
w'ArmA1L) Pi I: 101.000.423-000 a20.tit1
;c�
DEVE.LOPMIMPACT FEE ;1,909,00
:
UN t .;PRE -PAID FEES,
4250100 .
� y
.
RECEIPT
DATE
'�
BY'' w �;—
DAT ACED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
st Backs - _
orms & Footings
aab Grade o !rte
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck y,s"z'v tp -4
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 —
Drywall - Int. Lath
Final
Final 240 1
POOLS - SPAS
BLOCKWALL AP ROVALS
steel
Set Backs
Electric Bond r
Footings
Main Drain y
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines o OZ
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)
-+'�°t' `. . ,.a..` ...,;,c:�:.24:,��,t.�-.•:-.:.. . ' •,:'". ,.-�.i , ,-�` :itis, ,rr,.i7�•- •,-,.11}- 4: tii � •w 't . •--ti „t _-y-yr Y •.r.... r�i.,�.y�
P.O. BOX 1504 APPLICATION ONLY
Building `} E^ /JO 78-495 CALLE TAMPICO-'
Address ( 1 yC� v( LA OUINTA, CALIFORNIA 92253
Owner fftt ff�` % (�
` a " Q `- a• ` � L"" A•Q0f `m ' LL C BUILDING: TYPE CONST. OCC. GRP.
Mailing{ [[`�� t^
Address ii 1 "}�' A.P. Number
Cit Zip
l Zip Tel. `
1 l ��`I' 7� 1,�✓ts ��' �� Legal Description
Contractor Project Description
Aaaress
City Zip TeL
State Lic. ` ,/ City.
& Classif. ! L�� Lic. # Cf . IRIS
Arch., Engr., • ,��``���,1'' (�
Designer O 'N -J ` t
Address Tel.
City _ Zip State 4'
�rar�l? G 11 Z 3 Lic. H
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of theBusinessand, Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirmAthat 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, atter, 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
Division 3 of the Business and Professions Cade, 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 (8500).
17: 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
Professions Code: The Contractor's License Caw does not apply to an owner of property who
builds or improves thereon and who does such work hirnself 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.)
I'I I, 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 -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
11 I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that 1 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
177 Copy is filed with the city. 0 Certified copy ishereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred; dollars (8100) valuation
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 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
subject to the Workers' Compensation provisions of the Labor Code, you. must 'forthwith
comply with such provisions or this permit shall be deemed revoked..
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) '
Lender's Name
Lender's Address -
This is a building permit,when properly tilled out, signed,and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
- I agree to comply with all city.and county ordinances and state laws relating to building
construction, and hereby authorize representatives -oh• this. city to enter, the above•
mentioned property for inspection purposes..'
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No.. ( No. Dw.
Size 303 Stories I Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑.
3timated Valuationti
R r
'
T1
PERMIT % ,
'; AMOUNT
1 '�
Plan Chk. Dep.
A50 -
Plan Chk: Bal.
�.
•a�4M-+.•r1
Const.
- w
Mech.
Electrical
Plumbing
S.M.I.
Grading '
Driveway Enc.
Infrastructure
TOTAL
nctver�nnJ
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property'Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by
Validation:_
WMITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
,Desert Sands Unified School District
r r
47-950 Dune Palms Road r
'Notice: La Quints, CA 92253:.] tr.
Document Cannot Be Duplicated" k 760-771-8515
s CERTIFICATE OF COMPLIANCE- �=
Date 5/31/00- _ - -140-024
-r
No. 20492
w .
Jurisdiction -�La Quinta:
Owner NarreCanaday &Company _ _�' w,
• per`mit #0005-286
No. 47-940=Street Via Zurich a. t '+ .,e Log # r
r + CityLa .Quints . ` �` zip 922'53 Study Area '
,r
r ' Tract # 26152 " ;' .t Lot #. 80 s e Square Footage '3034 t r
Type of Development Single. Family Residence: No. of Uriits 1
Comments
r x.M1- Y
,.,_ t 3 • it �,. i ,. a }•1� .•`' At the present time, the Desert, Sands" Unified School District 'does •not , coll6ct fees on, garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes., It,
g.
.has been :determined the above-named owner.is ezemptfrom,paying school fees at'this time due to the following reason:
t � ., x � • ;� _' Tari ,;, �, . F ^ . :•� -. ' 1.
r"
EXEMPTION• NOT APPLICABLE'
This certifies that school facility fees imposed pursuant to Government Code 53080 • in the amount of >
2.05 `,X . 3,034 or $,,6,219.70,. ` .' ' ,,the property listed'above and that building ` •
permits and/or Certificates of Occupancy for this sgaare footage in this proposed project may now,be.issued
40
K: Fees paid By CC/Bank of Ainerica/Sue Pelletier
Teleoli'� `
one' ]760=771`-9636
Name ori -the checks
By Dr. Doris Wilson L iNrY ` r§ 'w,. t• r r '
. ,.
Superintendent
Fee collected /exem ted b Mary L. Bor ai Pa `ent`Received A 9 '
P by J.," Ym $6,219.70`
- Check No. � 2004888073"
" t"
Signature
a
NOTICE: `Pursuant of Assembly Bill 3081 (CHAP 549, STATS. Y1996) 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 whichr the building or installation permit forthis 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. t " • -
Collector: Attaiebq appy of county or city plan check application form to district copy for all waivers.
Embossed Q iguial Building Dept./Applicant "4.. "Copy = Applicant/Receipt Copy.- Accounting . ' '
fi to-of Occupan.6Cern caY 04
City of La, Qdinta,F
s Building and Safety-Departmento>F
2.
This Certificate issued:pursuant to the requirements :of Section .109 of the` Uniform Building 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 following:
BUILDING ADDRESS: 47.-940 VIA, ZURICH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No : 0005-286,
Occupancy, Group: R-3 Type of Construction: , VN Land Use. Zone: RL
Owner of Building:. CANADAY AND COMPANY, Address: 17480 EAST 17T" ST..#106
1.
City: TUSTIN, CA 92780
By: STEVE TRAXEL ,
Date: 05-02-01
Building Official .
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