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0012-117 (SFD)LICENSED CONTRACTOR DECLARATION. I hereby affirm under penalty of perjury that I am licensed under provisions 61 Chapter ?(commencing with Section 7060).of Division 1 3 of the Business and Professionals Code, and my License is in full force.and effect. License #. Lic. Class Exp. Pate 13 Date Signature of Contractor OWNER -BUILDER -DECLARATION l.hereby affirm under penalty of perjb , ry that I am exempt from the Contractor's License Law for the following reason: 1, 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 offeredfor .sale (Sec. 7044, Business & Professionals Code) - 1, as owner of th6.property, am exclusively contracting with licensed contractors* to construct the 'project (Sec. 7044;- Business & Profesgionals Code). O I'am exemptt-under Secti6n B&P.Cfor this, reason Date- Signature of Owner . WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty Of perjury One of. the following declarations: I have and will maintain a certificite of consent to self -insure f6r workeirs' %tio�, as�'provided for by Section 3700 1 of the Labor . Oode,for. t . he pompensa 1 perfofirriance 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 -f his permit qrmi is,,issued. My workers' compensation insurance 'carrier & policy no, -are: Cary ie'r ..Policy No.- AMERICA WAZWC0069515400 (This section need not be completed if,the, . permit valuation is for $100.00 or less). )Yl 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, 'and agree that. if I should, become subject to thJw kers'-compensaiion pr6�is�ions of Section 3700 of the Labor i�fort7 c w thcomply with Code, I Sha , tj those, provisions. Date: Applic Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penhd1ties andcivil fines up to $100,000, In additionto the Cost of com pensati on,: 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 fora permit subje6tto the c6nditions'and restrictions set forth on his application., 1. Each person upon. whose behilf this application is made & each person at whose request and for Whose benefit work is performed Linder or pur9barit to -any permit issued as A result of this applicatonagreie`s to, & shal I �inde6iiy & hold harmless the City of. La Quiht6, its officers, agents and employees. 2. Any permit issued as a result.of this application becomes null.and voidlif 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 -Cg .ity, and State laws relating the building construction, and hereby authorize -representatives of.this City to ehter upon the above-mentioned property fofInspection. purposes. /7 Signature X2Y Date A5 (OWn6r/Agent) _ J1 PERMIT# 'BUILDING PERMIT DATE VALUATION LOT601 117 TRACT .70 74. 26152 77 JOB SITE ADDRESS 47. 480 VIA Zivo.o APN OWNER CONTRACTOR DESIGNER ENGINEER CAWALSAY& COMPANY 174 oo r,,. i, 7ta o(, 174EA R, 17TUSTAM6. CA, 92')80 TUSUN (714)5W-4440 C.BUI: 44% USE OF PERMIT _J KWOLL, ;FAMILY DWMIAW0, IDT74. PLAN 30AR- 9P-b-:PFRMtT DOE3,140i XHCIXMBLOCK WAIAS, P004 Oft I)MVIMAYAPPROACH. PIA -0 CH WK. FIZZ, RKOIJCIKL. %T. F011MOIX111LE ISSLTA14CF, OF RAMY, PLAN TYPK TRACT CONSTRUCTION .3,934.00 3F P6Rr.t-vr-ATtogo'! W Q4RA09/CAP,P0XT (81F) .17,348.00 XSTIMAIM) C109T OF CON fWarlopT MOW FE2 WAYMIARY CON Wf RU C TI 04 YZ K 1101­0004MDOO PLAN CHECK FES. $194,04 FEE Y)EPOSIT 420100 NIWWANTCAL FV2. 101.-000-42 1-0001,165.00 8T110140 MOTIOWME - REIRAD 101.000 4 11-M SIUM, cluwala FSI?, 101-000-423-000- % 121.� 19 PF.Ui;P1 D FL 31?kTams r -Y . - ®x.2001 �.�- .°.. � ; SAN _ _ .. &=13 'o BY Y, DAJE FI 1AL E D/ INSPECTOR 46 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 4 Y Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck_ O.K. to Wrap Framing Insulation _ _ _ _ �j' _ / Exhaust Fans F.A.U. Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath �( e Final/APPROVALS BLOCKWALL Final POOLS - SPAS Steel Set Hacks 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 �� /gyp 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 o/ - c / Appliances Final COMMENTS: _. Final _ SJ Utility Notice (Gas) c( ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. 00, Smoke Detectors Q Temp. Use of Power Final Utility Notice (Perm) /_ 01 UILTcu P.O. Box 1504 78-495 -CALLS TAMPICO . (760) 777-7000 . 5thiningBrighter ThanEver LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7101 March 26, 2002 Postmaster LA QUINTA POST OFFICE 51-.321 Avenida Bermudas La Quinta, CA 92253-9998 Dear Postmaster: Please be advised of a new street name for the following structures. T)e structures formerly addressed on 47=780; 47-805, 47-810, 47-835, 47-840, 47-86=3, 477-870, 47-895, 47-900, 47-925, 47-930 and 47-960 Via Trieste will now be addressed at the same street number onNia-'Livor-nd! Please note this change and contact me directly at (760)777-7012 if I may be of further - assistance. - Thank you.. . Sincerely, Diane Aaker Building & Safety Department - s — 2 3 4- 5 SCALE IM 1/10 OF AN INCH I . 1-800-345-7334 WS MA ,S POR rR. A. o20-024 64-5— /4 ASSESSMENTiVRADSES oNLY POR. SE//4 SEC. 30, T. 5S.; R.E.7617-e0 47 M1 I — _ 4 7te r [OT A r�vn , I, SBS /12 4 G 74 \ /os 0 sr.79 sir!/ �cf ,� alpx m.•/ W-45049 � :- � /B .ems I . 107 .9 ^ 73 h� f 72 *#00 74Ao aeJj *Pm 73// 77 52 ' ♦I 01 = /9 4 `I p 0/•7/ 8b i0 11441qy 84 -- -- " so 9a w © O92 BS apBJ VQ7618 /Bro 72 p" I 649 - ®76 �B ` o ® b A o a h I 03 �.s.pe / ios •9: y� II�0 ^ { 1 7� • ` i Certific'ate of Occupancy,,,a� Cit of'_La, Quin ta F Saent OFBuildin and fety Depnti 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 foi/owing: BUILDING ADDRESS: 47-780 VIA LIVORNO Use Classification: SINGLE FAMILY. DWELLING. ' Bldg. Permit No.: 0012-117 Occupancy Group: R-3 -Type of Construction: VN Land Use Zone: RL Owner of Building: CANADAY AND COMPANY Address: 17480 EAST 17T" ST. #106 City: TUSTft CA 92780. By: STEVE TRAXEL Date:, 12-18-01 Building Official POST IN A CONSPICUOUS PLACE