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0012-119 (SFD)-� LICENSED CONTRACTOR DECLARATION � hereby affinnn under penalty of perjury that-,I'am licensed under provisions.of Chapter 9'(commencing 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 7 Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury. that.1, 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 1 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: ( .) 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. INTI 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': Carrier 'Policy No.' .r�IIRE��kI �E.�'E;t')�:• :{9A2'W'L0.10)17E3•V (This section need not be completed if the permit valuation is for $1.00:00 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 so as to become subject to .the workers' compens)tion laws of, California; and agree that if I should become subject to the orker)S' comp'ensation'provlsionsnof ectlon 3700 of the Labor Code, I shall�o : h-yvij comply with those provisions Date: f , `'' ! Applicant ' Warning: Failure to secure Workers' Compensation coverage is•unlawful and shall subject an employer to criminal penalties and civil,fines up to $100,000, in addition to the cost of c6nipensation,.damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT: Application is.hereby made to the Director of Building and Safety for a permit subject to the conditions .and restrictions set forth on this application.• • ". 1. Each person upon whose behalf this application is made &•each person at0- whose request and for whose benefit work.is performed under. or,pursuant�o any permit issued as a result of this applicator agrees.to, & shall, indemnify' & hold harmless the,City of La Quinta, its'officers,.agent§.and employees. 2. Any permit issued as a result of this application becomes null:and void if work is not commenced within 180 days -from date'of' issuance of .such' permit, or cessation of work for'180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct, I agree to' comply with all •City, and. State laws relating to the building construction,, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes."' Signature (Owner/Agent) ��� Date UIL•DING PERMIT PERMIT# DATE VALUATION p p 1 It yy� LOT" TRACT 6 1 JOB SITE I ADDRESS 4w'y'I1. 5 VIA, ss L 1 •✓ .0 v- r\ d APN OWNER CONTRACTOR/DESIGNER/ENGINEER 37480 3' 1711-1 ice..'€fid 06 174501L I7TI L 6106 CA 512780 'AM CA 92781 (714)5013-4440 L'kiVif 485 USE OF PFRMIT DWMING I.DT7b,i'f fi'Ma',.1<:::SII 'MMAITI bk-41.4ur.rNtitfineBLOCK WA LIA, P0014 OR f.; lRiV}71T'i.f?+Y >a1PWROACH. PLA14 L TIZE ' K FRE RE,,FDUCRO.. 7.5% FOR MULPIPLF 1er.SVA14C It s.91, <:.tkfid19PLKA TYPE. <• TRACT COND.- I'fi'UC".TIO 3,9 ,5;0+5 SF PORiQV/PATIO, 39?.:00 S C#!'h.idrl.M"C'AT2PS tRT (D) 1160. CQRSTRUCTIUH FES ]Ci]mf) 70n I JttO MUD PLAN CriWX't!' E IM17,ORPOSIT 101.000.435-:318 42501:00 1AEC°RAN ICA1,197dr I05-GQC3 4T4�a6f� �lci$,tl(P ELECTRICAL FE , f C►a =()�9Ce�4 A0.120U �I.Q°�.II�; PLX1As!!II• O ME. 101,-00&.419-000 $12klS e3 R�kTt� F�IC��'Ft 1�!"I'':%i.E� ^ I$C�n°�1C:► 101a0Q0.2A.1-`000 $1u,�•3 C5R.�12dC4�� �oi�•Cs�O•-�•?��0�3fa �.ao.� k LESS PRE -P PUZ $250.00 2001 : MAL PYRNIT-11IMS ►UNBOW, g RECEIPT DATE 1 BX r. D F ALD INSPECTOR INSPECTION RECORD OPERATION j DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 06 Forms & Footings Underground Ducts Ducts Slab Grade Return Air Steel _ Combustion Air Roof Deck _ Exhaust Fans O.K. to Wrap _ �� // F.A.U. Framing �J _6 J`> Insulation � Compressor 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 POOLS -SPAS 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 Sewer Lateral5 * Sewer Connection O.K. for Finish Plaster Pool Cover 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) o`o s CITY OF LA QUINTA �FboFr+°� UI &SAFETY DEPARTMENT 777-7012 p�Q INSPECTION REQUEST LINE 777-71'53 J0 � Y ANY ' Owner . :. ' Contract :ANI) COMPANY N .. Permit umber 0012-119 I POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 47-835 VIA TRIESTE SFD. LOT 76, PLAN 20AR. PERMIT DOES NOT 1 INCLUDE BLOCK WALLS, POOL, OR -DRIVEWAY i I APPROACH TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK t FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING l�—d PRE-GUNITE . i DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS I`< ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED i. ROUGH ELECTRIC :'• ' ROUGH PLUMBING 1 ROUGH GAS & GAS TEST _ 'HEATING & VENT - A/C , ' FIREPLACE ROOF t BOND BEAM O.K. TO WRAP - GROUT ❑ 4' ❑ 8' FRAMING INSULATION f PRE -ROOF �. COVER NO WORK UNTIL ABOV HA BEEN.SIGNE i. . DRYWALL INTERIOR i EXTERIOR LATH t POOL PRE PLASTER I POOL FENCE &.GATE Z } SEWER SEPTIC TANK Af i FINALS ELECTRICAL PLUMBING' -. FINAL GAS TEST j HEATING - A/C MIX HOUSE NUMBERS fI•. I JOB COMPLETED I ` TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO ';! TURN'ON UTILITIES OR OCCUPY BUILDING I CU. P.O. Box 1504 78-495 CALLS TAMPICO (760) 777-7000 ShiningBrighterThan Ever 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. The structures formerly addressed on 47-780, 47-805, 47-810,47-835-,'47-840, 47-865, 47-870, 47-895, 47-900, 47-925, 47-930 and 47-960 Via Trieste will now be addressed at the same street number on_Via Livorno Please note this change and contact me directly at (760) 777-7012 if 1 may be of further assistance. Thank. you. Sincerely, Diane Aaker Building& Safety Department rTr 1-800-345-7334 2 3 4 5 6 SCALE IM 1/10 OF AN INCH i TN/S MAP /S FOR%RQ A. 020-024 '643--14 . . AssEssMENrsw osEs aver POR. 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Y 67 'I " g 0 5/O y 7// O b 78_ 1 - - .. 720 72.44 /24A) 43.94 I 5 /904. 5d 4 - LO B6 � " -4. -30. _. _— - - .t/B9°3/'Ob"E 29 • M ry ``aa'' AVG II U�'' 3/ 32 n/ 4 - DI /A. M.I. 114109. Da `� 607 ASSESSORS MAP BK643 PG /4 / Y O MB.227177-78 Tract No. 26/52 R/VERS/DE COUNT? , CALIF `- ' ' �-'� Q RG x SEP.r -42 ,,� vrceseJ