0012-120 (SFD)LICENSED CONTRACTOR DECLARATION
wl hereby. affirm 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
Date Signature of Contractor fist
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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 offered for
gain (Gar,' 7n44, RllsinPsS & Professionals Code).
( ) 1, as owner of the property; am exclusively contracting with licensed
contractors' to construct the project (Sec. 7044, Business & Professionals
Code).
() I 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.
( ) 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:
Carrierw Policy No.
.�,ivitEf3�i~AN MAtRI .. ?.CSA rwi w ci s0
(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,
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 shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of,work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby. authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMTN
DATE VALUATION LOT ���"'�+� A T
/fig eR ,'G�45,146AO 77 {�I �2
JOB SITE 0f
ADDRESS
l'o
P e
(/�g 14M/ !
Q) ♦rl�.� "% �Qi�
OWNER
CONTRACTOR / DESIGNER / EN INFER +'
CiANADAY &, COW. ,'ANi.
(.F N ADAM & COMPAWT
1100 X„ 'I TPR9r,11'9.06
170WE',; 17TiT RY. 't4I 06
CA 92790
Tli�'�+e" CA. 92786
USE OF PERMIT
LOT "yy,q?, Pl..AWIRA _:FD • PNMIT 102NOT 114CLU0E BLOCK'W1LLS
01U)RIVENAY APPROACH.,
TRAM COMSTRUCTION Slr
PC' RC°IWATIO W0,00 SF
0MAGPJCARYORT (8 Mv 9,404-40
Yk o 1 T"ti' 4r;O.M.7 01- Z'0,-, l'l&':$'.IWC",X%0H
P.MNINT My., SUMMARY
CONi✓'9 RUCTI" FIRE 101 -000-418-000 MoJo
'PL-A'.W CHECK FEE
f;'i?R• 3t
q�l��CY�,�.�3.fis.A.I.
ypttt-�^�y2.j��-•t�E�(�
LENCITTUCIAL ME. 101,,000-420-000
ry9..UMBINQ 13,'18 101-0,00-4, 19 -000
SrTRON"O f>ri0't'IOt1 PUR, - RESID 101-030-241-1000 $14,51
aRA111MI. YOM 103-00"23-000 MO
CIEVRIP0 �Ia:.6y.IMPACT FEE SUVA
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SUB^'A,OJ.i,t'4LddrVA�161p.4A�.,yiiM.'.�nL4r
LES` MR -PAID AFF -:
x$2_50,00
lyA.NOW
A4AL Ppi+ IMPS
olb�Ati�6•.LtG�:'f�5'.
RECEIPT
DATE
BY
DA)EpI ALE D
INSPECTOR
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
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
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
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)
r
cli
P.O. Box 1504
n�%�► 78-495 C"ALLE TAM IlCO (760) 7,77-7000.
Shiring8righterThanEve,. 'LA QUINTA, CALIFORNIA 92253 FAX (7,60) 777-7101
March 26, 2002
Postmaster
LA QUINTA.POST OFFICE
51-321 Avenida Bermudas
La Quinfa,' CA 92253-9998
Dear Postmaster:
Please be advised of a new street name -for the following structures. The structures
formerly addressed 6n.47-780, 47-805, 47-810, 47-835, 47-8401-47--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 I may be of further"
assistance.
Thankyou.
Sincerely,
Diane Aaker:
Building & Safety Department
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{ - •O 777-7012 '
®f I VECTION REQUEST LINE
wv �77,7153
' Owner CAD OMPANY
Contract AY AND COMPANY
Permit Number 0012-120
' POST ON JOB IN. CONSPICUOUS PLACE
i. INSPECTOR MUST SIGN` A
'-I LL APPLICABLE SPACES,
JOB ADDRESS 47-865'VIA TRZSTE
SFD. LOT 77, PLAN 10A.. PERrMT DOES NOT
INCLUDE BLOCK WALLS, POOL, OR DRIVEWAY
APPROACH.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK -
' FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING — —�
• PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
t L CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUNDWORK
F DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
'ROUGH PLUMBING
ROUGH GAS & GAS TEST
'HEATING & VENT- A/C tib,
' FIREPLACE
ROOF
BOND BEAM '
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING S
} INSULATION
PRE -ROOF
` COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
' DRYWALL INTERIOR.
EXTERIOR LATH
POOL PRE PLASTER
• POOL FENCE & GATE
i SEWER SEPTIC TANK
s _ FINALS
c ELECTRICAL
f PLUMBING
FINAL GAS TEST_ -
H EATI NG - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
♦ • 1
Certificate of -Occupancy -�
City. of La Quinta.
Building and Safety Department �°F�om `4
Y 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
I
f the City regulating building construction or use. "For the following.-
BUILDING
ollowing:BUILDING ADDRESS: 47-865. VIA LIVORNO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-120
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: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 11-06-01.
Building Official
POST IN A CONSPICUOUS PLACE