0203-0283 (SFD)
79925 Anna Rosa Street
LICENSED CONTRACTOR DECLARATION
I 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
768595 B cam, fi 9/30103
Date Signature = Signature of Contractor`
OWNER -BUILDER DECL^'ARATION X
N
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 & 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:
Carrier STATE FUND , Policy No. 160341"2
(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 IsHall 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 w`h those provisi6hs..
Date:Applicant 44^a..
..r .p -4 .
Warning: Failure to secure Wor4ibtrs' 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 in`Iormation 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) ,t Date 1 i
! W
BUILDING PERMIT PERMIT# V
DATE VALUATION LOT Ca03_ 3 TRACT v
JOB SITE APN
ADDRESS 754-M AIN NA RW A .3d Cew=f I " -03D-045
M ':COFiFS, LP
74.760 MIGJf',WA?;YJ I 10200
TN ilm W1=13 CA 92210
USE OF PERMIT
CONTRACTOR/
DCM 171:; , .i c dba DESER1, crrffs DEV.
'78-600 1UGHWAN-A 11
iAt}URsrfA CA 92.253
(160)7"71-3145 CPU 7.180
SQA, • BLI 0, A UNIT IT 5% P Ate 23. PERM r 170,E tNOT INCLUDE
P001,, SPA, 131 1;; WALLS, OR DRrVWAY AFw.ROA(M. '?5% REDUCTION
IN PLAN 0111 SCK M -F, FOR MULTIPLE ISSUAINCE OF S.AM9 FLAN TYPE,
TRACT CONSTRUCTION 893,00 S
kBIVI 'i'1 `1D COST Or w(7PiS'k"RMTT aN
0,43S) (3
PERAM FER RAW MY
C'C3 40TRUC71014 ISE R
1011000-41 E4AXT,
W& 00
PLAN CHECK NU,'
101-000-4:19-918
'R43.61
MECHANICAL L FEW
101-.000.421.1000
$39.90
RLly.CTRICA1, Mt
101-000-420-000
$64.72
PLiI.M81140 FFIF
101-000-419.000
$93.30
STRON43 MOTION ME < RESI.D
101-000-P.1-000
$444
17WRIA)PER ThiPACT FFP_
S1,stm,00
17)3.3. C' A1., C".OPSTR JL OX s ND PI AI C;X iFiC 1 $2, 266,1 1
D --
L705 rME-1:1MMS $0,470
MAY u 6 2002
WV FI.ls►QUINTA IIIIIIIIIIIIIIIIIIIIIIIII 13
FINgNCEDEPT- IE
RECEIPT DATE BY " DATE FINA ED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ _
r�zZ<�Z 7
Underground Ducts
Ducts
Slab Grade
—p 5 7
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
G�
Final
3 S j
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
57
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1-03 S?
Encapsulation
Gas Piping
Gas Test
! a
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) p
_I
at
Certificate of Occupancy
City of La Quinta
Building'a.nd Safety Department
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: 79-925 ANNA ROSA STREET U-55
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
—ems
Building Official
vni
Bldg. Permit No.: 0203-283
Land Use Zone: CR
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE
` L r IIIIIIIIIIIIIIIIIIIIIIIII 14 t
IE
INSULATION CERTIFICATE L-- — — IC -1
Sit; Addlrms
Nrml: \'umbtr
Description of Installation
1. ROOF
-'��5
Thickness (inch; s) l3'
Qrnr
T;:.'„,a: RC3I5:ague (R-Va!ue) 3
CEILING '
Bat: o: E!art:•:et Type ,' olk `D
Thic ncss (inc`--s` (3" Tl:e rr a: ^sistar.ce (R wluc) -�`n
Loosc Fill Type �Cc s�t'� Br' -,d SA 00 `1 [-,O
Contractor's mli installed wcight/P' k ! 1i
_lb .:f:ni ^art ClineSS ib� inches n
N13nufacturces installed weight per square foot to t:chieve T;.c.—mal Resista_, ce,(R-Vsl'_e)
3. EXTERIOR WALL
A. &t�e�ti.✓ t xL S X(o—PIC`-rte ��.3
Material Bra_.dN=c xClc
Thick.^:Css (inchcs) iG Thermal Resistance (R-Valuc)
B. Exterior U-.)C'..y O
;4:aterial r � , S �i2: G' �C- C _ti�� .i�
Thickness (inches) 3' T e...,_. Resi;ta^ce ( -Value) v1�
RAISED FLOOR
-Meriel
Thic!<ncss (inc`z::)
SLAB FLOOR/?-ERIMETER
Mat�risl
Thickness (inches)
Perimeter Insulaticn Depth (inches)
FOUND' -'TION NV a LL
Nl.atcrial
Thickness (in.chzs)
T i._....al r csatar.c^ (R Val c)
B, -and- Name
T`crmnal Resistance (R -Value)
Brand Na: -.,-
T 'I- e.
a..,,T'e. .a! Rests:ane. ( -V 31L'e)
Declaration
I 1 :r -,by c.r.:fy tha! L'_ 3'-IovC InsulattOn .%]; 1n5:31i_d in .,._ s 3:..._ 2�0'.2 1OC3::on in confc,--mance wtth Lbe c'-'tT.n.
e
Er,era: Ec� S;�r.�.-�. for residential bail-i-.gs (Titl_ 24, Fan 5, Cavi `oni3 Cod c o:`Rcgatar:ens) ss indiea�,•d on the
CC:tI!1731C Of COr?:r!t1. InPI:C3bk:.
I em -s S;(2r rs._, Ds:,. Inst3:1int Sl b:Cn:r3C:Or (Co. Nanc) OR
V General Cor.tm: or (CO. N3Me) OR Ownt:
1! cm =�
C
—a:ure, Date
:U. ,.2-3
lcs:311ing Seb:ontmvor (Co. \ane) OR
Ctncral Cortrac:or (Co. ; 3mc) OR 0'.Yn:r
1-.s:all;c� Sutco wor (Co. Name) OR
Ccncral Cor.t;actor (Co. N3 -.1c) OR 0,A -r, --,r
A'36
�� INNER 15
: IE Standard Notice of Work Completed and Not Completed
NOTICE - All reccommedations may not have been completed. See below- Recommemedations not completed.This form is prescribled by the Structural Pest
Control Board, with whom a copy must be filed by license within 5 days after completion of work under contract.
THIS IS A NOTICE OF COMPLETION ONLY, NOT AN INSPECTION REPORT
ADDRESS OF BLDG STREET CITY: DATE OF COMPLETION
PROPERTY 79-925 Anna Rosa St. La Quinta CA 92253
INSPECTED: CO.CODE 33 10/22/2002
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
FIRM LICENSE NUMBER PR1401 COMPLETION STAMP NUMBER
Notice of completion
Sent To and date
Owner's Name and Address:
Copies sent to
This is to certify that the folowing recommendations on the above designated property, as outlined in STANDARD INSPECTION REPORT NO
nnne , date : 10/22/2002 REGISTRATION STAMP NO: no have
been and/or have not been completed.
Recommendations completed that are in accordance with Structural Pest Control Board's rules and Regulations:
Recommendations completed that are considered secondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
Cost: $
Inspection fee : $
Others : $
Total : $
0.00
0.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A nil pre-treatment was nerforme.-H on this property in accordance with Structural Pest Control Board regulations.
Signature
:If you have questions regarding the work as outlined above,you should first contact the licensee noted above. Id satisfaction is not obtain you may contact
the Structural Pest Control Board at:
Los Angeles - 213-620-2255
Sacramento - 916-920-5323
You are entitled to obtain copies of all reports and completion notices on this property filed with the Board during the preceding two years upon
payment of a $2.00 search fee to: The Structural Pest Control Board, 1422 Howe Ave.,Ste. 3, Sacramento,Califomia 95825-3280.
AT13:1520030313