0203-0279 (SFD)79965 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
i 68595 B CS RIC . 9/30/03
Date !! -- 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 & 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 POND Policy No. 10301642
(This section need not be completed if the permit valuation is for $100.00 or less).
(,,);fl 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:
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 four inspection purposes.
Signature (Owner/Agent) ``' /%c 'w fly, Date!—'t,--° !+,;:
rK
/ 1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203-179 TRACT
TRACT
$45,320M 1326U51 28601
JOB SITE
ADDRESS 75- fti ANIVIA RONA STAT
APN
649-W-045
OWNER
CONTRACTOR/DESIGNER/ENGINEER
.KRArLO "" , T -P
SSD L'13.'X,.:E7 C dba ]YR&M l' IRS.DEW.
74.7601`3101M,AY.1116200
78.6W1-11011WAY 111
INDIAN VELLS CA 92210
1-4 QUI TT'A. CA. 92.253
(760)771-31W C3 4 2180
USE OF PERMIT
} q1AqM.D
AL7Lti+FAMILY
SPA • BLD0.24 UMIT,51 PLA14 LA. PERMIT DOES NOT .INC1.UD?
P001.4 :T/i, BLOCK WALiL.% OR D125VFRdAYAPPRO/ CH, 75% .MiU i ON
114 PLAN CI EF.CK 1VZ FOR. MU1 T1PL-E I-V5LIAN E OF SA M% Pt.All TYPE.
TRACT CONSTRUCTION "ia.+6.(f4
CIARt1.4'3WARPORT 3T3A0 STN
:G YM C )b.r Off` t;O:IVB':1"R£IMMi, N
1WRAUT TITLE STINMARY
CONSTRUCrlrIQ4 FEK 101.000.418.0€ 0 SM8154
PLA14 C°1 -i1' ;iC YU- 101-000-439-318 WAS
MSCI.' H1Qt*%LFEE 101-000.421'`000 339J"
81.T? .TRICALNi?Ft: 101.-000-4'l.0.000 $6336
P:IrI)MY INO VKH 101-000419-000 W150
STRONG MOY;iO14 ME RESID 102.-000• AI. 00 $4.3.3
DEV'.EIA)PER IMPACT ITS E3,S69,tSa
STIR-I`o3`EAL CO:ENWUC°'iTON AW PLAN CW.01C
$2,?M.34'
1- e
A. L P 1V.tNE 3:x' :4 ME Now
MAY U 6 2002
IIIII III I I II 25
of LAQUINTi4 F1111111
CITY
FINANCE DEPT. -v <
IE
RECEIPT DATE
BY
DAJE FINALED
INSPECTOR
{
z
A* INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
6 = b
Ducts
Slab Grade
m - z
Return Air )
Steel
Combustion Air
Roof Deck
- 1? -J i
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls i
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
d
Drywall - Int. Lath
Final
Final
„S l.y 3 5
POOLS - SPAS
BLOC
WALL APPROVALS
steel
Set Backs
Electric Bond I
Footings
Main Drain i
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
-� o- S-7
Heater Final
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
Appliances
Final
COMMENTS:
I
;
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)
Certificate of Occupanc'
City of La Quinta
Building and 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: 79-965 ANNA ROSA STREET U-51
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
I/M
Bldg. Permit No.: 0203-279
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
IIIIIIIIIIIIIIIIIIIIIIIII 26�
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 79-965 Anna Rosa St. La Quinta CA 92253 10/22/2002
INSPECTED: CO. CODE 33
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 I COMPLETION STAMP NUMBER
Notice of completion
Sent To and date
Owners 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
none date : 10/ .2/2002 REGISTRATION STAMP NO: none 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:
Recommendations not completed by this firm
Signature
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Estimated Cost: $
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.
AT12:5120030313
IIIIIIIIIIIIIIIIIIIIIIIII 27
IE
INSULATION CERTIFICATL P - - IC -1
Site Addr-�ss
Dcscriptiolt of Installation
I. ROOF
�'a:crial & J 5 2
hickness (lincr::5) 1 J r
Pernl:.Numbar
Ti;cr 3,_: Rcsis:aace (R-Va!uc) 3S�
Ba!- o- . ^•tS
Bat' o: E!arket Tyre •x"722 E:'_ -d N -^c �� t✓
Thickr.css (irc'-'SN 1 J r/ 1 he=z' �sistanc:
Loosc Fill Type�CL,�N Brand /1 PP.t'1k �,ba-1
Contractor's r=i- installed weight/i:= k— lb lini ^'_ 1 t'i',<nss 7 inches n
M3.nufacturces itstalled weight per square foot to zc;'Levc T cnmal Resistance (R-Vel::c) ES2
3.
EXTERIOR WALL
A.
Material s
Brand Namc 3Ykua---, uto X1( ( O - _
Thicicress (inches)�G
Tccrrnsl Resistance (R -Value)
13. Exterior LA—)CLEW
Material �Cw-(`S
B-,—nd'� Name ___till
�----
Tcic;:ness (Inch's) 3'/a1
Thermal R'ststanc_ (:;'Va1L'e) 1�
RAISED FLOOR
-
Thic'.«tcss (inches)
T:.C.—, --'1 R C si stars (R -Valle)
SLAB FLOO?L'HRiMETER
M.at:.risl
Brand Na -.^.e
Thickne5s (inches)
Ther:r,al Resistance (R -Value)
Perir-ctcr Insulation Dcpth (inches)
FOUND.=.TION NVALL
M.atc.ia!
Bram Na -c
Thickness (ir.O.cs)
T" --z .a; Resis.anc: (R-Valuc)
Declaration
I hcrrby ccr.i:}• that t::_ abovc insulation was irstall_d in : = c_.._.-- a: _._ abo._ !oca; cn corfc-larcc wit`; tic c--rrer..
E'r,erg: E—icier Sror :r. for residential buildings (Titl_ 2<, .'_- 5, Ca!i `cnis Cod.- o,`Rega!a ens) as indiealt'd en the
Cc itr_at of Con �•.ia- u ...c applicable.
ltemS D9:c lnstDinz Stbccnzr3ctor (Co. Nanc) OR
Ce .:Fal Corit-3c:or (Co. Name) OR Ownc:
�natuc, Da,c
S t_rc, Date
lns:alling Sub—oncmctor (Co.'Nanc) OR
C.neral Ccr.trze:or (Co. ; iamc) OR Own:r
1-s:alling Su`cz)=3c:or (Co. Name) OR
Cc a! Cc,-.t:ac:or(Co. Name) OR Oµr_r
2.Jt A-36