0203-0278 (SFD)79975 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 13 C8 11.11C t 9 . 0603
Date d :::(-*=(A__ 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 workors'
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. lowoli)-02
(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 provisionsl
Date: la w. 1 7. Applicant
%-.,,I -rrlo . :' J,: _
Warning: Failure to secure Workelrs 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'll
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and Voi
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati 1.
I certify that I have read this application and state that the above information s
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. p
Signature (Owner/Agent) ! i Date s — A0 'pZ',
,,
BUILDING PERMIT PERMIT# 3'
DATE VALUATION LOT f'U*4178 TRACT
B14SU50 286011
JOB SITE
APN
ADDRESS l1 j 1 AF12i iA .Ib► M1taC ^.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1t►IJ1 MLOFa.E9, X.P
D DW., RX dna D1s:'4it.e .0 (2110 DW.
74.760 FUG AY 131 #900
78.600 0GHW Y I I I
]X,,0L%NEY-11n CA 92210
1:.61.Qif71NTA CA 92253
(760)771.3315 (1121Li, 2180
USE OFPERMIT
O4.1 . LY, {i• 1bWLJd .A•'A .LiLI✓r•
SS IrA • 13WCf. 15,'UN.IT60, P1AS12Bt PERMIT OOftS NOT YNC -I;UDS
FOOL, SPA. 8LOO'K WAit L% OR DRIVEWAY APPROACH, `11% kT;Ca-tYMON.
IN PLAN CHECK PEZ FOR MULTIPLE IMU ANC 9 OF SAME PLAN `FYP
TRACT CONSTRUCTION KJ2.00 5F
kt sin .rm coat or ComX`.121{7C'.L'Aon
0,405-60.
CONSTRUCTION C i ION ME 101.000.418.000 $408,00
PLAN CHECK PEE 101000-43SOIS T.93,6I
MEDC"WIC.AeL F" IM 101.000.4.21-000 $39,$0
91YV' RICA1,FE .01-000-420-000 $64.a
3'WM040 FEE 101.000419-0003 S291so
STI4.ONO MOTION PEP. = RESID 101.000-.283,000 $4.34
DEVELOPER IMPACT M 9
.t•
- --- 1B-1, CCl "4 iJ T"1f ilk AM1,7P1,.W CYWCiC
Ti
AY U 6 700 IDTAx. FF"U MS DITE NOW
CIRQUINTA
FINANCEPIANCEDEPlr
I IIIIIII VIII III VIII IIII 28
IE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
01A
INSPECTION RECORD,
I
OPERATION
DATE
INSPECTOR
OPERATION I
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
I
Forms & Footings
Q oZ
Ducts
i
Slab Grade
Return Air
I
Steel
Combustion Air
I
Roof Deck
.p Z
Exhaust Fans
I
O.K. to Wrap
F.A.U.
I
Framing
Compressor
I
Insulation
a . • D v
Vents
I
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
I
Party Wall Insulation
Condensate Lines
I
Party Wall Firewall
I
Exterior LathL�.
t'3•07— �'r•
I
Drywall - Int. Lath
c • a z—
I
I
Final
I
Final
BLOCKWALL AP ROVALS
steel
POOLS -SPAS
Set Backs
Electric Bond
I
Footings
Main Drain
I
Bond Beam
Approval to Cover
I
Equipment Location
I
Underground Electric
I
Underground Plbg. Test I
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
i
„Waste Lines
Water Piping
_
� ST
Heater Final
Plumbing Final
I
Plumbing Top Out i;
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
I
Sewer Connection
��(. p aj �j 7
Encapsulation
t
Gas Piping
I
Gas Test
Appliances
Final
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 fI
Utility Notice (Perm)
COMMENTS:.
1
I
f
`
i
,
Certificate of Occupancy
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: 79-975 ANNA ROSA STREET U-50
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-278
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
Building Official
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-06-2003
r. L'—
I IIIIIII VIII III VIII IIII 29 ,
IEN'SULA T IO`' CERTIFICATE t - IE IC -1
Ci,,: Ac!drCss
Dcsct-iptioli of Installation
Pernl. Number
1. ROOF `
Thickr.ess (inc-es) \3'' T;.e:;,a: Resis:ance(R-Value)
2. CEILING +
Bat: o: E!ankv Type � J E. -a ,a Na:7,C ���L)(�� t��� �Yl (�t✓l_S Sl
Thickncss(irc`.-s` The=!' ^sistar.ce(: 'aloe)
Loosc Fill Type a 3 \ Brand /10 0"
Contractor's rri- irs:alled weigh /f! � _lb Nf:.^.i_r t tkness 7 _inches
Manufacturees installed weight per square foot to ach:tve T",cm-nal Rcsist`-ce (R-Val,c) - -6
3. EXTERIOR WAT L
A.
Material Pcl!L. S Brand Na -c `� � U0 A-1 c) t 0, _
Thiekr:css (inches) 6/L(- Thermal Resistance (R -Value)
B . Exterior WCLUO r
lVateria! R�C�.��S 3rzr.d `a.^:.c �Yl('t u T
Ti.ickness (incises) �j`�— T'rermai Resistance (R -Value) (2
RAISED FLOOR
Thic'.cncss)—
SLAB; FLOOPU?:_RIMETER
;v`at::iQl
Thickness (incites)
Pcrirnc,cr Insulaticn Dcp,,, (inches)
Y FOU\D.-.TION `VALL
ThiAncss (inches)
T.._..csistar.c f (R-Va11e)
T'.crmal i esistance (R -Value)
B-sn� Na
%e.T..a: Res:s:al:ce (R-V3!L'l')
Declaration
I .,creoy eer.:fy th3! 1. 3b0CC InSL'latic n \tits tns!311::d Ln . _._ abo'._ loci:hen is eocf-rma;,:c with 6c eurr.n.
Er,tr : Ec�Sfar residcnti3! buildings (Title 2,, Fa- 5; Ca'i:cnii Code of Re g_la;:cns) ss indieat-,d oa the
SLb.cntractor (Co. Nan:) GR
Ger.--:al Cont-3cror (Co. Name) OR Owne:
I:c n Da,c lns:alling Sub:ontractor (Co. Narc) OR
Ccncrai Ccr.tractor (Co. ;V3mc) OR Owner
Sebeo.^.C3Ctor (Co. Nano) OR
Gzn, al Ccct:actor(Co. \ane) OR 0 w n c r
3 �
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 79-975 Anna Rosa St. La Quinta 92 253 10/22/2002
TNTQPrrmvn • CO. CODE 33
FARMER TERMITE CONTROL
P.O. BOX 5155
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
AFFIX STAMP TO
BOARD COPY ONLY
FIRM LICENSE NUMBER PR1401 I COMPLETION STAMP NUMBER
Notice of completion
Sent To and date : 03/13/2003
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
none , date : 10/22/2002 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
Cost: $ 99.20
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 99.20
Estimated Cost: $
.-
marks
• • u •'r•u� • •� r • •• • •.� •� • :•. • •�
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,California 95825-3280.
AT20:4620030313