SFD (0203-289)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 Ei p. Date
P6 �f B C8 M;1 � l� 94119103
f
Date !� 10 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:
( ) 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
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 & �Professiorials
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 Policy No.
STATE FUND 19036'i6-02
This section need not be completed if the permit valuation is for $100.00 or less).
yJel 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: _ J. ,.,^ Applicant` thio ' 1 !4..
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code,`interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance. of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building.
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property -for inspec on purposes.
Signature (Owner/Agent) ��� - A I )A -t ai Date
FA, st, . A
PERMIT #
BUILDING PERMIT
p�y ,Ilei t;.,m
,TRACT
DATE VALUATION LOT TRACT sa,
JOB SITE
APN
ADDRESS 19•4396,I4 'r.RAII'LO..!FY, 1 0UL.EVAI?D
:649-030-045
OWNER _
CONTRACTOR / DESIGNER / ENGINEER
MYSANVIVIR. IS Cil 9221 a
1A S,3%IWA CA 92253
(766)771.-534,5. MIR 1180
USE OF PERMIT
SFA . BLI30.31,piy3NI`i' 6i; PLAN 1.9.. PTZ3,t&F IT 1„100,3 NOT ENC:�.L1i]E
P004SPA, LvIJ`VCK WALIA CIR DRIVIrWAY APPROAe`.H, 75%It,EL' UCS.1014
TH PLA14 CHECK FEE FOR MULTIPLE ISSiDANCI, OF St' ME F'LA14 '1'y'P .
TRACT C0146TRUCTiON MASI?
�
EnWATM COST OF £.`ii1VI��':I"CiVC'n,'0P$
ERAfff FEE FMVURY'
CONSTRUCTION ME 101 -0004 1€ -000
PI.IkNT CI BCK PUB 178.51
MP-HANICAJ., r'EI+ $30.30
ELECTRICAL FK� 101-000-420.,000 $51too
PL411' BINQ PER 101 i-000419-000 98s,g0
STR.0 140 MOTION PUZ -'REBID 101-000-24 S -000
DDI FL OP^I It IMPA07 FEE
SY
;y '( (x I . `s b'fM i L"�I MIT AIS'
�'), S,i0.
AA yy[[1~��'++,1�:1NN:t�^�����c�T��ZyqECY, yy
Y :: .L.47�M3"I TART -B"C` M 1�
i
/,11
d/4i V V
uy vow
06 2002
MAY
CITY OF LAQUINTA
PIPIANCEDEPT.
4
,RECEIPT (
DATE
BY
DAT )YINA Lg
INSPECTOR
V t!(
a►
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade =�c d Z S7
Return Air
Steel
Combustion Air
Roof Deck /—ly' a Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation •B '1
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath , r .,a Z &r
Drywall - Int. Lath l2—Q • 02 S
Final
Final a
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _
Water Piping t�17 ��
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection d o $7
Encapsulation
Gas Piping
Gas Test f , �� , 0 3 77
Appliances
Final
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 7j -1
COMMENTS:
= C
INSULATION CERTIFICATE IC -1
Si;c A:'c'r_ss
Description of Installation
I.
Permit N•umbar
--
Thickness (inches) \31( Rcsis:aace (R -Value) 3
2. CEILING
Bat: o: E:an'.etType E:a-a �'a ^c��1X\`� ���Yl (�LILQ
Thic'u:css (inc`.es` j3" Thz: z. ^sislance
Loose Fill Type �Cc �� Erane' A Q!2A1
Contractor's ria installed weight::' �_lb iti4iri ^c -t t�!ickness ib_ �inches
;�4anufacturces installed weight per square foot to achieve T c.—mal Resistance (R-Veluc)
3. EXTERIOR WALL
A. b4Ae l(�,V L\>Ws' aX(o-P1C 3
Material ) Br2-,:d Na -c M1 t t (( 0 - _
Thickness (inches) % Thermal Resistance (R -Value)
B . Exterior lc>C UO
Material Brand Na -c
Ti:ickness (inches) ; ' o Tee.=a: Resistance (:t -Value),
RAISED FLOOR
Thicl:mess (inches)
SLAB FLOOPiTERI`tETER
Material
Thic:kncss (inches)
Prric vu Insulation Depth (inches)
Y% FOUNDATION ViALL
�` iv(alc:ial B.; -a N3 -c
T;acicncss (inches) Ti-e:r.:a: R--sis:arc.- (R-V31L'e)
Declaration
1 hcre'oy cerify that t• -- abos•e irsulation v. -as inoall:d 3. ._ sbo•.c !oca:icn i, coir-, t3,;cewith tic c_rr,-:
Er,erZ, Ej7-n'e ,Sror•a:r1 for res;denti3l build-,gs (Title 2 ran 6, Ca'i:cnis Comae o`r2eg_!z,`:ens) ss indieat-,d ca the
L ::n s sxgn ,r_rc, Ds,, l :a:lis : Slb:cntr3.:Or (Co. sanc) OR
Ger.:: nl Cor.;�ccor (Co. ;:ane) OR O•++ne: •
1:r -n :3,nature, Date Ins:ailing Subcontractor (Co. lane) OR
C:n:-al Coctrzc:or (Co. N3mc) OR 0wncr
Sid et_. , Da
B, an 'j N 3
Rcsistar.c^ (R-Val,c)
B:znc Name
T crural Resistance (R -Value)
F.:1•=• •Si 2=J
Ir.s:3lli;.� Su`_conu3wor (Co. Nine) OR
Cc- r3i Ccr.t-ictor (Co. NaMC) OR Owner
A•36
-' _ U
I
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, NOVAN INSPECTION REPORT
ADDRESS OF ,BLDG STREET.
i CITY: DATE OF COMPLETION
PROPERTY1Vllra F101eS Blvd La Qulnta CA 92253
79-898 10/11/2002'
INSPECTED: CO.CODE 33 .
FARMER TERMITE CONTROL. z AFFIX STAMP TO
P.O. BOX 5155 • BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
FIRM LICENSE NUMBER'. ' PR 1401 COMPLETION STAMP NUMBER r,
Notice of completion
Sent To and date : 03/13/2003
h
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 : 10/11/2002 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:
Cost: $ 70-00 -
Inspection fee : $ 0.00
Others : $ 0.00
f Total : $ .7000
Recommendations not completed by this firm t
Estimated Cost: $
Remarks
Asoil pre-treatment was perffirmed on this pr in accordance with Striictnral Peet Control Board r .gulations-
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::
AT20:4420030313
..
►fi ca to of OCert
Y
►t of La Qu►nta
• � Gy.
. 4-
Building and Safety Depa r ent u,dOf T
A
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,
certifying that, at the time of issuance, this structure was in comp/lance with the various ordinances
of the City regulating building construction or use:. For the following:
BUILDING ADDRESS:. 79-898 MIRAFLORES BOULEVARD U-61
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No:: 0203-289
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
City:' INDIAN WELLS, CA 92210
By: STEVE TRAXEL
�et_L Date: 04-30-2003
Building Official
POST IN A CONSPICUOUS PLACE