SFD (0203-290)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 4 (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
7 5a B ts m,C' ! 9A30103
: #
Date /2/. -'22 Signature of Contractor k;A,
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 FL�I_I1 Policy No. itS4J$lfi-s'1
(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 provisiq s.
Date: ..Applicant—", I _ 10o f i -, a
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject: an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application.is hereby made to the Director of Building and Safety
for a permitsubject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property,.,for inspection purposes.
Signature (Owner/Agent) J i9r ( Y.rn .Pt Date(,r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 02290 TRACT
JOB SITE
ADDRESS..,?1k�4�C�:e�4'��C�Jen1DnD
APN
I Q�1r1�i`
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Idi@.PIMLORFA 3 p
1.)(:1'3DEV, 1140 dba 1M.—EX .' CTT DEV.
74 40t311WAY.111 V2.00
-7B-600I°ITCrHWAY- 113
INDIAN W LIS 1 CA 92210
1A QpwA CA 22"53
(760)t -3345 mg, )l go
USE OF PERMIT
U3NGIZ1?AYA ,Y' A7hA.0 4D
SPA , FiLlm.3tj UNIT Fid, PLAN IB .:FaKkvIV IT I'Jows-NoT INcimr,
P001, OPA DWIX WALM OR )a WFWAY h'al-PRO.4 q 4l 730WR s1DUcT I'm
• IN PIAN CHOCK FEB FOP, IyItJI•'I'1PIZ MUPaIM OF SANTE PLA14 TYPIC
TRACT CONOTRUC1'I,ON . °A0.00 ST
BMW TIM tAoiS` r 01? %:ONYI.'.�`.UMM4
�f►.t3�.i3.tlt�
COIJii°1'.1$UCTIOrOi 101-000,419.000 $343.00
PLAN CliECY. SEE 10.1-•300•439-318 "1 .fin
14 ECH,{iM. his Mr 101,,,bOD- 421 -C100 $39.50
Z'LFCTRICAL Yft 101 -00", 20-000, $Srs.UII
Pi;i.?1sALU1140 FEE 101,000-419.000 3fis.911
Sz°RON. C'MOTInN PEE, RE .ID 101-000-2,41-000 �ii.Lifl
OFIVY,LOPER IMPACT FEE 9yf,3ii�.08
-u4 X ALC �i'7 t53t! 7t '4�ToAATC"51T. t ,
�q1A
$2,386.31
LEND PRE -PA � V
§AY 6 2$ PXV"f FIMISDUL11 s�OWcITY OF LAQUIN
FINANCEDEPP._
a
RECEIPT
DATEBY
f`
DAT ALED
3oO
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings /B. . o z..
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Oy
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation . a y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ! • l • c SJ
Drywall - Int. Lath ,9 • D Z 77
Final
Final
BLOCKWALL AF PROVALS
POOLS - SPAS
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
Water Piping O�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection ' Si
Encapsulation
Gas Piping ,
Gas Test 5
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
C.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 6357
COMMENTS:
INSULATION CERTIFICATE IC-1
Sitr Addr:ss
Description of Installation
1. R001
Thickness (inc :cs)
Fern.!* N`umbzr
/
LQ—
T;:,r,a Rcsis:aacell(R-Va!uc) 3g
2. CEILING
Batt or E!ankv Type �'"Y.�.�S E:s N;mc ��L�'\� "n 'n !?
Thic'kncss (inc`.-s` l3" Tr:TM:
ea: ^sistar.ce (R-Valuc)
Loosc Fill Typc a,3,(\"
Erd /1 oQ.n��-1
%
Cor.tractor'3ri-ir_s;allzdwci3hlft=�16 N4ir:i^_mt.•Ilckres5 _? inches n
Manufacturces in -stalled weight per square foot to uhievc T —mal Rcsista_�ce (R -VENC)
3. EXTERIOR WALL
A. }l ti.✓ tJ��(S G-) o�X(OWlo op 3
Material j Bred Na -c �� ��' � Un �c c O _
Thickness (inchcs) U- _ Thumal Resistance (R -Value)
B. Exterior. -C.L�r,O
lV:3teClal C� S JP_: d N�`:IE�lJ
Tcic'kness (inches) 1 : erma! ' -.sista•^•c: ('-Valve) 1
RAISED FLOOR
?r:a!eriai
Thic`kricss (inch --s)
SLAB FLOOIL'?ERNETER
Mat.risl
Tbic!cncss (Inches)
Pcrlrnctcr ImLlaticn Dcpth.(Inches)
B:a;:- \a--_
c)
T,:cr:�,al r.esistanc:,(�-Value)
Y% F0U\D•-:TION, \VA LL
�` ht.atc:ial 8-3-.
Thiclucss (inchcs) T1- .e
-m
Declaration
1 Icrr'cy c:r.irr t h 3 ! L 31J�'L ir-s a cr. `..3s lns!aII_d Ln th= c_:!c:-.z
Er,erZ. Ej,n'e,; fcr r:sidcntial buildi - ,ss (Titl- 2-, F_ 5
Cc it,_3t crCo,:.;!ia-c ,u a piicable.
I
_ f
Itcm . :a:_:c, Da;c
a N,_`
_! Rztsa.ance CR-V3lu'c)
_._ :`o•._ .oca:icn in cor f,cla ;c. with Chc c,rrc,-!
Cil "-r.-,:3 Co-: c rRugula ens) as indieat--d on the
Ce;_ a1Cor.tm:ror (Co. Kane) OR Ownc: .
1-1-:2111ing Su`.ommctor (Co. Nanc) OR
C.:,cral Ccr.!i:tc:or (Co. i 3mc) OR Owntr
I Sc`cz=wor (Co. Narno) OR
C c.... 2! Ccr.,::::or (Co. Name) OR Owner
A•3o
r U
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 OFBLDG STREET CITY: DATE OF COMPLETION
PROPERTY Mira FlBlvd La Quinta CA 92253
INSPECTED: %9-890 ores CO.CODE 33 10/11/2002
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 dale : 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: 10/11/2002 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 consideredsecondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
Cost: $ 70-00
Inspection fee : $ 0.00 r
Others : $ 0.00
Total : $ 70-00
Recommendations not completed by this firm
- - �' a,. v �;t, f 'y� �5 ' fY 3 11! — tl- '�,�).� I •
Signature
If you have questions regarding the work as outlined abobe,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
I
Certifica . te of.,Q.Ccupancy
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 fol%wing:
BUILDING ADDRESS: 79-890 MIRAFLORES BOULEVARD U-62.
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-290
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP. Address: 747760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
l b' Date: 04-30-2003
Building Official
POST IN A CONSPICUOUS PLACE