SFD (0203-291)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury thai 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 C$ MC��Uff1�
Date r�"' a—f" 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.
( ) 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).. 1:
( ) 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 6f° 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. 160616.02
(This section need not be completed if the permit valuation is for.$100.00 or less).
(>I:, l 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: 4.1- + Applicant �, 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 1
for a permit subject to the conditions and restrictions set forth on his
application. r
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 riull and void if
work is not,commenced within 180 days from date of issuancewof 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 i �spection purposes. a
Signature (Owner/Agent)f >fr�I=a'. Date�-
BUILDING PERMIT PERMITk
DATE VALUATION LOT TRACT
JOB SITE
APN .
ADDRESS,i►,.F.4.F�..:e�J.i.9.F:er°1;7G''d�.l:••D•'�i•a,v�3,s
•
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1",PLM 1.YEV/.;, JWC dba .ti'MSEP , CT - 4 DEV.
74.700Y912THWAY111,0200
°gf�«6�Ju:t.���a�ir�►F 1 �;
INi IM, VPZI LLS CA 92210
L.A. x.15.1 °PA CA 92253
��ErC9)779•:S.s :a C:' Lot 2:180
USE OF PERMIT
11 63, PLANINC.'.p%�t�:fIJDE .
IDy1�.s
�Ppf�giv2����,4:'gC�l�apt4►Y}.,���1NOT
�IS]f+Y�.,m
pp;,�aUp;�a4;��i1'.'�d'i
q� p�^tgf �.e
L-SPvf.0 yl `'�,. BLOCK Vr,>;�S. L9, OR AJ%q.F�[ dei' A I .f'IA-Ti'�,�.)k].rn'�KA, I5% ��Ei;;'UC t�10W
ON PLAN. CHLP:"% FEE POR YU1U1 1'1PL•E IOWAN�1a O� .�ia°a ML• PI�.�iN 'f y %'!>.
j
MAC T CONSTRUCTION OF
'. .W,M, �,:"fi,?SM C3�?' sl: l iC".1 4LW
' J%3,Q'1�. �t3�3•
y��p�y�• �,��qqww--pp g 9�� ^gy y,,yy� �E/i�,�
.B'ii».�iJ\:ll„i. �9 I'.�.,6.'. SC�iYB.A.ti::], ..
(:OiJS'1`RUC•i1O14 FF',1t 101.000.411 x000 $34.4.00.
PI -NN C1.1Z<,L:KFEE
WIFICHANICA1.1FEE 101-000-421-000
k".lXC TP}CAL M 101-Q00-420-000
PLUMBING YZE, 101 000-419d000 $$Uo
riEVE, �Og'E%C,WFAt; T FFE
!4
11 PRY -PAID 1 ;. 7.
X
$0,00
FERMT vmns 'o LTC, now
1,
F`f 6 1 901
- WYOFLA►QUINTA
FINANCEDEPT.
RECEIPT
DATE
BY f
DATE F LED
INSPECTOR
4r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�C7
Exhaust Fans
O.K. to Wrap
Framing
F.A.U.
Compressor
Insulation
,oL yT
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z '
Final
Final
BLOCKWALL
A 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
S�
Neater Final
Water Piping
_ _ _
s
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection a �� •D
Encapsulation
Gas Piping
l
Gas Test
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) ,2( p
COMMENTS:
INSULATION CERTIFICATE IC -1
5itr Add'r.ss
Description of Installation
1. ROOF
7 / r
Thic:<r.css (inches) J
Permlr Number
Rcsls:aace (R-Va!u..) 3 '1
2. CEILING
Bat- o. Elanket Type }! ` E:s-'_ \a^c ��)(�� h l� .Yl (�L l•
Thic'u:css (inc`.-s' t�'� Tr:e ^ a: sist3r.ce (R aloe) -�j�j
Loose Fill Type`CCJJt/\ Fr --rd
Contractor's ini installed weight/it' _lb rt t knas l _ �inches
Manufacturces it -stalled weight per square foot to achivvc T c.;nal Resistance (R -Valle)
3. EXTERIOR WALL
A. &IX(o—PiC'wto 3
Material Pck/'_. Brand Na -c a)�k n Ac c 0- _
Thickness (inches)— Thermal Resistance (R -Value)
B . Extericrl,UGAO
Material BRr.d i\e:::e
Thickness (inches) Ti:e.^a: Resistant_
RAISED FLOOR
MMart_! B anzl N_--:
Thie'cncss (inches) T :._....,i ccsistar.c (R Val-uc)
SLAB FLOORiPERINIETER
Macerisl B;z:td Na: e
Thic::ncss (inches) T`er;.al Resistance (R -Value)
Perimeter Insulatic i Dcpt'n (inches).
FOUND' -'.TION \'%ALL
tvi.atc:ial B -a -a Na -c
Thickness (lnchcs) Tr.e.T.._? Res:s:ante (R-V3111C)
Declaration
1 i:reIy e2r;iry that t`_ abov: i.sulaticr. s,as ins:311'Ld in :h. c_:'c:--'a: ._ zbo•._ loca:icn in eo, fe�ancc with tic e_-rr....
ErerA: E icier.e� Srord.r. far residential buildi=.yrs (Title 2-:, n 5, Ca'ifonis Code e: r eg a,^;ens) ss indica��d o the
Ccni1 1-a orCOTrIt1�C w-_.:11 C351e. -
!tc ;� -s Sign• _. _, De:. 1-s:a:li� S;.b:entrac:cr (Co. Nam:) G
Ge._. UI Cor,::-acror (Co. Name) OR Ownc:
Date
]-s:ziling Sub.ontmclor (Co. Nam.-) OR
Cc-r_rai Ccr.trzc:or (Co. Namc) OR Own:r
Ir.s:alli.� Sc`con^. actor (Co. Nave) OR
Cc.... z' Cc; -.,:::tor (Co. Name) OR Owner
Au- .,:2 31 A -3o.
Standard Notice of Work Completed and Not Completed
NOTICE - All ieccommedations 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 79-882 Mira Flores Blvd La Quinta CA 92253 10/15/2002
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 PR 1401 - 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: 10/15/2002 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:
Total : $ 0-00.
Recommendations not completed by this firm.
Estimated Cost : $
Remarks
A soil pre-treatment was : eformed on this property in accordance with Strucwral Pest Cntrol Board regulations-
t. Signature!.
4-
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
Cos 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.
AT20:4020030313
certiricate or occupancy -,
Cit of La Quinta J
Building and Safety Departmentof.
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: 79-882 MIRAFLORES BOULEVARD U-63
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.:' 0203-291
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
Date: 04-30-2003
Building Official
POST IN A CONSPICUOUS PLACE