SFD (0203-292)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
71159595 B Ce T c -l—,, 9 Ci!i�3
Date ;L"^ Signature of Contractor 1 �� { i ✓; ^
OWNER -BUILDER DECLARATION
y
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).
O 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:.
CarrierSTATE-1FUNS Policy No. 1603610-92
(This section need not be completed if the permit valuation is for $100.00 or less).
(ty� ° 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 provisions. ��jj
Date: Applicant `h z' / %p�'U�
sP :.,.s —,,>
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, agentstand 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 oP 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 propertyifor inspection,purposes.
2
Si nature (Owner/Anent) k6 -, Date
V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03-2TRACT
SAMOA) 133,21U64 z8e;61
JOB SITE
APN
ADDRESS 1 74 w1wKrLoREs
649-0V-045
OWNER
r
CONTRACTOR/DESIGNER/EN INEER
14-760 MCEk1WAY.111 0.2,00
I
78-600 TlIGAIV9A.Y MI
DOM WEELLS:' CA 92210
LA QM11h, CA 922S3
r?60)1'11.3345 X141 2180
USE OF PERMIT
SIVA • RL V.:43, IYNIT Ciel, PERMIT DOES 140T IMC.),AIDE
MA, SPA, Cab t3(. K WAX.,IA OR DRIVEWAY APk'i t7,r7►C".iFL. li% fk3ZUCT1QN
rN PI" CHI= FEF, fYS3R MULT(FIX lvSUANCIl OF W %1.F, Ea1...AN TYPK
TRACT CONSTRUCTION 700.0D 8F
KISID.Gri. COST OF C0IriT15'=.�4_ 1`1U1i
38,010.0
MUTI' MIT t 11115b a'"Zy
CONS` MMC TION FEE 101-060438-000 $34:1.00
P kNi HeCi; FILE 101-QiiGi-sk39-�1€3 .5t
1.000 .St?
T�1 :H,VQCAL FEF 101-000-411-000
P11=1 FUCAL 1700, 101 -OW-4-20-000 $5100
FP;7M BIN{1 FEE 101.000.419.000 100130
ST),ZONO 1UdUTIGN FEE . XZE,STID 1014100-241-000 13.'so
DE'F.iOI' K34, IMPACT FRE �15di�,t10
s:
€ UP141YYTA f l7cf'i1C:N AND I>T.�f�N CFS
$20 9.0,a
PAM
$aoo
MAY 6 ZC902
�i� �tr�rRovv
CITYOFIAQUINTA
FIRANCEDEPT.
RECEIPT
DATE
BY
DATE FI ALED
INSPECTOR
I
.►
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
.vt/ j7
Ducts
Slab Grade
y a Z 57
Return Air
Steel
Combustion Air
Roof Deck
Z .4 Z %
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
a,Compressor
Insulation
. p 5
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
b
Final
Final o
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
Water Piping
l� rl��
Heater Final
Plumbing Final "
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
. p
Encapsulation
Gas Piping
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) �j
COMMENTS:
INSULATION
CERTIFICATE
IC -1
Batt o- Eian"t Type s'"Y.�
Sits Ado' r:ss
Description of Installation
I. ROOF 1�,
Thie'<r.ess (Inc-cs) \31( jrr
Penal: \umbzr
Ti..r = Rcsis:?rice (R Va!ue) 3S�
2.
CEILING`
Batt o- Eian"t Type s'"Y.�
Thickr-css (inc`.s` l3"
Th e 7M _. F6sis
:tar.ce (R- 'wluc)
Loo_c Fill Type jlOC s��
Er"d k:M oojqi'��-1
Contractor's rnir installed weight/f:" k- Ib
N-1; ^_mt. Ii ckness lb-? inches
Manufacturces irztalled weight per square foot to echivve Ti -c: -.,nal Resistance (R -VENC)
3.
EXTERIOR WALL
A. &t t Jli (S d>c(o—PiC'�lo 3
Material ] -
Srz^.d\a-c , 0, _
Thicknxss (inches) 3%
Thermal Resistance (R -Value)
13 . Exterior Lj_)CU'O
Material Cu 5
Bard NL -,.7. t .�
Thickness (inches)3'�
1 e.^.,al R:s;sla-^.c! (t -Valve) - k'
R.AI`SED FLOOR
trial
I✓;3 _
_ _
ii: ar- �_
Thic'.cricss (inc`cs)
T i:_....sl ccsistar.c (R-Valuc) —
SLAE FLOOR'?ER1NIETER
iv!at�rist
B. -and Name
Thickncss (inches)
T crmnal R�sistar,c!! (R -Value)
Perirnvct Insulation Dcpth,(inches)
FOUNDATION NVALL
M.atc.ial E ara Nar:c
Thickness (ir:zhcs) T.-.e=a': R!sis:ance (N-Vsl::c)
Declaration
I h: ry CCr:;r•' tIIa'. !.-._ 31-10vC IMU131iCr W3i ir,s:alkd.tn -,._ !C•Ca::Cn ... With C4c CL'
Ener: Efiicien'z for residenti:0 builai .gs (Title 24,°a- 5, C3:i.onia COC'.- o' R gul_5cns) as indite --d on the
Cc::i:izat� c.`Conr!.�. u a pi;C.IbI .
I! n cs S;l2r P _, Ds:. InS,3'.li Sl_bzcn-r 3.tor (Co. Narnc) OR
C -
GC.._.aI Cont -3=r (Co. Vane) OR Ownc-
�-..3:u-C,. Da:c 1- .ailing Sub-on-a:tor (Co. lame) OR
Cc: cral Ccctrc:or (Co. ; ric) OR O'x'ncr
Scbcon_-3ctor (Co. Name) OR
C 21 Ccr.t;:z!or (Co. tiame) OR Oµ.r_r
'A-3116
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 79-874 Mira Flores Blvd La Quinta CA 92253
INSPECTED: CO.CODE 33 10/15/2002
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 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
date : / / REGISTRATION STAMP NO: 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
Total : $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performer) on this property in accordance with Stnictural Pest Control Board Regulations.
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.
AT20:4020030313
Certificate of Occupancy
City of LaQuinta
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: 79-874 MIRAFLORES
BOULEVARD U-64
Use Classification:
SINGLE FAMILY ATTACHED
Bldg. Permit No.:
0203-292
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