SFD (0203-294)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
Date 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 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 11111M 3 Ft D Policy No. f �R�616-512
(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,
1,4hall 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: --i- ?_ Applicant �--�• �����
..,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. ¢
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify'
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property four inspect yon purposes.
f {;
Signature (Owner/Agent) i•� (,d�,�'�; Date
rt
PERMIT# ..
BUILDING PERMIT
DATE VALUATION . LOT 0203-294 TRACT
,�✓�
JOB SITE
APN
;
ADDRESS 79— diA'i'A1RsA.9.'L0RXSBOMEV
61 7 t� f �ai y
OWNER
CONTRACTOR/DESIGNER/ENGINEER s•
maxi7LORE's, LP
f h Fi jos -
`ti3 ,. XC dbA bEy 30Ek,C
74-760 19W
76-6
1A1TF'>17 f"_, 3221
f.AUttY
USE OF PERMIT
w i Ftf� iC:i� AITA(M)
SFA - RLDO; 014ir 61� Pt AX 313 , PF+AMIT C. O ' Var INCLUDE
Pools SPA, W=, K WALIA OR .iSRtVEMAY APPROACH. '15% JAY-T)iJLV.014
tid P1<�2+I Ck1�;iF; '#ra�.if, E''c'fl•:1!�171.,T�litt.l? .i$SLt.�:?•1C�ir O,'E� �FsNA�:1'9.°ftt~i'fYt'�
TPACT CONSTRUCTION W0,00 M�
39993MTED x:091' OF COQ"S'A���S�''.� ON
39,010.00
�p'(''(��f
PJ1Y,7mm A
CONSTRUOT1014 YFIZ 101.0004M-000 SIMIDD
PLAWCK'E:CK PEE 1,01i -000-439-31,q X5.:51
ELECTRICAL M 101-000420-000 M00
PLUmA3l on, 101-000449-000 3$8.30
5TRONO MOTIC44 FZS ° KPISID 101.000-2AI -D00 s. U
DZYMOP911 INFACT YX - E,scs�.tin
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at] k, ; �3 (t13 �9,)L?AND;RLAITCM CK
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°,i"KES
PERKT IME NOW
$2,10D.11
CITY OF.IAaUINT�
u. 1^IPI�INCEDEP'��--
RECEIPT
DATEBY'
"
DATE F ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
. - / - AZ
Ducts
Slab Grade
Return Air
Steel
— 4Z
Combustion Air
Roof Deck
O 3e• a Z— 5.7
Exhaust Fans
O.K. to Wrap
f.%F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
•,� O t.
Drywall - Int. Lath
•02
Final
Final o b
BLOCKWALL AP ROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�3 --Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�1, 0 3 �,
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 165
COMMENTS:
_=C—_
INSliLATIO-N CERTIFICATE IC -1
Jttc Ad-ress
Permlr Number
L ct �:_.... /../
Description of Installation
1. ROOF
"S.a:.riall.�'LS E -ars
Thickness (inches) j' T i:c ;,,_1 Rcsis;_nc: (R-Va!ue)
2. CEILING �� '
Bat. o- Elanl.et Type YL E, -a-' Name j��� L
uj
Thickness (inc`;.$ The=a. ^sistance
Loosc Fill TypeBrand QQ,t'1 iJ¢r
Contractor's r -i- irs;alled weigh /i� ]b4ini ^'. t t'z'ickness (b- inches
anufacturces ir�tallea weight per square foot to achieve Thc.—mal Resistance (R-Velae)
3. EXTERIOR WAT L t
A. &t �e�t„Yt,.x�ts dX(o—P1CwtO'P'A3
Material Brz^d Na -c
Thiclu:css (inches) Tccrmal Resistance (R -Value)
B . Exterior u-)GLko
Material Bard Na:e
Thickness (inches) 2ja1 Tcermnai Resistance (R -Value)
P aISED FLOOR
Thic'.cncss (inch. -s) _
SLAB FLOORYPFRIMETER
N.ateriat $:and \ale
Thickr,ess (inches) T<ermal Resistance (R -Value)
Perimc:c- Insulgicn Dcpi� (inches)
FOU\ D. -.TIO\ %V ALL
Kate-ial Baca N27c
Thic'kncss (inches) The. -ma! Resis:arse (R -Value)
Declaration
I :rcr:cy ccril•• tha! t::_ ab s, c.irsularcr. t,zs ins: all=d In h z a: _._ ado'. !oca;icn it ccrf.-- is .CC wl!` Ci cL'rc....
E a� ,
Bier :. fiCier.c� $;Or. r for r_sidcnt,a. buil^_i .gs (Title 2�, . a- 5, Ca:.:oria CO�c o Reg .adeps) ss indic��rd cn the
Cc i:l:atc of Co ; •.ia-c , µ aapiici5!e.
Lyn
In5,a!lir, Sib..0 6tr3ctor(Co. "Sane) G
Gc -.meal Cor.tmctor (Co. Mme) OR Own::
i
' B, and Na.,._
Ti;..,,,.ai Resistance (R-Valuc)
1 -,:ailing Sub:oncmctor (Co. "Sana) OR
C --neral Cer.trae:or (CO. ; ame) OR Ourer
1-s:311i Sc`_cor::-actor (Co. Nama) OR
C- 2! Ccr.t'a::or (Co. Nam,-) OR Owr_r
Standard Notice of Work Completed and Not Completed
NOTICE`- All reccommedations may not have been completed. See below- Recommemedations not completed.This form is prescribled by the Structural Pest
Control Board, with whom a copy must be filed by license within 5 days after completion of work under contract.
THIS IS A NOTICE OF COMPLETION ONLY, NOT AN INSPECTION REPORT
ADDRESS OF BLDG STREET CITY: DATE OF COMPLETION
PROPERTY Mira Flores Blvd La Quirita CA 92253 10/15/2002
INSPECTED: 79 858 CO.CODE 33.
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
FIRM LICENSE NUMBER PR 1401 COMPLETION STAMP NUMBER
Notice of completion
Sent To and date : 03/13/2003
Owner's Name and Address:
Copies sent to
This is to certify that the-folowing recommendations on the above designated property, as outlined in STANDARD INSPECTION REPORT NO
date : / / REGISTRATION STAMP NO:
been and/or have not been completed.
Recommendations completed that are in accordance with Structural Pest Control Board's rules and Regulations:
Recommendations completed that are considered secondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
Cost:$ 70-00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ ' 70-00
Recommendations not completed by this firm
, have
Signature.-
If
ignatureIf you have questions regarding the work as outlined above,you should firs_ t 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 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: 79-858 MIRAFLORES BOULEVARD U-66
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.:
0203-294
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
-!b Date: 04-30-2003 ,
Building Official
POST IN A CONSPICUOUS PLACE