SFD (0203-295)I• 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
7158595 13 ca MC -11 OMI/03
Date—"' �� a 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 Coder -.
( ) I, as owner of the property, am exclusively contracting .with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). r
() 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 ,��IJNI? Policy No. fadl5lr�ti2
(This section need not be completed if the permit valuation is for $100.00 or less).
(<f 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
14
Code, I shall forthwith comply withi`those provisions
Date:I?..- Applicant ` `; .I�`•� i_b�t't
Warning: Failure to secure Workgrs' 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 io`r,inspectlon purposes. 1
Signature (Owner/Agent) • t rv.t���° Date
z
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203.2?l TRACT
1334UP fi> M
JOB SITE
APN
ADDRESS al� Y.
649-4tv-045.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IvSagi�joofi'v, LP
:(SW 1 EV., DIC arta ]DESS T'�.` ES, lkl.
Mb;16U,Nxl.�'�1.`'�VAY 1119-200
'l:�=t<St'3DFUGHWAY 11.1
INDIAN WMLI CA 92210
LA C,iLINTA CA 922'5
�1�ri3�3�i'1,33d•5 ' :l�Ef �1.8t7
USE OF PERMIT
MME
Fda ., l31.LziT. lf3; UNIT 6 ,. PLA 28. ,PT+t2.i IT O>OES I4t0T INCiy'UOr
P0014SPA, BLXK il�[.L%Off.DIUVit�,i& i!aff'P}t��Ll.i.I556�I��tfti:i'i;?t�
IN PL"'' CHPCK: FZF, F'i.7P CdIi 1 aiPIX,'ISSU:,N, NC'P OF RAME PLAN TYPE.
ESISTMA'.I:li�..i!' COS' OF CO-MMUCTION
Cp13Mit`.'f1OA FEE 101.000-118.000 2408,00
PLAN CHECK PUF: $0.61
Ml'?.C"1W* 4ICAL, 799 101.000.421.000 539.50
1aZCTRICA.1, FEE 201-000-420-000 $64.72
PLZ'MOrNa FFE 101.000-419.000 SWO
STRON13 MOTION FEE — P=SBA 101.000-241-000 V4.84.
Dt&MA30. IMPACT FEE
D A. iV+ 1;%3 fi41: co11 1 .1d AND1%lAW �`11�+P
LES'S P7Fc�:_?P2D <5 1
$0.00
pp
� U r T : f�llrk�'{S1�Sa4V't�"
,
i
t�✓,�n`�
WYOFLAQUIltrA
FINANCEOEPIr /
RECEIPT
DATE
$Y
DAT LED
INSPECTOR
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-.2`d
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
C 7Y—�_
Combustion Air
Roof Deck
17
Exhaust Fans
O.K. to Wrap
e 7
F.A.U.
Framing
Z 77
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
42 •p¢. eft
Final
_
Final
BLOCKWALL APPROVALS
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 z
-z g , m
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�� -p -5
Encapsulation
Gas Piping
Gas Test
/ . , �p 3
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) O
COMMENTS:
u
C
INSULATION CERTIFICATE IC -1
Sit: Addr -.1,s
Description Of Installation
I., ROOF
Thicknc-5s (inc'Incs)
Penal: \'urbzr
Y2
E
T*I-:,-rma: Rcsis:aace (-.),-Va!u--)
2. CEILING
E.a-a Name -Zk'mk--, �Ict,-n dcu
13a,
Thick.r.css (inc',s' a) Th-=!.FfSsistanc.-
�q
Loose Fill Type A 0 (2, n
Contractor's rnilr installed wcightJf:-' I b IM; t.1ick-mm ID -,; _inches
N13nufacturces installed weight per square foot to achitvc T"^c.—,,,al Resist—ance (R-Valuc)
3. EXTERIOR WALL
A L,, -
Material VYJIT5 Bra -rd N=c An() (((0,
Thickness (inches) Thermal Resistance (R -Value)
13 . Exterior LA -)6A0
Material ?YlltiBr-2-d'Name
Thickness (inches) T',=.a: IRzs;sIanc! (R -Value)
RAISED FLOOR
Mm e r i a,
L, an --" N
Thickness (inches)
T' .....s1-s:star.cc (R -Value)
SLAB FLOORi'HIRINIETER
N2Me
Thic'kncss (inches)
T<c—,al Resstanc: (R -Value)
Pcrimvcr InsuIaficn*--DcpIh (jr.ches)
FOUNDA.TION ViALL
ty(.ale:ial
Na: -.,-
Thickness (inches).
T*. -!.7.a'; Resistance CR -Value)
Declaration
I ',i:rt:'I-y c2r-.:ry tha! 3bovc irsulvicn .vas ir,5,311z-d in
2: !OC3::cn in confc.—manc-C W;Ih Ch: c, --,m,-.!
ErerR,Ejtcie!SY for r. silcntial bull - :.Ss (Titl: 24,
?a: 6: C11;- MlaCod: as indical--d on the
C C:: i;"I 2 1- c'C o... •a -.,c
D 9
Cont-mclor (Co. Name) OR 0-A"r1t,
I: cm Da',c
1:-I:zlllng Scb-on-,mcior (Co.N.amc) OR
C -::-,:,al Ccr.?rzc= (Co. Nj=c) OR 0,,vr-.,:r
Sign t z
Su`Con:ic!or (Co. Name) OR,
C rr'3 A .3 (3
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.- 79-850 Mira Flores Blvd La Quinta CA 92253 - 09/08/2002
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 PR1401 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
1 . Estimated Cost : $
Remarks
i
A soil pre-treatment was performed on this pro er y in accordance with Strncniral Pest Control Board regulations-
sSignature
If you have questions regarding the work as outlined above,you should first contact the licensee noted above.'ldsatisfac6on 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.
AT20:3520030313
*Certificate 0f .Occu-pa' n-cy
City of La Quinto
Building and Safety Department
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 compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-850 MIRAFLORES BOULEVARD U-67
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-295
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
Jd� AleDate: 04-30-2003
Building Official
POST IN A CONSPICUOUS PLACE