0203-247 (SATT)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
7683 5 B (48 7-tfc\ Fm 0103
DateE"D2 Signature of Contractor -' /0 412A'1)Z
OWNER -BUILDER DECLtlARATION
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).
( ) 1, 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 3`l ATF. FUND Policy No. 1-03616.02 -
(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 provisions
Date: pa Applicants'' --••-I- /0 kb-'Wil
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. s'
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 su
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above informatio
correct. I agree to comply with all City, and State laws relating to the build
construction, .and hereby authorize representatives of this City to enter u
the above-mentioned property for inspection purposes.
fte
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT M3-247 TRACT
JOB SITEp
APN
ADDRESS l C 4iL9Cfl r ik�a�
64.9-0.30—E45
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1 Aia.t.d:)M., L`Cs
DCvD IM, V., WC: dba T)MR.T C:UW DEV.
74.7601WHWAY 111 A.200
7€4.600 MGHWAl; 113,
rtl:!Xi N VJ:E€< S CA 9.2210
%:AQUINTA CA 9.2232
C.760l771 w: 34-5 C~BLA 2,180
USE OF PERMIT
SFA„ HLD[1.10, UNIT 20, MAN IA. PIMMI',". I)C7W NOT tNC"i.UDE
PO04 5`,_PA, I3I OCK WA.IrYA OR DRI.1fi'� WAY APPltO:A N-1, 61A R.F:DU "'jJON.
114 MAN CEIEC i~ FEW, FOR MIiCIT<d' PLZ ISSU ANC Z DY 3 -AMS PL%*N TYPE.
TRACT C ONSTRUC-TION 5F
�rA.It��.I�r+.�r���.Iz.� xrt.4ffr Sig
PHIR i'!ti' 0F.Y. M7k>C.1d'.ARY
CONSTRUCTION TION i+ E 101 -OW -418.000 Ms,H
MAN CHECK PKE 101-00 0-439-3418 prpm
MECII:WC:;+ L FEF 1411.000.421.000 $30.30
ELFAI. TICAL I &19 101-00"20-000 '$65.96
PLUMI3INOT' E 101.000-419.000 3811L511
STRONG tt OTIM Me • RESM :401-000-241-000 $4.53
I°iWFi.i)k`ER IMPACT FEE s1,son
'r
P
mi) PLA3l" O':m4:'n"
ME -FAM MU
$0.00
�HIAY 0 7.ii9f?ni IhIl
CEIPT 1
BYA��� i%»'
DAq,TE ISL O <
INSPECTOR
=! iUI TA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—O,;t
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�=
Return Air
Steel
_
Combustion Air
Roof Deck
• 2 .v �—
Exhaust Fans
O.K. to Wrap
/e5 , l % -.eF.A.U.
Framing
. < <•-e. S7
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
/o • - Z
G .�✓
u _ (.O� S
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
, 0 C_
Encapsulation
Gas Piping
Gas Test
( , O Z 67
Appliances
Final
COMMENTS:
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)
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 79-940 Cassia St. La Quinta CA 92253
INSPECTED:
cO.CODE 33 08/05/2002
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 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
Asoil pre-treatment was performed on this property in a ..ordan .. with Structural Pest Control Board R .gnlations.
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.
AT21:0320030313
INSULATION CERTIFICATE IC -1
A-: ress
De5cripti011 of Installation
1. ROOF 1� ,
1 htckncss (incl-cs) \31(
Prrrl: N'umb2r
-ani� _._. :: k��` �`� �_(n n
Rcsis:!nce (R-Va!ue) 3
2. CEILING ` r
Ba!! o: E'.ankv Type E:, -a N,mc 'n t LQ
Thic ncss (inc.`.•s` 13" Th' -_=a. ^sistanc (R 'alt c)
Loose Fill Type Brand `A 00j-1 � l
Contractor's rni.- installed weigh f:' �-_lb NI; ni ^un tnickmns ld_ 7 inches
Manufacturces installed weight per square foot to achitvc T;. —mal Rcsista_�ce (R -Valve) -
3. EXTERIOR WALL
A.
Material Bra -rd N=c „r1
Thickrtess (inches) — Ti crmal Resistance (R -Value)
B . Exterior WCLA.o
Material y C _ Brzr.d Name (--;L-(-LThickness (inches) 3� T'termai Resistance (R -Value) - 1�
RAISED FLOOR
MMeri'_l
Thickness (inch. -s)
SLAT; FLOOIL'P ZRINIETER
Iv!ate: isl
Thickncss (incises)
Perimeter Insulaticn Depth (inches)
FOUND, -.TION NVALL
I�1;.atcvial
Thickness (irc'r.cs)
Declaration
B,anJN e
T
c.—, 2-1 KcsiStdCC^ (R- Val, Sc)
B, -and, Name
T<cr:nal Rnistance (R -Value)
En.T .en-_; Resis:anc: (R-Vsluc)
1 hereby eer:ify tha! t.`._ 3b0�C trsul3ron %kas irs:al!:d in tc_:' .-- 2: _._ ab0.= !oca:ien in, eonf::-Ian,cc with Ch c_r.n.
Energy E!j,cierc� Srrc Y f- residentia! buildinSs (Titla 24:, -an 5, Ca!i:Cmia Com: o`Regal3lens) as indieat_d cn the
Cc^iticat of Co rr!iaaI , u aop!icablL.
Insta!lin. Scb:cnnz,.cr (Co. N3mc) OR
Ger.:.-al Cor(I:."or (Co. Mme) OR Owre.
1lCT1 =
.a:_rc, D3!c
!ns:allina Seb:onLr3ctor (Co. Namc) OR
C:nCra! Ccc!r3c:or (Co. ;:amc) OR Owner
Ir.sallin� S.:`conz-wor (Co. Name) OP
C,-.._.2! Cc, -.,:::!o, -(Co. tia:.,e) O:Z Owns.
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: .
Use Classification: SINGLE FAMILY ATTACHED
79-940 CASSIA STREET U-20
Occupancy Group: R-3 Type of Construction: VN
Bldg. Permit No.: 0203-247
Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
Building Official
City: INDIAN WELLS, CA 92210
By: STEVETRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE