0203-288 (SATT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter9 (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 PTATE -PUNS Policy No. I6f►'yP+16-t1"'
(Thissection need not be completed if the permit valuation is for $100.00 or less).
U). 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:-, Applicant
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminalrpenalties and civil fines up to $100,000,Xin
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 Ouinta, 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 for inspection,•purposes.
Signature (Owner/Agent). ")0 ( Date- °f .•„��
f
PERMIT #
BUILDING PER_M_I_T
DATE VALUATION LOT. f TRACT
132' W OUISO 8t1 I
JOB SITE
ADDRESS 47«..720 P9C•IXAC'�En ��
APN
6404YLA4AMS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
wp,pac2 opmq, LP
DCD IVY, 1KC dba D9,9Mt1' (XIIES'Dro V”.
*74 -7 60 HI%I'V6IAT.1114200
76.600 MGHWAY 1 I I
TADIAN ZX)ELL..� CA 922 1 A
LA Qi ilt fA CA 9225'
Ci��7?n5 c,1BIf a?v
USE OF PERMIT
SPA• BLDO. UNIT 0, PIAN IA. P#; R.MIf DO1rS'iJ0T INCi,UDY
P004 SPA SLACK WALIz'3, OR DR.TVT4'WAYAMO6aCH. is%AVIDU'G`ii`IQW,
rN PLAW ClO CK YEE FOR MULTIPLE ISSUANCE OF SAME PLAN °rYP&
TRACT CO'NSTRUCTIC'.*1 Sy
CiAk2 AM1PX OX`I'• . 3 J3.UfD SIP
.%'�'a`.lri1,'1L�.`MD MVf OF C0.NMJJ4 ,�.10r4�
45,32064310
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y �qg����t /",� * py (�
6eOfi O RUCTION l'J�;•.G 101-06l!-4118`,i,� 0 S��Id.iSO
101-060-4118,,000
f
PLAN CHWX FEE 101 -OW -439-318 swi5
MECHANICAL, AI, VSF 101X000-421-000 s3%so
MECTRICAL = 1111 -Ott -420-000 05.46
PLUMBING FRE 101-000-419-000 $O
r
STRONG MOTION IVES - X'NSID 101f1Qf3-�R1-0. 00 T4.53
L1E1'E'.i OPER IMPACT .9
a:
rt 1fi=dw7.f°ti)ASTR CT:€OWA19.01a1:AXC 10?ZC.
$1,243.34
LE so PR,-PMDFIEFS
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F 1r SD�U.NOW.
MAY
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6 700[
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WYOFLAQUINTA
FINANCEDEPT, I
RECEIPT
DATE t
:BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —
Underground Ducts
Forms & Footings
Ducts
Slab Grade - U�
Return Air
Steel J _
Combustion Air
Roof Deck -/G .o Z -7'
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation - l c o a- S T
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 5 =� O S7
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 —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test �3 �� 21
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) c 3
COMMENTS:
Standard Notice of Work Completed and Not Completed
, ,• NOTICE - All reccommedations may not have been completed. See below- Recommemedadons 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 47-720, Sumac St. La Quints CA 92253 08/22/2002 y
INSPECTED: 1, CO. CODE 33 11-4
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
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 : 09/22/2002 REGISTRATION STAMP NO: non 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 coil pre-treatment was performed on this property in accordance with Strnctural Pest Control Rnard regulations"
y
Signature
.i
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 $2.00 search fee to: The Structural Pest Control Board, 1422 Howe Ave.,Ste. 3, Sacramento,Califomia 95825-3280.
AT16:5520030313
1
INSULATIGN CERTIFICATE IC -I
Sit: Ad''r.ss
3.. f _•_-I_tv:3:n-.
Description of Installation
1. ROO
Perml: Nunb2r
4! � k �- � "' �- � � -
- r,
Ti;,r,;,a: P.csis:ince (R-Va!uc) 3�
2. CEILING
Ba'.t o: E!ari'.;et TykeY.`J B:s-d Nz^c�X�� L
Thie',u-.css (irc.`.:s' �3" The:^.: a: ^sis:arse (R '.aluc) VZ, -
Loosc Fill Type2-td ,l ,
Contractor's r -i- irs:alled weighYf:- lb niekress ld_ inches
Manufacturces installed weight per square foot to ?chievc T;.c.,,,al Resist`nce (R-Veluc)
3. EXTERIOR WALL
A.aX(o—(C'L rte 3
Material PpeljtS BrzrdName
Thicicress (inches) Thermal Resistance (R -Value)
B . Exterior i,vCiLo
Material Bard `a:nc t�
Thickness (inches) The.,^.,a: Resistanc_ (R -Value)
RAISED FLOOD, _
Thic:cncss (Inch-.$) T .. ..sl Pmcsistanc (R -Vail.^.)
SLAB -FLOOR'PiRlMETER
Matcr isl Band Na: -;;e
Thic!mess (inches) TL(:r:T,al Resistance (R -Value)
Pcrirnc!cr Insulaticri Dcpth (inches)
FOUND.-'
T10N WALL
ivl.atc:ial. E N -c
Thic'Icr:.ss (inches) T .e r -a: Resis'a ce (R -Value)
Declaration
I h c r y e2ra r" that f.'_ 3jovc in5L13 tion -as Ir: s:31!.d Ln :h �_.': �.-- 3:.-._ 3�3'.= !c,c 3:iCn ... ccnfC— -macre with the c,i....
Er•erz; EjiCiene�S:nc�.r- for residential buildinsss (Title 24, 5, Ca!i.-Imi3 Coe: R.gaL ens) ss indieattd ca tF-�
I! m3 SLID:on:r3..or (Co. Namcc) OR
Cor:-3::or (Co. Nene) OR O•++n^--
, t
�13a:r1', ate
Sid
1-1-:alling Su` zonractor (Co. Name) OR
Ce: -,:.,al Ccc:rac:or (Co. , ame) OR Owner.
Sc`cz .wor (Co. Iramc) OR
Ccr.,._..,; (Co. Name) OR 0,A -r, -.,r
t
Certificate of Occupancy
City ofla 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: 47-720 SUMAC STREET U-60
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
-o 4_1
Building Official
vni
Bldg. Permit No.: 0203-2W
Land Use Zone: CR
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE