0203-284 (SFD)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
I3 CSlF o� I`! 913fli;3
Date "� � `U Signature of Contractor _)4
.0
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 STA9TZ IWD Policy No. 1603-16..02
(This section need not be completed if the permit valuation is for $100.00 or less).
()[). 1 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. �l
Date:?.. Applicant �3 fj<p 'y`iJAjj
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person' -at `
whose request and for whose benefit work is performed under or pursuas t to
any permit issued as a result of this applicaton agrees to, & shall, indert�nify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is'
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prop efrty�,for inspecti C °purposes.
Signature (Owner/Agent) '�. +, �h� i-'� Date!
(i.
BUILDING PERMIT PERMT#
DATE VALUATION __ LOT - TRACT
.
A� 5p6 B21"'I'm - - 8601
JOB SITE
APN
ADDRESS r�7 1 Itifita'V�i'tia�"5"%'
�s8• €1s Q$
OWNyyER(�rt�yy
CONTRACOENINFERR
.U/a r6i11'4..".OTC.I:a7y L+
..
dyLJY'V., 19C dba DMCuEts JJY
4-160:f3.f6f:I WAY 111 t#200
78.6001-91GHWAY 111.
WD-Im WFLU Ch 92 210
LA QUWTA CA 9 x51
C160YI % 1.3345 C01.* 2180
USE OF PERMIT
D.111?f�2..Y+d�L].LVdLLId. Y'Y��F'9A�•s�
UFA, EG1.!Xt,24 UNIT 5fi, PLAN 2B . PERMIT DORS NOT FNCl.UDE
POO) , 911A:, 'BLOCK WALL,I, OR Y, RIVEWA,Y AIPPRO.A.CTI. 1314 REDUCTION
IN PIAN CHECK FEE FOR DAUULTIPL-F', Inti ANCE OF ElhNAZ PWILN 'I'1P•i'"&
TRACT CONSTRUCTION SIS
'ESJi.LL�Y.M➢R.Cn7✓ �_r1JSp. OF 4r01i61:P]46J1.XA,'�L,.�.N
'?C�d'A�OTwiuf7T.J'
CONSTIIUC f'IOR 1W 101-000-418-000 S4M.00
PLAN CHECK .FFA' 101-000-439-318 39-'318 '$91,6.1
MECHANIC, &L FUE 101=•090.421-000 134,39
f EC7'R.iCAL FEE 101 -000 -420 --opo $64.72
PLUA!MDD40 FFX 101-000419-000 $33,50
STaRMTO MOTION Ir`I-IC . RESI.P 101.000-241-000 $4.94
DEVILILOPER IMPACT FEE
ONMTYCT40W AND PLAN G',11RCK.
$2,26€.97
D T235 PIZ&.PAM F
$0.00
Ads P I S,1.'P'1�s !'.� JNow
��Y � 6 2002 `
WYOFLAQUINTA
RNANCEDEPT
RECEIPT
DATE
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
! Q - -
Return Air
Steel
Combustion Air
Roof Deck
J7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
z 2. , o L 157
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
.157
Final
Final-!
D 3 E::17
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_� ( p 3
Encapsulation
Gas Piping
Gas Test
Appliances
:i 5
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: a DATE OF COMPLETION
PROPERTY 47-650 Sumac St. La Quinta CA 92253
INSPECTED: CO.CODE 33 10/22/2002
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:
Owners 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 : 10/22/2002 REGISTRATION STAMP NO: 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: $ 99.20 .
Inspection fee : $ 0.00
Others : $ 0.00 1
Total: $ 99.20
J
Recommendations not completed by this firm
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 repots 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.
' AT13:3120030313
r
C
INSULATION CERTIFICATE IC -1
Sit; A' -r css Nrml: Number
DcscriptiorI of Installation
1. ROOF
I`�atcr:a! F�(.(_/�� Or3;:'.a.• �:.^.._ � �lJ'�'(\�� ��t .111 1 t i1. �.
Thickre55 (ircF:c,) 13-"
2, CEILING
Bat: o: BIar:`cet Type s+"Y.v� E:a d Na; -,c
Thick-ncss Orin`, s, (3" Th
e rr3:^sistar.(1- 'aloe)
Loose Fill Type OLBrand o,.n (-
Contractor's rni installed weight/R /�lb �fi.^.i^_M t kness --j-inches
\Ianufacturces installed weight per square foot to ach:evc T cr, ,al Resisiance (R -Value)
3. EXTERIOR WAW L
A.
Material Brand Na -c
'Thicicr:ess (inches) iC _ Thermal Resistance (R-Valuc)2
B . Exterior ' ' C•U0
,Vaterial PYJ: 5 B2nd'N-17nc
Tcickness onci:es) Therm_: Resistance (=-Value) - (�
R-?ISED FLOOR
titt,,:�teri_;
Thic:tn=s5 (Inc` --s)
1 .. ....i! 1 _s:s1anC (R-Valuc)
SLAT; FLOORRERNETER
M;3tcr121 Brand \a ^e
Thic::ncss (inches) _ Th ermnal Resistance (R -Value)
Pcric.c:cr Inscliticn Dcpth (inches)
FOUNDATION WALL
Katc.ia! B-sra N2
Thickric�s (inches) Ti-e.7na': Resis:as:�: (R -Value)
Declaration
h:rc y ecr,:Cy that t:'t 37o% -c Msulvion was In::3!1Cd Ln 3: L._ '`;0'.0 lona:icn 1 n eonfc. '.1]OCC with 6c cL:ne,'.t
Er,tr r jl-iencz Sror�.r� for residential buildings (Till_ 24, Pa- 5, C3!i.`cr nia Comic a.`Reg_la tens) as indica��d on the
Cc: all=al:, o�C0r-- ::C µi:,.1, pI:C]`JIe.
Lo -t Sign c, Ds:c Irsta!li-_ SLb:cnr actor (Co. Wmc) OR
Geccral Cor,tn:..ljr (Co. game) OR Owne:
Uatc
1-st311ing Subcontractor (Co. Name) OR
Cc-,cral Ccr.trac:or (Co. „ami) OR Owner
1-.s:altir.7 Su`Conc7wor (Co. Name) OR
Cc; -e'2! Cert.ictor(Co. Name) OR Owner
A•36
LI
Certificate of Occupancy
City of La Quinta
K�
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..fo/%wing:
BUILDING ADDRESS: 477650 SUMAC STREET U-56
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-284
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: - MIRAFLORES, LP
Building Official
Address:
74-760 HIGHWAY 111 #200
City:
INDIAN WELLS, CA 92210
By:
STEVE TRAXEL
Date:
05-01-2003
POST IN A CONSPICUOUS PLACE