0203-287 (SATT)L!CENSED CONTRACTOR DECLARATION i
I hereby affirm under penalty of perjury that I am licensedunder provisions of
Chapter 9 (commanring 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
6815 -5 R CS WC-1?YJ0/03
_f wfl3.„s
Date -7 �0"02 Signature of Contractor .a- .
1
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:
Carver :STATE FUND 103616-02 No. 103616-02
(This section need not be completed if the permit valuation is for $100.00 or less).
k,l'l 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 provislons,",
Date: —fes^ 01, Applicant
Warning: Failure to secure WOrk2fS' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety..-.
for a permit subject to the conditions and restrictions set forth on his?,
application. _
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building_
construction, and hereby authorize representatives of this City to enter upon -
the above-mentioned property,for inspection purposes.
i?r"J Date
Signature (Owner/Agent) ti •• _�— �•
�f
BUILDING PERMIT PERMT#
DATE VALUATION LOT 02487 TRACT
„a"� : -,r, , ;32+,NO 'k� d1(35 860 :j.
JOB SITE
APN
ADDRESS 47-724 St sM. U SME
OWNER
_
CONTRACTOR/DESIGNER/EN (NEER
i
7'4-7(v0111, )WKY''139.9,200
76�60013101`1WAY111
DWXMW9U1,11 CA 9=10
1.Aq k A CA 9225
(760771-3345 019114. 2180
USE OF PERMIT
f%KaLX.'P tN31I;Ti=ACMD
SFA .. RL130 30, ITNYT �9, PLAN ]A, PeRMIT DOP..S IN= I1dT:i.tID4
POOL 31,14 OLOCK W,..L£% OR. DITUVEWAY APPROACH. 75$ R.E1:)LTC'IaION
IN PLAN C'Mr-ICK FEE FOPMU1,71 LE. ISSUANCE 017 SAMZ PI—A.'PJ T'YPL
TRACT CONSTRUCTION WO. 00 SF
UA.rwF.4: ICAP"R f 3 .00 5N
EIX T. M. C09r OF CON'!r'"IRUC` ION
�I��2dJe6�3
C014EPYRUCTION x`9E 101,006418.000 SM.Sa
PIAN CHECK ISE 101-000-43d-318
NIKI ICAL FEE 101-000.421.000
EL TWC:.AL M. 101-000-420-000 165..46
k'T.UMBINO M 101.000.419.000 $80230
STRONO MOTION 11M a RE -SID 101,000-W-000
90B.-TMAT. CQk iCT:Tf:".`,i`1:l` 14 ANTU PLAN' CRIXK
$2,243.34
JX33 PUS -PAD 14110k
$0.00
D
axe 1;'ERMW M8 DVE NOw
MAY u 6
WYORAQUINTA
FINANCEDEPT
RECEIPT,: z DATE =
BY i
DATE FINALED
INSPECTOR
Cv.,S
'c;R�
C
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs i5
Underground Ducts
Forms & Footings _ 2 —e-, 7
Ducts
Slab Grade - 2ZP
Return Air
Steel
Combustion Air
Roof Deck /o- (�. o?� �as7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation o Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath / • cs�
_
Final .S 63
BLOCKWALL PPROVALS
Final
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection , p 5
Encapsulation
Gas Piping
Gas Test
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) . .o
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 COMPLETIOF
PROPERTY 47-724 Sumac St. La Quinta CA 92253
INSPECTED: CO.CODE 33 08/22/2002
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 P121401 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
none date : 08/22/20M REGISTRATION STAMP NO: none have
been and/or have not been completed.
Recommendationscompleted 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:
I'
r
Il
Cost: $ " 70-00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70 -00 -
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 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.
AT16:5420030313
n
C,—
INSULATION CERTIFICATE
S,it. Addrns
Nrm.l: Numbzr
Description of Installation
1. R00 _ l
Thickness (irc-cs) 1 j " Ti:crew, RC315:2aCe (R-Va!uc) 3�
2, CEILING
Bat' o: E!an':et Type E:' -'d Namc - Ye &.XA`;
Thickncss (inc`. s' ( Tie r* a: ^sistar.: (%-V.aluc)
Loo -cc Fill Type Brad
Contractor's ri installed wcigh;/P- 1b M;-;m_mt. 1J c kness 7 . inches
Manz:facturces installed weight per square foo: to achieve The.—mal R:sist2 ce (R -Value) - `?j-6
3. EXTERIOR WAT I
A . blje tL,,, L, -Us dX(o-P1c e�pA3
Material 5 Bre-nd N_-
Thickness (inches) _ Thermal Resistance (R-Valuc)
B . Exterior LL)CLZW
Material Brzr.d Name L,—A_
Thickness (inchr:s) T ermal Resistance (R -Value) - 12,
RAISED FLOOR
Material _ B,ar.3 \_:-e
Thic`.cncss (inch—eS) T i:c...,si Rcsistar.c: (R -Value) — —
SLAT; FLOOR/?: RNE T ER
M!attri al &-and Name
Thickncss (inches) T" mal Resistanc' (R -Value)
Pcrirsetc:.Insulation Doth (inches)
FOUND. -.TION ViALL. .
I�(.atc: ial i✓ 3r.a \ a: -c
Thickncss (inc'r:cs) T .em,.21 Resis.ar.ce (R-Vsluc)
Declaration
I hcrr"y ccr:ify that t;._ 3' Svc irsulaticn ..as ins:sli_Gt Ln ... 3; IOC]: cn ... co^fc-iancc wit` L,Sc currL...
Enerti: E jtcie.,:S far residmiia! buildi: Ss (Till_ 24, Pan S, Ca';.c-rnia Cod: c: Reg L ens) as indieat_•d oa the
CC:tltl:al:. Of COTr!t3'c w _,.. Z�p1:ca51e.
Da: I-va!lir SLb:cntr 3c:cr (Ca. Namc) OR
Cc .oral Cor.;:�c:cr (Co. Nave) OR Owne:
1,cm
C --n z co F C., IM 3
--a: rc, Da,c
S!, , DaI_.
1 -stalling Su``_on^-actor (Co. Namc) OR
C,: -,_-:a1 Ccr.trac:or (Co. ;;3mc) OR Own:r
Ins:ailir� Sc_ -Cor actor (Co. Nemo) OR
Ccr.,:!:!or (Co. Namc) OR Owner
�._
Certificate of O
City .of La Quinta
J
BuildingSafety and 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:
47-724 SUMAC STREET U-59
Use Classification:
SINGLE FAMILY ATTACHED
Bldg. Permit No.:
0203-287
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
CR
Owner of Building: MIRAFLORES, LP
Adm
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