0203-266 (SATT)LICENSED CONTRACTOR DECLARATION
Thereby 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
76+8595. B p$ nip" .� 9103C 33
Date el 7 Signature of Contractorbp
OWNER -BUILDER DECLARATION Y
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 .,TATS;rq;WI? Policy No. 260 61fS-i13
(This section need not be completed if the permit valuation is for $100.00 or less).
I s)' I certify that in the performance of the work for which this permit is issued,
fiall 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 witFi those provisions..,
Date: Applicant
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 t
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.
Signature (Owner/Agent) 1 k �' �'� A • Date
- BUILDING PERMIT PERMIT#
vv'
DATE ' VALUATION - LOT = _ —TRACT
BMW 28601
JOB SITE
APN
ADDRESS 4743,2 SUMACS -MUT
649-M4045
OWNER
CONTRACTOR/DESIGNER/EN (NEER
74.760MCaHWAY.I I1 X00
78-6001-TIWWANt- 1I I
Ii3:'MAN VIALI�.E" CA 92210
LAN QUWA. CA 92213
(760)771-3145 f -SIR 2180
USE OF PERMIT
SPA - i31.0010, M41T 39, .Pa.AN L8 . FF"'„d� ) T DO&S NOT Z'ZJe~l..t: 0Z
P0014 SPA 0I..Ut:k( WALLS. OR ASTM`M Air' APPRO.A CH. 7S% REDUCTION
IN PLA14 Cf•Z&1K. ",Z FOR MUL 1'ZPF, ISSai7ANICBt OF W4Z PLAN TYPE-
TRAXT CONS'1°. IC ION 700.00 SIV
38,010,00
PY.8'Gi Ur XI 117eka iJUAWA LSA
'
CONSTRUCTION FEE 101.060-418.000 $3410
PLAN C-H1_tKFEE 08.51
MECHANICAL ME 101.000;:42.1.000 "9130
EI.XC.TRICAL FEE 101-10"20-000 $52."
P[.'UMBINO FFIt 101.000.419.000 S38.119
STZ ONO MOi'IONI FFLe - RSSt1TJ 101 -Loi? -241-000 $3.80
i 11VE PHR IMPACT Irez 81,s69.00
M M, -PAID M3,
$0,M))
1101M' U 2002 , ERw DVE now
CtTY®FLAQUINTA
FINANCE -DEPT
RECEIPT.
DATE
r
,,,.�
BY
DATEFI ALINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- p
Underground Ducts
Forms & Footings
- e�
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
.d z
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
7— •.7 s
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K:.for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection—
7.0 3
Encapsulation
Gas Piping
Gas Test
��, 1j'• O 2.
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:
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 COMPLETICN
PROPERTY 47-732 Sumac St. La Quinta CA 92253 08/20/2002
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:
Recommendations not completed by this firm
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $
Total: $
Estimated Cost: $
0.00
70.00
Remarks
soil nre-treatment wag • r•w • •n this • •• • •.� •� • C•. • •�
Signature _
If you have questions regarding the work as outlined above,you should fust 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.
AT21:1020030313
_=C-
INSULATION CERTIFICATE IC -1
�i.. A 'rrss
Description of Installation
I. ROOF
Peru!: N'u;mbu
Lc!
Erar.d ^-
Th:crm:-,: RC31S:!.ice (R-Va!uc) , -S
2. CEILING
Bat: o- E1,an';et Tyke ,"Y. S B. N me Xl od( Q
Thickr.css (irc`.•s� l�J" The=!' ^sistar.c
Loo_c Fill Type �aad
Contractor's rni- installed weigh;/f:'�C_lb tlficknessld-�inches
Manufacturces invalled weight per square foot to ach:evc T crmnal Resista_ u (R -Vele) -
3. EXTERIOR WALL
Material 5
Brand Namc f-, UjD n'l O _
Thickness (inches) _
Thermal Resistance (R-Valuc)
B . Exterior WGA0
Material
Erzr.d Name
Thickness (inchs) 3'
T: eri.,a: Resistance (R -Value) - 12
R-% ISED FLOOR '
Mj!ertal
B, an Na..--
Thic'.encss (Inc`: s)
'�,
T itc:^R=sistar.ce (R Val -u c) —
SLAB FLOOR,?.RIMETER
Natc.:ial
B and.Name
Thickness (inches)
Ta curial Resistance (R -Value)
Pcrir..e:cr InSj;la[;CjL Dc?tt (inches)
FOUNDATPON WALL.
Nla:e-ial
Baca N's --.c
T•i Ic'kr,css (lnchcs) -
Tce=al RC s:s:ante C-Valuc)
Declaration.
stalled in :he c_:I=:-.4 3: _._ _c;'._ loci:ieni, ecr.f.a ;
Certificate of Occupancy
City of La Quints
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: 47-732 SUMAC STREET U-39
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Bldg. Permit No.: 0203-266
Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: `STEVE TRAXEL
l d Date: 03-21-2003'
Building Official
POST IN A CONSPICUOUS PLACE