0203-267 (SATT)tF LICENSED CONTRACTOR DECLARATION
I.hereby affirm under penalty of perjury that I am licensed under provisions of
I Choptor 0 (oommenoing with Sootion 7000) of Divicion 3 of tho Sueinoes and
C,4141) , Professionals Code, and my License is in full force and effect.
C n c,) License # Lic. Class Exp. Date .
r--Cy
LLJ
? kf 1" X53 39 ca Irp ``: , 9/:30103
oZ r— Date Signature of Contractor
Q r-
J U C) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ Il License Law for the following reason:
Z( ) 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).
co () I' am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
N
L) Ll
WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
LO Cc
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
Q. performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
tl 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier c TATS Pi)3D Policy No. 10D3tia.f-fl 2
Cb =
r0
Q (This section need not be completed if the permit valuation is for $100.00 or less).
(,k)f 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 r1,
Date: ,Nwn Applicant "' XAY (�U'..PSl
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 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 propertyfor inspection.purposes:4
Signature (Owner/,Agent) �f°r4 �_�r:��. Dates'
- BUILDING PERMIT PERMIT#
UAII_ VALUAIIU14 LOT ��� -2 TRACT
JOB SITE
ADDRESS 47-.728 �r"1�2i��.AC t7 7 sT
APN
6.}i 5 -030 0415
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MIRM',OR ,1.P
DU 1DE,V., WC aba.DESEWr ClUffl, DEV.
74-760 k31CMWA::' 11142.00
11
1 LW 34w..0 CA 92210
LA qOWTA CA 92253"
(760)771.3345 (Im1:i€ 21s0
USE OF PERMIT
AXV,6
SPA = UNIT 40, PLAN 1B, PeRMIT DOES ;+ ,0T INCLtD'131?
POOL, SP,k R VOC K, WALL% OR Dl'.IV0VAY APPROACH. '75% REMUC 1 t61
IN PY1?
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel ; — 1 �- ez.,
Combustion Air
Roof Deck o . `- o Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 61
Compressor
Insulation — 7 •.9 Z- 157
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath L— I q. z 2 -
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 — o
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection f_ O
Gas Piping
Encapsulation
Gas Test
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 • 0 5
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 COMPLETION
PROPERTY47 728 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:
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 Strnetnral Pest Control Roard regulations -
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.
AT21:1120030313
DCSCrlption of Installation ,
1. ROOF
Thie<^ess (ir.c :c;) \31f
Resistance (R-Va!ue)S(
2. CEILING
Batt or B!ankv Typc ?Y.,-�
Thickr css (inc`.es` (3"
The rr �' ^sistar.ce (R- 'aluc)
Loose Fill Type �a �t�
Er_::d l
Contractor's r;:i- installed wcighYf:' _lb
Mini ^_ t t�cicncss ib'l-inches
n
ManLfacturee's installed ,weight persquarc foot to achieve Tce.;,,al Resista.�ce (R -Value)
3. EXTERIOR W ALL
,
A.
;a]
Mater,
8:2.^d \a -c AQc) t (( O- _
Thicicress (inches) 6Tr.etTrtsl
Resistance (R -Value)
B . Exterior h�ltlt_)CAo
,L:aterial 6 5
B d IN Ln( -A
Thickness (inches) :a o
T er-;a: Resistance (R -Value)
RAISED FLOOR -
M' ' m-, rial _
B. an. _ N -t -7-,z
Thickricss (Inc.`,: s)
T :._....II-Rcsistar.ce (R -Value)
SLAB FLOORTERIMETER
Iv'aterisl
Brine Name
Thickmcss (inches)
Tt:cr: ,�l P.esistance (R -Value)
Perirnvc: Insul3ticn Dcpth (inches)"
FOUND"-:TIQi\,ViALL
T1 ickricss (InCGCS)
T. -:=a! Res:sta !C'. (R-V31L'e)
Declaratiotl
1 hcrrcy ccr.ify that t:,C 3bovc ir-suI3licn tik3S Ir5:all=d`Ln i,._ C_:'_. -.z 21 _._ 3�o•.^ iota: cn in Cor. :T?Ia with Chc C, cn.
Ererg; E jrc;erc� Sror.:.r1 f- residcnti`3l buildings ( T idz 24,
-a-6. Ca:i:onis Code e`Reg'_.a :ens) ss indica�rd on the
CC:'.I:IC3t;..Cf COr';rl13nC
l csi �s So' 2r _._, De:.
lnsta:li; SL`r.cnf]c:er (C3. NJMC) rJ
Contactor (CO. ;\ane) OR Ownt.
1:'c:n =,
S:� D3,_
Installing Sub:onnsctor (Co. \arc) OR
C.ncra1 Ccrtr3c.or (Co. , i3mc) OR Own:r
Ins:allic� Sc`c,;r•. wor (Co. N3n�) OR
Cc,...3: Cc,.,,. _:tor (Co. Na -e) OR Ow'r_r
A -?o
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: 47-728. SUMAC STREET U-40
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit .No.: 0203-267
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: 03-21-2003
0 POST IN A CONSPICUOUS PLACE