0203-315 (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 o the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class } Exp. Date
17( D ca THC
Date �2 -07 Signature of Contractor—
OWNER-BUILDER.
ontractor 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 ST .f FUND Policy No. 1603916-02
(This section need not be completed if the permit valuation is for $100.00 or less).
(}A 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 witktho_se provisions.
Date: .(p. px• Applicant i,: :Ar L% IL—
Warning: Failure to secure Worke s 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 cn his
application.
1. Each person upon whose behalf this application is made & each per
whose request and for whose benefit work is performed under or pursu
any permit issued as a result of this applicaton agrees to, &'shall, inde
& hold•harmless the City of La Quinta, its officers, agents and emplo s.'
2. Any permit issued as a result of this application becomes null and v aif
work is not commenced within 180 days from date of IssuAce of,, uch
permits or cessation of work for 180 days will subject permit to cancelli ion.
I certify that I have read this application and state that the above informati
Correct. I agree to comply with all City, and State laws relating to the bbilding
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo?.inspection purposes. "t
Signature (Owner/Agent) 4, Date
BUILDING PER_ IT PERMIT#
M
DATE - VALUATION LOT _0203-31.5 TRACT
'844'=1 28601
ADDRESS 47-7(*R1MAC: ST��
JOB SITE ]!N
64940,04A15
OWNER
CONTRACTOR/DESIGNER/EN INFER
!&RAFbORFS, L11
D= 1141C (U)a .1DJF219r (:UIRS I)IX,
74.760 k1[GF.'W.NY). 91 A200
-141.6001-UGHWAY 111.
WDIAN VP.MLS C•A. IP2210
L& Q1 MrPA CA S32. 13
USE OF PERMIT
MCX,.lA..%M Y ATrACIUM
SFA. = RL1 0.44, UNIT i' 87, PLAN 2A., P.EI:..`VIIT DOES NOT tNCB..E;f.1)E
POOL, SPA, 81,OC;K WALLA OR I1RIVls'i)�.A'Y AVPRCiA04, 75%UDUC_710 f
TNI PIAN CHECK ",E POI` MULTIPLE ISSUANCE OF MAWK K.Jh:•A1 TYPE.
TIRA CT CONSTRUCTION 903.04 SF
C. IP.9A(i0JCA?[2P01ZY M. 0.00 ,SIr
X1 UD CAST OF C-0JRT1XUCW01q
asq,€1,9.60
PF-lafff b la SUMM l,R'IS'
CONSTRUCTION IEE 101-000-418-000 SWI S
PLAN CHECK FETE 101-000-439-318 P02.3A
MECHANICAL KR 101-000.421 ^®00 139.50
F.L CTRICA1, MLS 101-D0"20-000 5..i2l
PL11ME11140 Fft w 101-000.419.000 S38.50
STR.ONLI MOTION FES • P.4SID 161-000-242-000
DZVEWPER IMPACT KX �1,�49.t16
e � , �+(.q �/q�q�7�y yyry'�+y' y '�+.p J,�� /y��• /{yy
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(f4/�
yF..4�%+ioi.24
X,&W PRE PAW S
$0.00
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:F1N:A%jCEDEVr
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RECEIPT
DATEBY
DATE FINALED
INSPECTOR
.;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings lo . I? ►Q
Ducts
Slab Grade p
Return Air
Steel
Combustion Air
Roof Deck .p y 5
Exhaust Fans
O.K to Wrap. qv
F.A.U.
Framing
Compressor
Insulation / p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath .02—
2—Drywall
Drywall - Int. Lath / • V Z 3
_
Final � _ Q3 �
Final
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 9-3 _
Heater Final
Water Piping —(o_ o '2— »
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection , J "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)
Z
INSULATION CERTIFICATE IC -1
Sitr Ad�'ress
Dcscri.ptioti Of Installation
1 ROOF
1`fatcrs! Li,i�5 -
Thic:<ncss (irc es) \3
„
Perrnlc Numbu
1 -� �•�_...._.
T;:,=a. Rcsis:aace (R -Value) 3
2. CEILING
Bat: o-E!an!:et Type �'"y.�5 E. -'--a N -;^c
.Thickncss (arc.`.^s` _ 13" Tte:r.:a' ^sistarce (R
Loosc Fill Type 0)KFX Er-ndA oQ p[
.J
Contractor's r -i installed wcight/R- )_lb _mt'�!ickness 7 inches
Manufacturees installed weight per square foot to achi--vc TI.cri—nal Resistance (R-Valuc) - A-6
3. EXTERIOR WALL
A. �>c(o—P1C'wt o 3
Material Brz^d.N2-c`� ��(l y�� Un An c) t � � O
Thickness (inchcs) Thermal Resistance (R-Valuc)2
B . Exterior L -)6A0 rr
Material C.. Bracd'Name
Thickness (Inches) 3` it.er ai Resistance (R -Value) -1�
RAISED FLOOR
Thic'.cncss (Inc`;: s)
SLAB FLOOR)'HERI`tETER
Mate: ial
Thickncss (inches)
Pcrir..ctc- Insulaticn Dcp h (inches)
FOUND.=.TION N'•%ALL
N1.atc.ial B -a -a Na 7
Thickness (inchcs; T z-,.7-. a! Resistance CR-V31Lc)
Declaration
I ceriry th3t l.:_ 3, JvC-ir-su13(icn ,vas install:d in the - -- 3: !oca: en in ccrIc- ;-ranee with Ch ccR.r.t
Enera : Eficier,C,, Sror for r:sidential buildings (Title 2-, p- , 5, C3!i:
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 409 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: 47-705 SUMAC STREET U-87.'
z
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-315
Occupancy Group: R-3 Type of Construction:. VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
1 City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
�4�a" Date: 05-01-2003
Building Official
POST IN A CONSPICUOUS PLACE