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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
768.595 B C o Me 9440103
Date _'' „?=� Signature of Contractor _
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 STATE FIY14D Policy No. 1603616-02
(This section need not be completed if the permit valuation is for $100.00 or less).
( )/.I certify that in the performance of the work for which this permit is issued,
l.*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 thoseprovisions,
Date:I ter.-gz?�Applicant
' M .-ir ti wir'
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 i
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 persort+t, ate
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. 5
Si nature (Owner/A ent) Date►
1 fix:
PERMIT#
BUILDING PERMIT
����'�?
DATE VALUATION LOT TRACT
U8,435.60 13251.'49 286,01.
JOB SITE
ADDRESS 47-60 G U1i}E WAN"
APN
649-030^045
OWNER
CONTRACTOR / DESIGNER / EN (NEER
• •PLOF-EB, LP
DC -1) DEV, , INC &€sa CiTWIS DEV.
74-7 60 1U011WAY'.111 #200
781600 MIG 1i`WAY• 111
1X+ DIAN WfILS CA 922101
LA OtT1UTA CA. 92253
(160)771=•3345 E';M4 2180
USE OF PERMIT
MNGLE .nA1 Y. 12TA 0M
FA . i,U)0.2i, UNIT 49, PLA14 2111 . PERMIT L1093 NOT INC1.LFS.:ip
P001.6,1SPA, T4W)0K "s,1►AL1.% OR DRIVE'+F/AYAPPROAC H. 75% REDUC`fi'WN
IN PL:A14 CHEXCK FEK P70R MU1,TI7r LE ISSi1MIC Z 0110 SME PL,-%Rl'iYPR
TRACT 00113TRUC:TION 310219D alt
1,11STMATED CSS' tit)' C009MUC"°i;1.s'7.T.4
45,435.10
CONSTRUCTION F131) 1061.000.41.8-000 W&DO
AL" ('1iIrC.".K. Ig1a.E 101-000-489.318 $9.1.61
MECHANICALFE1t 101.000.42.1-060 $30,50
&FX'1'RICA.L, iift '101-000-420-01N) $64.r't
PLl1MOTNO FU 101.004 419 -NO $600.50
5TRiCYND M fION .FAM • MID 101-000-241-000 $4.94
Of)V?E1.OPERIMPACT ME3I,i60.�6
i.
b TC".UM AWD Pl'AP,a'' CIMCr!'.:
$2,26Fr.1
- LESO M. -PAD FEES'
$01.00
:C KWU Les DUE NOW
$2,26617
cny Of LAQ Ta -
F1
RECEIPT
DATE =
,15 - = =
;BY
// 1.
DATE FINALED
--6- 3
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
--p
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
.D L
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
lL -Q. o z 57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Y,2• e3 e P?
Drywall - Int. Lath
_.Z ,�3.,1 5-'7
Final
Final 0 3avPOOLS
BLOCKWALL APPROVALS
- 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
Y.7
Encapsulation
Gas Piping
Gas Test
. O 3
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) a
COMMENTS:
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:
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
47-665 GERTRUDE WAY U-49
Owner of Building: MIRAFLORES, LP
Building Official
vnl
Bldg. Permit No.: 0203-277
Land Use Zone: CR
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-06-2003
�-.
INSULATION CERTIFICATE IC -1
ci;r Address
Description of Installation
Permlt '-,'umber
I.
I. ROOF
Thic:<ncss (ir.chcs) 1�j'r %cr ;_. Rcsis:ance(R-Value) 34
V9
CEILING
Nam
.c or.E!r.k
aet Type , ,� �'
E, -a :d a-�c �� L
Thic'kncss (inc.`. s� (3" Tr:e r* _: ^sist_r.cl
Loo_c Fill Type�KFX Bran?
Contractor's rni- installed wcigh'lf `)_1b �4ini^_m t ickness inches
Manafacturces it,4tailed weight per square foot to zchievc T c7minal Resista_�ce (R-V!1_e) - S-6
3. EXTERIOR WALL
A. 'P'A _2�'
Material j Br2z d Namc a A'ua-'' i.. n AC() r ( ( O _ _
Thick css (inches) lG Thermal Resistance (R-Valuc)
B . Exterior t.uCIko
Material Brznd 'Name
Tcickness (incises) �j�- Tcet-ta: Resistant= (?-Value) - 1�
K ISED FLOOR
;!Merial
Thievtcss (inches)
SLAB FLOOPUTFRI`1ETER
N.at�risl _
Thie:-ne5s (inches)
Perir;cter Insulaticn Dcpth (inches)
�! FOUND. -.TION V ALL
Material
Thicic.rtcss (irchcs)
Declaration
1 t1c: ..ii Rcsistanc (R, -V
$;ane \arise
T;
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
PROPERTY 47-665 Gertrude Way 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 I 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 : 09/25/2002. REGISTRATION STAMP NO: none 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
Total: $ 9920
Recommendations not completed by this firm
Estimated Cost: $
Remarks
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,California 95825-3280.
AT20:4620030313