0203-276 (SATT)I—
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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
768,195 C8 1=
Date �-� Signature of Contractor 4'" ''� ?4y`=+•
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 �,�-1 D Policy No. 1603016.02
(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,
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 provi'sionsl
Date: ;�i�.n'1 Applicant -1 `V C "JAYI;
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. y F
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. ,f.
f �}ai
Si nature (Owner/Agent) ;1-4 11.0f ,kXP3 Date "to 1`'
BUILDING PERMIT PERMIT#
f
DATE VALUATION LOT 0203-21 74S TRACT `
JOB SITE f
ADDRESS 47-675 Cv R1UJW&Y
APN
649-010-00
OWNER
CONTRACTOR/DESIGNER/EN (NEER
:Pr�i { i-,L.CYtzri3, LP
1)C .? D.E V , me, && Dmzr all -m -'s Dof
1114200
B-u0�SUrt�T��sl}f.�"4:�I°17�AY 111.
y7��y�7a6ipJ�t1+'li�i�,�ylw�+t�'�AY
,.+c� ryy/�
J.L`lJ..+AC91Y 'h`.fl.`.S�1. S CA 92210
�y �.9
Lp%. (�e. W lA CA �`� 251
tIZ/1771•S345 C73LO 2180
USE OF PERMIT
"W011. Y sTl`ACHM
SEA a 8E,00.24, UNIT 44, PLXN 30 . PUU! IT .DOES' NOT INCI.UDIR.
P0014 SPA, BLOCK `KUAJ. L%, Oft DRArA, V'tAYAis'h'RC.t1CH. $Vo REDITC 1'1014
TIM PLA14 C'trEIWK FEF: Ft'JRMi3J.:Tt1 LY,15.%IA,NCH, OF SAME i'i...,P.°Ad TYPE.
7'a%ACT CONSTRUCTION TION 392.4 vii
E17, 7Y1!1ATr.D COST" OF t:'ONSff'itlTM-lon
40,4245.60
CONS'7'1iUt'•TIMI "B.,.i? 101-000-418-000 $403.00
PIAN Cti CK iy'KE 101000439-418 $91.61
MECHANICAL WE 101a000-Ul-000 $".$0
FAIRIICTfUC,AL FSf, 101-000-420-000 $64.72
PE:L1'mar,40 V&F, 101.000-4.1.9.000 $82,50
S7'R6. NO d+4*OTIt;+7,9 IYER, RMID 101-G(?fJ>241-000 $4194
i71:VELiJf''M NPACT FIRK, $ja"3 dJ
81114 -TOTAL � OXISTRUC1,10KAND PUNCHEXX
LESP PRE -PAM 1W13
Q _0 }..
ZO-00
PD
%SAY u 6 2092
CITYOFIAQUINTA
FINANCEDEPT.
RECEIPT
DATE
r r:
_ fin✓ F:/ ,
DATE F ALE
INSPECTOR
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
z9Z
Ducts
Slab Grade
Return Air
Steel
o cd
Combustion Air
Roof Deck(o
• o Z ?
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- JX -d 5
Drywall - Int. Lath
I l• L e Z
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
J a Z
Heater Final
Water Piping
_
Plumbing Final
Plumbing Too Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
I • m Yf
Encapsulation
Gas Piping
Gas Test
Appliances
�`"7
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:
C,.
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: VN
47-675 GERTRUDE WAY U-48
Owner of Building: MIRAFLORES, LP
Building Official
51
Bldg. Permit No.: 0203-276
Land Use Zone: CR
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE
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 47-675 Gertrude Way La Quinta CA 9225
INSPECTED: CO.CODE 33 08/25/2002
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 COMPLETION STAMP NUMBER
Notice of completion
Sent To and date
Owner's Name and Address:
Copies sent to :
03/13/2003
This is to certify that the folowing recommendations on the above designated property, as outlined in STANDARD INSPECTION REPORT NO
none . date : 08/25/2(102 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: $
Inspection fee : $
Others : $
Total: $
9920
0.00
0.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performed on this 1ZlLy in accordance with Structural Pest Control Board regulations.
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.
AT12:0920030313
I �L1LA T IO-` CERTIFICATE IC -1
�zi,; Arc!r^55
Description of Installation
1. ROOF
Thickncss
CEILING
Nrml: Numbar
QrcnRcsis:ance (R-Va!ue) 35
Bat' o: B!an!;et Type Name ��n� t� lrf .1'1 (�t✓� � 9
Thickr.css(nc.`. s` 13" The ^ a! F6sistar.ce (R- 'aIuc)
Loo -cc Fill Typc�CC1Jt'�
Contractor's rni- installed weighYi`-' ,�- lb t*.fickness inches
Manufacturces installed weight per square foo; to achieve T hc,—mal R.-sist:_�ce (R-V�l:e)
3. EXTERIOR WALL
A. j-)X(o- �C'wt 11':2 'A 3 ..
Material ?:)(,L&7j Brand Na -c �Yk z-,�, 4...10 -C) t (0, _
Thickness (inchcs) _ Thermsl Resistance (R-Valuc)
B . Exterior LA-)LLUo rr
Material ?y1tkS _ Br2nd Name Ln( .LL T.
Ti Ickness (incises) 3' T er:;al Resistance (?-Value) V - k2,
RATSED FLOOR
Thic!cncss (inc`:es)
SLAT; FLOO.VHRI`IETER
;✓.at::risl
Thickness (inches)
Pcrir: vice Insulaticn Dcpt; (inches)
FOUND. -.TION WALL
I�S.alcsial
Thickncss (ir.chcs)
Declaration
T:._= ---'I Rcsistanc: (R -Value)
T,' -c --mal Resistance (R -Value)
i✓ --d N'
r.i.T.:'_; Res:s:ance (R-V31LC)
Certif' th3! L-_ 3170,': IrsuI3tt,,.. `va& ins.allcd Ll t e C_:I_.'.d . _._ 3�0'._ !OC3::Cn t , w; Ph C5e eL=..-n!
Enera: E j c;er,;S f r resid:nti3l. buil i:.gs (Till= - 2<, F- 5, Ca:i:Cnia Cod: Of iens) as indie3tzd ca the
CC::I!i�3IC Cf COr .,.3
,h� -&en 161
it•:m =s S,i2r _. _, De:,. 1-�t3ili SL�.cn� 3<:or (Co. N3m:) GR
Ger._.31 Cor.t-.3.ror (Co. Name) OR Owne.
l:c:n
-C, Da:c
Sid .1t•,.. L. Da._
1-,:alling Sub-ona-=or (Co. Namc) OR
Gcr_ral Ccrtr3c:or (Co. , smc) OR 0,,vri:r
1Su`con=wor (Co. Name) OR
Gc.._.a! Ccr.,::c:or(Co. Mme) OR O'xrer
A-36