0203-275 (SATT)CA
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61
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
685 95 B G8'F1t`-\ :"/30/03
Date �: - 4a -p 4,Signature of Contractor S J, J_.
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 STATB MD Policy No. 161113613-0
(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 provisions.
Date: Applicant -4A �ra�
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 ori• his `fig
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.
Signature (Owner/Agent) �. �- 1"Jry )�f;i�a Date,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 02413-277 TRACT
1324 V ,}
> 1324UK
. ,• !�, ..+') �! D"Oa j9� XT.1 28001
JOB SITE ]APN
ADDRESS -685 C�A rL + AY
^I�• 044
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MMWILORES, LPL
C' 151', ii., Xhf f' &a DM, R'T =2 DEV.
74-760 HtGHWAY.1110200
IS -600 MM W. AY 1 s 1
iNDTAX W . S CA 91,2141
LA QU WA Cls: 922-5 2
0.6 ',771-3345 CHIN 2180
USE OF PERMIT
MOLE ]AMLY MAMED
SPA • &9LM.2A, UNIT 44 PLAN 28 ..:PERMIT,L'3C7 W 1,110l' INCd.U. "P.
PLCO%., SPA. Blk=WALLSy OR iONEWAY A-PPkOACH
TRACT CON"I'MUCTION 992,100 SP
9SYMIA 3'o LOST IP CLsNTI'IdUCIION
PEt"f 1')°b.`E SUMMUM'.
CONSTRUCTION 101.000.4,18.000 $408.00
PLAN C1iItCK FEE 101 -OCA -•939.3 8 $366.42
MWiM 1L..AL ?KE 101_000-421^0100 Kip.50
GSI w ,R)".am" Fez 101-000-420-000 $64.72
PL UM1311'dL'3M 101.000-419.000 =19
STR .?Z Ta moTI(' l PEE — RESID 101-000.241-000 $4.34
D-WELOPER. F.MP:ACT ME - $1,569.20
FEE L3,L' P05i.7' 101.000.439-31 a ��'3tlti.f9t<
p Q p I. .,135 Y..E-PAID F
4300,00
F910M MS DXTP,' NOW
&=40."
6 1002
CITYOFLAQUINTA
FINANCEDEPT.
RECEIPT
DATE
LV
BY
DATE F ALE Z
INSPECTOR
i
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
y
Ducts
Slab Grade
—
Return Air
Steel
Combustion Air
Roof Deck
, a 2 5r7
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
' Z2 •o z 5 T
Drywall - Int. Lath
t- lit •e -a._ ?
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �'
— 3m
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ - 0 5
Encapsulation
Gas Piping
Gas Test
• O
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lau Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) - O
i
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: 47-685 GERTRUDE WAY U-47
Use Classification:
Occupancy Group:
SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-275
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
POST IN A CONSPICUOUS PLACE