0203-274 (SATT)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
B co 1901 9t30103
Date Signature of Contractor L ,
�I
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.e. 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 WIJ 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 hall 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 wit0hose provisions.
Date: Applicant '--b ; �f' 1•
Warning: Failure to secure Wor(rs' 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. a
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on 'hist
application.
N :T
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 tc�
any permit issued as a result of this applicaton agrees to, & shall, indemnif�r
& hold harmless the City of La Quinta, its officers, agents and employee . D
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this City to enter up.
the above-mentioned property for inspection, purposes. a 3
Signature (Owner/Agent) lk !` t�.'* Date"%
YAC
J
BUILDING PERMIT PERMIT# `
DATE VALUATION LOT 01203-'"4 TRACT
- �% . .- ;o) ,32 SO 1A2::3U46 28601
JOB SITE
APN
ADDRESS 47-1503 G'IMURUD:9 WAY
649K-Wc' Z -•-
OWNER
CONTRACTOR/DESIGNER/EN (NEER
:f tTCtAL,L o"S, LP
DCC DEV., INC dba DEZURT W%i= S DEV,
4-760 T-41011WAY 11 14200
78,I wo KIGI tAY l I 1
1g31w 1AN WELT, a CA 92210
i A QUNTA. CA 9225.3'
�60�a'�1r3S�15 C>�A�f3 2180
USE OF PERMIT
a`T9NIZIE, WQN.OLY JUTACIM3 D
SF a SIX -0. X4 U1r17 46, PLKH I.A. PERMIT WES NOT UNC.LUDF,
K)OL, SPAT BLOCK WALLA OR DRIVE W6%g' APPROA.CM• 73% Fti+D UVTI0H
Tkf PL&N CTIECIC "M FOR 1t9t1LTIP:LP. IS''SU1114CW. OF SAW i'•l..A.14 TTP]?,
TRACT C(XNSTRUCTION InIV, 0 Sze
CVkRA.GWCA.RPORT `S33.U0 S
EMMA17D C.•OiU.f ,OF CONZITisiC�AJ M_ ON
45,3200
CONSTRUCTION UC'TION FEE 101-000-41&000 $338.50
PLAN CHECK W. 01: 101-000-439-3`18 $V.85
MECH.Ati1QlCAL I= 101-000-121-000 $35.50
91,ECTRI AL A•'EE 101-000-420.000 363.45
PLUMBING FUR 101-000-419-000 9981,50
S'FRONO MOTION FEE - RESSID 101-000-241-000. V.53
D.EVIT'LOPER IMPACT ne.9 %i,169.00
i
IAMB PRE-nmi7 IT -71B 13
$0100
TOT -411 PMTH "M5 DMNOW
$2,143,34
.MAY U
CITYOFLAQUINTA
FINANCEDEPT
RECEIPT
DA,TnE "'fI' ';
BY: )!
D F ALED
INSPECTOR
FA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— y
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
d . / .Oz ,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
— 3 no z 57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
—
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
• O S%
Encapsulation
Gas Piping
Gas Test
Appliances
!= O 3 7
/
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) c�
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 47-695 Gertrude Way La Quinta CA 92253 08/18/2002
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 I COMPLETION STAMP NUMBER
Notice of completion Cad Desert Cities nevelnpement 46-753 Adams St. La Quinta CA 92253
Sent To and date : 08/18/2002
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:
Recommendations not completed by this firm
Cost: $ M00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70-00
Estimated Cost: $
Remarks:• nre-treatment was• r•u� • •� • •• • •.� ' •� • :•. • •�
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.
AT11:5520030313
INSULA i ION CERTIFICATE IC -1
Sit, Ad;r_ss Nrml: \'u;,btr
Descriptioli of Installation
1. ROO,
Thickness (inchcs) j r
2. CEILING
T�:.r a RcsIs:ance (R-Va!uc) 1 3
Ba'.: or B'.anket Type �YJ j Bra -d N2; -,c "run p& Q_
Thic ncss (inc`.cs` (3" The=. ^sis!ar.: (R 'aluc)
Loo.c Fill Type j�CC s�t� Er-nd
Contractor's rni- installed weight/f: �_lb �4ini u inches
N-lanufacturces installed weight per square foot to zchievc Thenal Resistance (R-Val::c)
3. EXTERIOR WALL
A. X(o—PiC'wl o 3
Material '?YL�-:S Brzrd Namc �� ��1, � Un 'YIs0. _
Thickness (inches) _ Thermal Resistance (R-Valuc)
B . Exterior t )GAO
Ma?erial yR-)Cl "S 31zr.d NameLnn-LL
Tcickness (inches) 37--5 T e=ai Resistance (R -Value)
RAISED FLOOR
�.l!eri°i
Thickness (inch --s)
SLAB FLOOTUPERINIETER
N.a?�riQl
Thicknc-ss (inches)
Perimc!ce Insulaticn Dcpth (inches)
B. ar.1 Na..-_
T 1!.cr ..31 P.:sistar.c (R-Val1c) —
B, -and- Name
T<errnal R,!sistanc? (R -Value)
FOUNDATION WALL
Thickness (Inchcs) Tr.e:r.a! Res:s.ance (R-Valu'c)
Declaration
I !icre y ccr':r,, tha! lie 31 -love IrS1!3l:cn `.%7i IGS'.31!.d Ln th_ 11 w:!4 Lye C' -' m:'-.'.
Er,era: F jt_;er,c� SrarY for residential buildi-.gs (T itl= 2,, =an 5, Ca!i.cri] Co::: o,`Regula,`;ens) ss ind•,e1�i•d cn the
CC:'.l't-al:: C�CoTr!t1'C
GCL:: 'I Cc' -3z Jr (Co. Name) OR O -n::
D3:
Sid n .:t -_:e, D]!_
I-s:ailir.g SL:bzontracior (Co. Namc) OR
Ce -_:al Ccn:i2c:or (Co.,Mmc) OR Oxr;:r
Ir.s:]ili-� Sc`c3r. ]Wor (Co. Na mo) OR
Cc-^�_: CC,.;:a-!Cr(CO. tiaiiC) OR OWM-'r
V
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: 47-695 GERTRUDE WAY U-46
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-274
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
POST IN A CONSPICUOUS PLACE