0203-273 (SATT)LICENSED CONTRACTOR DECLARATION
U I hereby affirm under penalty of perjury that I am licensed under provisions of
H _ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
�.;" Professionals Code, and my License is in full force and effect.
C) License # Lic. Class Exp. Date
LLJ M595 B CS M14) 9130103 cf.
Z � Date w `P l'a'x Signature of Contractor '
0.
r-- I— OWNER -BUILDER DECLARATION
Ha r*_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
co ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
a Z WORKER'S COMPENSATION DECLARATION
IIO Q0:1 hereby affirm under penalty of perjury one of the following declarations:
� O () I have and'will maintain a certificate of consent to self -insure for workers'
X UJ �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
CD Q U ( ) I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
Il � Z permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier 2TAT-9 FUND Policy No.
ao � 1603616.02
C)
Q (This section need not be completed if the permit valuation is for $100.00 or less).
J s 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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. r
Date: Applicant
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 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.
Signature (Owner/Agent) �1 ��' +;'.�r;r� ?Date •r!4' -T7
BUILDING PERMIT PERMIT#
0703473
DATE VALUATION LOT TRACT
$45;312030 T323`V45 (10 1
JOB SITE„
ADDRESS W J-7 �e1}:Ts�� ✓i L°� �Ja'iY
APN
6119-030-CK's
OWNER
CONTRACTOR / DESIGNER /ENGINEER
mllto m, X!p
:= VEV., IWC dbatll]yG .ry C -Lf MS DEV.
74-70 MIGHWAY.1 11 4200
78-600HTGHiAY 1.11
T91ULAN W r1_( J, CA 92210
LA QUDrfA CA 92253
(760)771-3343 i CBW 21 s0
USE OF PERMIT
SPA - D; LD0 23., UN;T 43, P"14 1A.. PERMIT NOES NOT ItJC..LUDE
POOL, €ITIA, BLOCK WALLS, OR JR':fr/'. AYAlaPROAC H, 4,1S% REDUCTION
1N PIANI 01= F'E:F FOR A4131AVLE 1.S,SUANCE 0,11? 3Aabc Y, PIAN TYPE.
TRACT CONSTRUCIM4 700-00 gy
flii}T,.f1.WCARPC1'9tt !rrZ.00 sp
'►' AUtD COST Wit C:OMTRUt.:"ITCJW
443J20
4ONS'i'It.C4CTION FI.E 101-000-418-000 $383.90
t%11.1vwd CkRWIK PFUr 2x11-00,0.1439-318
MECHA7`II(AL VEL 101-000-421-000 $2155
KW-TRICA.1,'"M ; 01-OM420-1200 $63.361
PLUMBING ITS. 101.00I8419.000 188.40
MID 101 -WO -241-000
- MID
y+STR�nt7�♦�rq��isUroTyi�aQ}�ry�dp.FS'S
D Y EI!)PER. IMPI R:GI 1•L'+,lS .F IJ•�4i�ai?4J
AND PLAN MXX
$2,243,34
1X23' PRE-PAED XM8
$0.00
�2A�� 2001 PERM.Vley,P;�?���;�I�t�
�!Q434
CF1 pFlAQUINTA
O�NANCEDEPT.
RECEIPT
DATE -.BYD
TE AL 6
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Plumbing Top Out
Forms & Footings
Shower Pans
Slab Grade
Sewer Lateral
Steel
Roof Deck
v
0. K. to Wrap
_
Framing
Insulation
ej.a Z
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
j -o -z–
J61 r1 1.
Final
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Final
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Fans & Con
Condensate
Final
POOLS - SPAS
Steel —_
Electric Bond
Main Drain
ADDfoval to Cover
Test
PLUMBING APPROVALS
Af
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
f
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures _
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power _
Final
Utility Notice (Perm) -�
14;►
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:
47-705 GERTRUDE WAY U-45
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP Address:
Building Official
City:
1-32
Bldg. Permit No.: 0203-273
Land Use Zone: CR
74-760 HIGHWAY 111 #200
INDIAN WELLS, CA 92210
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
PROPERTYGertrude WLa Quinta CA 92253
INSPECTED: CO.CODE 33 08/18/2002
47-705 ay
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 : 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
none . date: 09/1 R/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:
Recommendations not completed by this firm
Cost: $
Inspection fee : $
Others : $
Total: $
Estimated Cost: $
70.00
0.00
0.00
F -
As
• • u r •'r• u • •� • •• • •.� r •� • :•. • •�
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.
AT12:0120030313
_ = C
IN StiLA i IOC' CERTIFICATE IC -1
Sitr A.C'dr.ss. Penn!: Numbzr
52�-
, c
Description of Installation
1. ROO"
h;c.Cne55 (1rc%C5) (R-Va!u--) 3 r�
2. CEILING
Ba': or E!anl-v Type s+yI-(:: 5 E.a : c t n ,Yl od(
Thickncss irc`.,s` I3" The ^ _.sistar.cu c)
Loesc Fill Typc� Brand /1
Contractor's rni installed weighJi:= A- 1b I4ini _m t�kness 7 inches
Manufacturces ir_stalled weiRht per square foo: to achievc T—mal Resist- ce (R -Valle) - - 2)-6
3. EXTERIOR WALL
A. G)t �e!( w I,JC "t> c--') -�) X'(O— �C'�-Yl 'p A 3
Material s Brand Namc ICIt
Thickness (inches) Iq Thermal Resistance (R-Valuc)
B . Exterior lvCLUO
;Material r, )Cak—s Br?nd 'Name Lnn --t `
Thickness (inch..es) 3' 0 T erma: Resistanc_ ( -Value) -
RAISED FLOOR
.Thickness (inc; --s)
SLAB FLOO?L?ERPNIETER
material
Thickncss (Indies)
Pcrir-.cter Irsulaticn Dc;) -,h (inches)
FOUND,=.TION ViALL
Nlatc.ia! i?.. -a \'a -c
Thickness (ir.c'r.cs) Rzs:s.ar:c: (:Z-V3luc)
Declaration
I hcrcby c.r:;.r)' th3t L. 3,7ovc Irsulancn was Irs:31!_d L-1 t,;_ !cca::cn in ccnrC,^1a„cc wish t.5c cCR.n!
Er,er,;:: E jicie:Sfer residential builaings (Titl= 24, =a-6, C�•.i:cni3 Coce c.`Regu!a- `cns) as indieat,-d c;1 the
CC: i.5 aIC of COR r::1'c , µ iL.. ,lpp1;ca5l�.
SLI:cn, 3c:or (C3. Nanc) OR
Cer.c-LI Ccr.:-3cror (Co. N3rae) OR Ownc:
B:_..- N -
T -Val lc)
Bane N _7ne
T`c. ,_! P.esistarce (R -Value)
I:c n-nat,:rc, D a t c !-s:allicg Su`'conLmctor (Co. \arc) OR
C: ;era! Cer,tr2c:or (Co. Nanc) OR Owner
S t Da _ Ins:all; Su` -c,,= 3cior (Co. Names) OR
' - Cc..,::.:or (Co. Na„ nc) 0R Owner