0203-269 (SATT)U)
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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
768595 q CV lucrr 9p.-0103
Date Signature of Contractor
f
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. 704.4, 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 9TA.,V-&U qI) Policy No. 11ro,w.&02
(This section need not be completed if the permit valuation is for $100.00 or less).
,SKr I certify that in the performanceof the work for which this permit is issued,
( 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 with6ose provisigns.
Date: ApP licant
/
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) 7 Abate �5 "�
y. .
BUILDING PERMIT PERMITtt
M3-269 Ar
DATE VALUATION LOT TRACT
. G • r t Af3D.€ i B21'U4Z ?€601
JOB SITE
APN
ADDRESS 47-759 GEWIR.UDIR AY
6451-030-N.5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MW.M.T.Amm :£.1:?
LXM DEV., 114 dba.IMMM C:1"' tS :C3I':'il"'.
74-760.1-MEWtY 1110 200
78.60019011WAY I I1
Nnmw WE112 CA 92210
LA OUBITA CA 92251
C° ft 21 so
USE OF PERMIT
SPA - OLDO al., UNIT 44 PLAN 18 . PE IT DOW, NOT 1N0.1U.D
P00I.4 SPA PI Wr WALIA OR DRIV•EWA'ti APPROACH. 41',� 9":frDUCTION
114 'PLAN CH: POK PYW FOR. 1U1>; LT9PLE ISgiJAINCZ Or SAM. ;-r PGA -1.4 TYPE.
TRACT CONST1tEICUON SF
C09r OF CrCiRKX'T UC.L;;CON
FFRhff ' M: C1A9:i4i,&kY
CONSTRUCTION PIZE 101-1000-1118-000 $341.00
PLAN CRECIC. MEW 1 G1-f2EtQ-tts9�� # f3 $ i�.�t
MECHANICA1, WF 101,,000--421.000 0.4150
ELF,CTRICAL FEE bbl-QC1d-<#2t3-fI(?di $59.00
PlIUMBINO FRE 101.000.419.0010 1i SD
STRONID MOTION PEE - RESID 101-000-241-000 $3.80
WeVRIA)PER NPACT RE 81409.00
k '
SUE - OTAL WNT.M.'Od11-.314 ,qM PLAN' MIECIC
$2,180.31
JJ303 PRC -P AID P=5
$0,015
I5'101MIC' MIS IATA NOW
� 1180.31
.. MAY u 320021' {
CITy0FLA
RKAkCEDEPT.
RECEIPT
DATE.
Q
BY
DATE FIUALEV
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O. 6.d C__ _57'
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
-�'z•r if
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- Z 57
Drywall - Int. Lath
eJ L
_
o
O L
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
�• �j. o ?j
Encapsulation
Gas Piping
Gas Test,
Appliances
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) — , o ,5-7
INSt.LA T IO`` CERTIFICATE IC -1
Perm!: Numbzr
Description of Installation
I. ROO;
.-. al � 5
Thic'.<ness (inches) --
CEILING
T;.,��a: Rcsis:aace (R-Va:uc) 34�
Bat: o: E!an'cet Type UaJ—D 8.---� Nam,c «Q
Thickncss (inc`.cs` 13" The:rr:a: ^sis!ar.ce (R- '.alIu-c)_ /
Looe Fill Type �a sJ� Brand 1/1 OQ.tq C�
Contractor's rni installed weight/P-' k- lb Mini^_ -t t.1ick-mns ld_ _-' inches
NYI3nufacturces in -stalled weight per sq'u2rc foot to ach:-.vc 1 ilk=mal R--sistance (R-V.I,.C) Q- - A-6
3. EXTERIOR WALL
A. bt�e�ti.✓ tJ a5 o�X(o�PiC'WL� 3
Material'&L-�—j Br2,rd Na -c U0 A-1(
Thickness (inches) -— Therms! Resistance (R-Valuc)2
B . Exterior ht:.C.Lo
Material (tel` 7 _ Bra d tame Lnrt , 1
Thickness (inches) 3' Thermal Resistance (?,-Value) - (�
RAISED FLOOR
j!eri.].l
Thic'cncss (Inc`. -s)
SLAB FLOOT'?ERI`IETER
Nate: isl
Thickness (inches)
Perimcter Insulaticn Depth (inches)
FOUNDAMON WALL
I�1.alc; ial
Thi:'mess (ir.chcs)
Declaration
....si Rcsistar.c (R -Valu--)
B' -and. Name
Theal Resistance (R -Value)
Bn-a N :-.,-
i.e.T.:3. Re5:S:3.^:C: (R-V3IuC)
1 hcrcoy ccr.; � • t}13t L:_ 3ti'iJ�'C IrS!lI3I1Cn 1�1i IGS:ail:d Lrl :�:= � _.!_." ?: _._ 3�J'._ .C•C3:iC❑ 1:1 COi:�C'?IaC,CC Witt: L5c Cerr....
Er,er,3:; Ej--i cie,;Sror.• :rte for residenti3! buil-•i-.gs (Titl= 2-, =a- 5, Ca!i.Cmia Cocc of Regula,;cns) as indieat--d ca the
Ccr iti_at e` CoT;
I �!
Ds:c 1-s:a:li; z S tcntr actor (Co. Namc) 0:
Cer.::al Ccr.:actor (CO. Name) OR O-wnc:
:., -t,
3n3:..re, Date
ins:3!lir.g Se`:onzmctor (Co. \ac e) O.R.
Ccn--.a! Cc,- -2e:or (Co. N, 3mc) OR Owner
Ins:allin-, S_`ccr.c7ac!or (Co. Namc) OR
C:.._. _. Cc.... _::or (Co. Namc) OR Oµ•ncr
A-36
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 47-759 Gertrude Way La Quinta CA 92253 08/20/2002
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 I
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
date : / / REGISTRATION STAMP NO:
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: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ M00
Estimated Cost: $
.-
• • u •-r•mi-• Feli • •• • •.� r ' •� • :•. • •i
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.
AT21:1220030313
, have
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 ordinance's
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 47-759 GERTRUDE WAY U-42
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-269
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