0203-270 (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
iN � j Professionals Code, and my License is in full force and effect.
O =5 M License # Lic. Class Exp. Date
�
u.IW 768395 B C$ NIC" 9/30/03 ,
6 Z r- Date. —sP �r' Signature of Contractor `- '�� �� .h
CID 0 0 11
U C) OWNER -BUILDER DECLARATION
W UJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
ce) () I am exempt under Section . B&P.C. for this reason
LO
N Date Signature of Owner
ON
Q)
a Q WORKER'S COMPENSATION DECLARATION
p 2 ZI hereby affirm under penalty of perjury one of the following declarations:
LO ~Cc
O () 1 have and'will maintain a certificate of consent to self -insure for workers'
X W LIL 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.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
- IlLID
Z permit is issued. My workers' compensation insurance carrier & policy no. are:.
aD = Carrier sT, an NI Policy No. It3@3616.1f1
g (This section need not be completed if the permit valuation is for $100.00 or less).
Se) 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
3 Code, I shall forthwith comply with tApse plovisions.
h /1
Date: =t6,p Applicant 4 -t ✓` P' -IA af�'
F
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.
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. r -
Signature (Owner/Agent) r a' / 4 Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 00.3-7.70 TRACT
��- S445A2 ).80 B22U43 2$601
JOB SITE
APN
ADDRESS 47-777 C'1,+°.RWJ1)EWAY
649`IXX1045
OWNER
CONTRACTOR tDESIGNER
��i�, �Ay�I �-`y�y�t��tvv Y1
Al"l.AblJr'l�MV,RG' I L.1?
�/ENGINEER 7��a�C��+ fc�>
MID A?.I�..+V ., WC dba 1/ * r� 41' MUM M L,}J:..V .
74.7601 RT011W AY'.111 0200
78.600 TtUGMIA-Y 111
INDIAN14" MLS CA 92210
LAQUINTA CA 922$3
( 60)771.3345 CBT • 21 SO
USE OF PERMIT
:sm . Bp,ri', a W7. UNIT $3, PLAN LA. PFIRMIT VOM NOT INCLIMS
I'00,4 9fti., FiLt)OK WALM OR Dis;%ir')a+WAY APPITt3A.CK 75% Its UCTIaM
W PLAN C)iL(K FIDE li?OR FAULT IPLit ISSUAI-ICF? C9F S&ML PI.A. T^1 YP'E,
TRACT CONSTRUCTION 8G'
C;iAR,A.43 ICARPORT S9'
'TTAUTE"D COST air C �A�4c pre.�TC�' on
45,320110
••qq����y;�tyy�� `AAm�p' yy gy'Cs� � g r �q ,�
i-.�Q.ig.I]:7,.EJ,� Ill1:e".:Y r�M.fYdAL 71.
CONSTRUCTION F3.iL 101.000.418.000 S�3`3.rob
PLA.14 CHECK FEE 101-000-439-318 $1;7.85
.tAMH ANICAL FEE 101.000.421.000 %7400
IffXWTRICA1,.FRE, 101-OaO-4213-600 05.46
PLUMBING FEE 01.000.419.000 $98,50
STRONG MOTION F99 - I'�.3iMID 101-000-241-000 $4.53
L EV9LOPMI:MP A.CT 371Y1'r $1,369.00
sn
bl)-YOT t 'ii [TC'11C ANSAP M.,C_C
`$2,:�4.1. 4
JXSIn I?T� .Pfi ? PrIMS
tMAY
P
$i .00
U 3 2002
�T YKIRIM-Cr IM0 DVE.KOW
CITYORAQUINTA
FINANCEDEPT.
1!1M&34
RECEIPT
DATE
BY i
DTE FI ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— Z -t9
Underground Ducts
Forms & Footings
% —rye
Ducts
Slab Grade
- 6
Return Air
Steel
- 6
Combustion Air
Roof Deck
Q •-O L 5
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
. D
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Z57
Drywall - Int. Lath
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
_
O�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ _
5
Encapsulation
Gas Piping
Gas Test
Appliances
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)
COMMENTS:
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 47-777 Gertrude Way La Quinta CA 92253
INSPECTED: CO.CODE 33 09/25/2002
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 I COMPLETION STAMP NUMBER
Notice of completion
Sent To and date:
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:
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 : $ 70.00
Estimated Cost: $
.-
• • u • r•rn • on this monerty in accordanceJ!est Control:•. • •&
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.
SS21:1920030313
, have
-- = - -=F
-
INSULATION CERTIFICATE IC -1
�i;r Ac'dr:ss
-^ Prrnl: N•umur
4/71- 7ZZ .
Description of Installation
1. ROOF & yi
Thic:<r.ess (incl -c5) \31(
--
T�..r,<<�: Rcsisance (?-Va!ue) 3Si
CEILING
Bat' o: E!an':et Ty'`.tI- "- S E:-: 2 Nam,c � � L
Thickr.css (inc`.��s{` (3" T)..I= : ^sis1.ar.c. (R- '3luc)
Loose Fill Type�,la Er
ind
Contractor's r -i- ir.s;alled weigh /r t' k-_lb�f
....... _:n t:Zickness lb_ inches
;`4anufacturces in -stalled weight per square foot to achieve T c=mal Resist`nce (R-Veluc)
3. EXTERIOR WALL
A
Material ?-D(JtS Br2-nd Name `> k4, Undi c c 0- _
Thickness (inches) — Thermal Resista^ce (R-Valuc)
B . Exterior LL)c,&OO
�:at_ Brand Fame
erial piyl;tk�5Thickness (inches) 375 Tie.^ 3: Res;stanc_ (:L -Value) - (�
R -WISED FLOOR
Thickncss (inc` ts) _
SLAC; FLOODlPERIMETER
Iv: at::risl
Thic kncss (inches)
Perir..cter Insulation Dcath (inches)
FOU\D�.TION ViAr L
lvlatc:ial
Thic'kncss (inchcs)
Declaration
czar_ �•---
15=--1
T i:_....__._sistar.cc (R -Valu--)
B, -and- Name
T crmal Resistant: (R -Value)
E: -.r. -Z' N., --c
Tce:r.._' Res:s:an c: CR-Vs':uc)
I eer.ify that l:._ a Jae irsulstier. was installed Ln th= c_.!c:-- 2. _._ 3bJ.= !oca:ion is ccr.fc -ia witi the e-'mn!
Enera: E�:c;ene� S:Ilr, .: far residcntia: buildings (Till_ 2-., °a- 5. Ca'i.cnia Code c`2ega!� ens) as indie3��•d ca the
e;rCorr:;..iar.c , µ-_.c a piiu5le.
LDere I-s:a!lir z SLbMIt 3: Or (Ce. Nano) OR
y Gc-cral Cor.;mcror (Co. \ane) OR Owne:
1:c.n 'Si .a: rc, Da:c
!-,:311ir:a Sub:onsactor (Co. \arc) OR
C; ,::al Ccrtr3c:or (Co. N3mc) OR Own:r
I. -.s:3!1;-7 SL"CO=3C`-Or (CO. N3n,2) OR
Cc-^ ! Ccr.t:i::or(Co. Namc) OR Owner
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:
47-777 GERTRUDE WAY U-43
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction: VN Land Use Zone:
0203-270
CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
Building Official
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE
N