0203-271 (SATT)U)
(V LIJ
O � M
d r
W �
oZr�
O�
CSO —
O
H(0
W W
I- a
U)
Z
Co
LO
N
ON
U_ <
It W Z
0 Cc
Lo r � 0
XW
C0 <
O
M
`1- Z_
ao �
r d
Q
J
F1
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
11 C185 9115 13 03MC
Date `01. Signature of Contractor t f ' ��` UU&
t'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.C. for this reason
Date Sionature 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:
CarrierSTATE AMD Policy No. 1693616-02
(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 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,provislons..
Date: -",-may Applicant`° -1.•,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $T00,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest, and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.',
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building -
construction, and hereby authorize representatives of this City to enter upon =
the above-mentioned property,fof inspection purposes.
i fry.
Signature (Owner/Agent) �` - --�% `r3 '.Date .-w'r/o ""..
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203-2,71 TRACT
,32020 B221144 28601
JOB SITE
APN
ADDRESS 47-783, G1ER RUDgT WAY
%
649--030.0451
OWNER
CONTRACTOR / DESIGNER / ENGINEER
)MAFLOR.¢nS, L_ -P
D(M DEV., WO 4ba lyL, � `r MES Mkj.
74.7601 -HU -IJ.f?,,'Y 111 H,200
7tR•6`-s00 HIGHWAY I I I
I1+I1)LkX'WlbaA S CA 92210
IA Q7t7IP ..rA- (,A 922:53
Q,5gy'fi,I,3345 4'33'4 2160
USE OF PERMIT
L1 CSI ? ISA Y EfiA'I�..C�
SFA - SLDCVA' UNIT 44, PLAXI.A.. PZ.RNTIT "OES IN0T INICLUAtr
P0014 VA, HLOCK WALL% OR DR_1+ NVA,Y APPROACH, 760K, REDUCTION
INKt.'k3E4:.K. FSE FOR MULTIPLE ISSfY.F NCR OF SAME PLAN TYPE.,
TRACT CONSTRUCTION 7119,10 SP
6: iA.xf.A0?JC"AR,P0WT 3N.00 30
Xa3' WA` IV coyr GF C0r4Gs.L,.$`,VC!)r10.r
455-,,32020
0
PO''Af.I F ME S%W11M4'xRY
CONSTRUCTION Fa 101 a000418.000 $AM50
PLAN CHECK FEE 101••000.439..318 W1.83
MECH.A:N[L',AI, FRE 1.611 X000.421000 :$39.."
RL,FfZT R.1CA ,, 11ER, 101-000-420-000 $63.46
PLiIMBINO fit 101.000-419.Cs00 3881$9
STI:'' NO MOTIO.14 - ILESI;C3 101-000-241-000 54.5:3
DEVELO %k IMPACT FRE $1,SaUD
ff0B-7KYrAL c."t`:NM1X�7G0W ,At i7 I'LAN Cllril:: X,
$2,243,34
ims .n.r . , Ids
d a r
$0.00
TER NOW
V,243,264
Dr -F,
MA, u 3 2002
WYOFLAQUINTA
k, FINANCIFOEPT
RECEIPT
DATEBY
DATE FINALED
-,k/ .o -s
INSPECTOR
.%b
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— —
Underground Ducts
Forms 8 Footings
— 9 _ o
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
oed
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
T
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Final
BLOCKWALL A PROVALS
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
zi
Gas Test
Electric Final
Waste Lines
—_�� p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas iping
Gas T
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) .O
COMMENTS:
INSULA T IO`' CERTIFICATE IC -1
Si,: A dd r_'ss
Prrml: Number
Description of Installation
1. ROO'=
;�'atctal �L�
Th'Ic,<r.esS Or
CEILING
Ba'.: o: Blankv Tyrc Evan' Name
Thic'u:css (irc`cs' 13" Tire:.^.:=: ^sis, ar.ce (R 'aluc) YZ -
Loosc Fill Type h -al
Contractor's r::i- irstallzd wcighJf:= �- lb 4ini ^c -t t. ic'..ncss LQyinches
;14anufacturces in -stalled weight per square foot to ach:e:ve T crimal Resist`.ice (R-V:(_e)Al
3. EXTERIOR WALL
A. w u,X "i5 X(o—P�C"1-0'PA'
Material RY11-tr's Brand Na c U0 Aq
Thickr:ess (inches) _ Tr.erm_1 Resistance (R -Value)
B . Exterior LoCLUO
Material PYJ5 Brand N-Ime _ (-r;..(,
Ti ickness (incht!s) 375 T-erma: Resistance (R -Value) - 1�
RAISED FLOOR
IMMer iai
Thic'.cncss (inc`--s)
SLAB FLOOR)'?ZRIME T ER
N: ate:isl
Thickness (inches)
Perir-c:er Insulation Dcat (inches)
FOUNDATION %VALL
i�(.atc:ial
Thi c'u:css (ir.chcs)
Declaration
Card N:^?
T .._....al Rcsistanc (R-Val.ic)
B'a;ld N --7,e
T`er. ,al Resistance (R -Value)
?:mrd Nann-
Tl.e=a; Rzs.s:ancz (.Z-Valuc)
I hcrrby ccr.;Cy that t�: lr su!aticn ins'.3iI_d in :}':: _. loca::Cn in With: t.5c c'--r—u ..
Er,erg:; Ejicierc' S;�r:, f:,r residential buildings (TitIz 2-, Pa -6, Cal; `ornia Cod-- of Regulnicns) ss indiea�t-d on the
Ccr:itr_atc c:`C1,n"'i ,-c , u -_.c a piica5le.
Lem =s S;i2- _._, Ds:. 1-stallir z S b:cntr3aor (Co. Nanc) OR
Gcn:. al Cont-3c:or (Co. Mme) OR O•+ nc:
-na:•.:%, Date
Sia • Da,_
Ins:allina Subcontractor (Co..Nanc) OR
Ge-:ra! Cor.tr_e cr (Co. ;Vane) OR C)Wr-r
1-s:atli-g Sc`co=3c:or (Co. Nar:e) OR
G--=-21 Cc,-.,,. ac:or (Co. .Nar, c) OR 0,xncr
ca = Au_ 2-)1 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 47.783 Gertrude Way La Quinta CA 92253 09/18/2002
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
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: 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:
Cost: $ 70-00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A sail pre-treatment was n .formed on this property in accordance with Structnral Pest Control Board regrlatinns_
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.
SS21:2120030313
.;
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: 47-783 GERTRUDE WAY U-44
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-271
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