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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 B C8 HIC RMD/03
Date'' ._.lA�. Signature of Contractor
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 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 FV) qD Policy No. 1f�YD36x6 ��
(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 with (hose provi§ions?
Date: Applicant•—�
Warning: Failure to secure Work 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.
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) Date�I.�i� ,
BUILDING PERMIT PERMIT#
����� 63
DATE VALUATION LOT TRACT
V155,320. B 1, � U31 286011
r
JOB SITE.pr
APN
ADDRESS 4�7^ 49 OK . 1TVIE WAY
64"XV-045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
: MAT?LOR,+ ,1'. 7
DCM MM, INC dist IrESE, e C'1 DIM D -EV.
74-7 60 JUGHWAY. I I 1 ;Y#2G)ty
78.60010t31HWAX. 1I I
DIrDbultMIll IS CA 92210
Li.Q% IMA CA 92251
(760)771-3345 (1,810 2180
USE OF PERMIT
MOM FAMILY ArfACM3
SP'.Al -131.x](1. 11% X3141T 36, PLAN N Y.A.. PER= D09S NOT h-JCLUr)
P0014 SPt%'FkWVK WALI;2k OR DRIVEWAY APPkc).hCK 74%RMlxc'TION
K1d PLAN CHFICK : !EE VGjli: ivKtlC,' 1P1191=JA14CZ OF V.VIS PLAN TYPL,
TRACT CONSTRUCTION 709,00 O
GARAWc;ARPORT . .00 SF
H,17I iitt TF.D C:01V OF C ONS"IRKJtv':1TOn
C riSTRUMIONf WE 101.060.418-000 $358,50
PL.A114 CHWX FEE 101-000-43.0418 $87.85
A+11wtw.HMUCAI.FEE 101-000-421•000 $39,34
N:L7XIrRfCAL PEE 101-000-420-000 $651.16
PUMBINOr1 101.0010-419-•000 W01.s1
S'P RONO MOTI014 F Et < IR Sa12:D 101-000-241-000, $1.53
DEVELOPER IM ACT ME Si, 9.t04
4A
9 s IAMB 11RE,, -AtD Y=5
MOO
MAY U 3 2002 }1�tG
,. A1;1Mffl.' F s yX_R 1 01W
CROF'AQUINTA
RNA14
$2,24134
Nc�DEF�r:
1
RECEIPT
DATE
(
BY''
h
M
DATE FINAL D
INSPECTOR
Xi
,f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
a
Ducts
Slab Grade
—pZ <2
Return Air
Steel
- -5_m_
Combustion Air
Roof Deck
c Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z1 G ���
o• - v 57
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral.
Pool Cover
Sewer Connection
Gas Piping
a ZD
Encapsulation
Gas Test
2_3 • a y S�
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)
COMMEI Zp
L�
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 47-789 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 COMPLETION STAMP NUMBER
Notice of completion
Sent To and date : 03/13/2003
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 19/2002 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 : $ 70_00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Estimated Cost: $
Remarks
•
are-ImalMent was nerformed on this nronerty in necordancePest Control:•. . •n
Signature l4 -ti
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.
AT20:4920030313
I
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 47-789 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
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 : 09/19/9002 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
Remarks :
• • u • r•w • •n this nronerty in arrordance with Structni-A Pest 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
G' r
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.
AT11:4220030313
INSliLA T IO`` CERTIFICATE IC -1
5i,, A"dr_ss
Dcscriptiort of Installation
1. ROOF
L-ly-
T hic:<r.ess(in c=CS) j`r
Prrml:.Numbzr
Ti;;.;: Rcsis:znce (RVa!uc) 3Si
CEILING j
Bat: or EI rik t Type �Y.v� E:'- .=' N -mac
Th;c'Kncss (inc.`. s' 13" The=!' ^sistar.c (R aluc)
Bram
Loe.c Fill Type `OC,�t� /l 00a'l h_LI
Contractor's rni- ins:ailed weight/ft= / - lb Mihir _ tt ieckn:!ss -7 inches
113.nufacturces in stalled weight per square foo; to ech:-ch:T c.;:,al Resist_ ce (R-Vah�c) � - ` -6
3. EXTERIOR W T L
A. X(O—rtC'�Ylo v� 3
Material.-� Br2"d Namc
Thickr.css (inches) — Thermal Resistance (R -Value)
B. Exterior t,ocluo
Material �G13±S Brzr.d `amet _U,Tcic'kriess (inches) S-72-2 T er::a: R:s:staace (R -Value) - (�
RAISED FLOOR '
h!aterial _
Thic'.cncss
SLAB FLOORDI ERI`1ETER
M:aterisl
Tbickncss (inches)
Pcrirnvct Insulation Dcpth (inches)
FOUNDATION ViALL
M.atc.ial
Thicicncs: (Incr:cs)
B,ar._ NSm—z
T i:c....3i ..esistarc (R -Value)
Brand N=rne
Tl ermnal Resistance (R -Value)
B.ar.a \'a.....
Tr. e. m. Re s:s.arC'.: CR-Va1uc)
Declaration
I ger.-Iy C.ra�y that t.:_ 3bo%'C IrLSUlatlon \N1s lnsta!lCd Ln t1:_ -- 3'. _._ 2. o•._ !cca::en :;1 with t.5c cL•rTLn!
Energy E j cienc�S:nc'.rd for residential buil^i:'.gs (T itic 24, °a- 5, Ca'i.`or-m';3 COL': o.'Rcgula lens) as indiea�L•d on the
CC -1:1=3I:: ofComr't3GC µ'-.0 a. pFcable.
It_m -s S,i2r i1rt, Dst� l �t3ilir.z �L`xn�3aer (Co. Nano) Ga
Gcr. c: al Co -:motor (Co. ;game) OR OHnc:
1: cm �5: jr:aa rc, Da:C
Si, , Cat-_
1,s:311ir.g Scb:on-actor (Co.,Nano) OR
Cer_ral Contractor (Co. ir3mc) OR Owner
Ir.s:3ilin� S�;`cZn-3ctor (Co. Name) OR
Cc-.^ra! Ccr.t:-.., ., (Co. Nanc) 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: 47-789 GERTRUDE WAY U-36
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-263
Occupancy Group:
R-3 Type of Construction:
VN
Land Use Zone: 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