0203-262 (SATT)H
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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
1685,95 D CS, Fac f 9/130103
Date 15-40 -02 Signature of Contractor�-I_ 1
rf
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 v="fAIL I'llit D Policy No. I603613-9
(This section need not be completed if the permit valuation is for $100.00 or less).
XI 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 provisions
Date: Er —I. -A7 Applicant �,*'
Warning: Failure to secure Works' 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) t�rs� r-?a"f Date ^' "
c
BUILDING PERMIT PERMIT#
DATE VALUATION' LOT O�Z03"262 TRACT
5 - 6- - F, ;,? 5 BI811"35 28601
JOB SITE�q
APN
4A
ADDRESS 1-7(9I GF1?1K WAY
V i.�
'649-030L-0 5
OWNER
CONTRACTOR / DESIGNER / EN (NEER
L M) DEN., )NCS dba 7JIMERT't'a"°Ii}ial DEV.
74-7 60 HIGHWKY I I I f900
7 R_ 600 111
DIM)WI WF IS CA 92210
LA, (JUM 1. � VA 92233
(760}rilr3365 M" 2180
USE OF PERMIT
SMILE-, FAMILY AWACICEM
SFA - BLI)GAtZ, UNI T35, PLATA IA. PERMIT t>ONS'NOT INCLMDR
P001, SPA. 9LOCIC WALLS, OR DRTii;KWA.Y-APPI: OACH, 75`Yo R12DUC'f iON
IN P14r' IN CHECX FEE FOR MU13IPLE ISSUANCE' OF SA'fxW PIAN TYPE.
TRACT 0043-TRUC'TION 700.00 `Wt
GARA.t'1FUC,113LPORT 373.00 V
E STWA [�'Iti CC?F•� A' 011 CON11511:r>��il't.;".ITC: N
yy'���7y;;���y���yy�� �y 2� �
it
CONOTRUCI 1QN FEE 201 -000•418 -WO
PLAN C:IUCK W 101-600-439-:318 V11.95
i►i&C:MNICAL FEE 1014=421X000 3399 51D
F;l.k :7RIC.ii.Y.1p E 1014)00-424-000 $65."
PLUMBING FEE 101-000.4.19-000 St°:.so
S'TRC3NQ MOTION FEE: - RESID. 1.09 X000-24'1-000 $4,53
DEVELOPER IMPACT PRR $1,564:00
!
4)V.�" 'V,L 2y6J y;l' 4L1a.+.1 i`.J- .i JV ,['y.tc1. :V �,..X'.tSfrFnc
$2,249.34
F -IRE -PAID RIMS
T0.00
°ALriff"*9WEh0"il
MAY U 3 2002
WYORAQUIVA
RECEIPT F N
BY +
4
DATE NALID
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
-per
Return Air
Steel
2-5 - 5 -o
Combustion Air
Roof Deck
,v. Q, c 7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ 6- o i S7
Drywall - Int. Lath
4f. e 2— ---,")
dnn(G
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
g -2 - OZ. �'J�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ A
Encapsulation
Gas Piping
Gas Test
�{j ( Z 57 -
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)
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 47.797 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
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
none . date : 08/18/2002 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
Remarks• nre-treatment• r• u • •� • •• • •.� •� • C•. • •�
Signature
If you have questions regarding the work as outlined above,you should fust 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
INSULATION CERTIFICATE IC -1
5itr AIddress
Perm: Nu;mb2r
Description of Installation
1, R00
1Jrr
an d=mrice n 1 t ��
T;:, ,_,; Rcsis:ance (R-Va!ue) 3g
CEILING
Ba'.: o- E:anzet Type �' Y.v� E: a ,� Nam. c "C
Thickness (inc`.-s` i3" The:rr:a: ^sistan:e (R 'ales)
Loosc Fill Type`C(,J�� Brand /l OO:t'l
Contractor's r -::i installed weight/f:' lb tYickness 1L,..7 inches n
Manufacturces i%talled weight per square foot to ?thieve T;.c. gal Resistance (R-Velse)
3. EXTERIOR WALL
A. b/ L,, -,CU. t, �-_) -;� /X (O— P1�'�-rl v"�!' 3 ..
Material S Bre^d Name a k -_-, UD A-1( j t � Q_ _
Thickness (inches) _ Thermal Resistance (R -Value)
B . Exterior l,t->G_U,0
I'Vaterial �� 3tzrd Na^e It l L
Thickness (inches) T ermai Resistance (?,-Value)
RAISED FLOOR
Thic:cricss (inches)
SLAB; FI-001UPEREMETER
Nate:isl
Thickness (inches)
Peric.e:er Insulation Death (inches)
Y. FOU\D,A.TION %VALL
/` I�S.atc:iai
Thick.ncss (inches)
B,an3 N
1 1:C....;1 R Csisran. (R -Value)
B:znd Name
T, crTal Resistance (R -Value)
i;�r.a N
T .e.7na; Res:s.an c: (R-V31UC)
Declaration
I hcr:-Iy ccr.;:'.• that t:,_ 3"o -c irsularcn % as tr:s:all:d in the 3: ._ a`iota::Cn 1:1 cin �cna ;cc with LSc c::rr....
Energy Ejtcie:CY
SIz. raidentia! buil,_H,gs (Title 24, Pa.-. 5, Cat.i.Oria Code o.`Rcgula^ens) as indieatzd on the
Ce:'i:mate e:rCorr.;.!ia�c , u -_,c a. piica5l�.
1!cm _s Ds: ]r.s:ailin Scb:cn�a.:er (Cc. Name) GR
C'ec::81 Cor.; . ur (Co. Nine) OR OWr.c:
Date
lns:allir:a Sub:onL-actor (Co. \arc) OR
Ccn:ral Ccmrac:or (Co. ; Esme) OR Owner
Ins:allin.; Sc`cor.c.wor (Co. Nara) OR
Ce.._.a! Ccr. ::_c:or(Co. Na., c) OR Owner
C _ C._- i .: iTS A•36
Certificate of Occupancy
City of La Quintal
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:
47-797 GERTRUDE WAY U-35
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit. No.: ' 0203-262
Land Use Zone: CR
Address:. 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE