0203-243 (SATT)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 ,lsr C$ BIC� 913MI03
—•
Date I Signature of Contractor (—) - h^a�-
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). 9
( ) 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.
(M 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:.
Lamer ;'l, 'P1 p--UNla Policy No. 103616-02
(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 wifh those provisions.
Date: Applicant " 1 -•rte R
41
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) til •/"W "A -a V 0 Date 4= a -•'Z a 4),J
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OUG-243 TRACT
. e�, _ (r,7 M0101W 7,9611
JOB SITE
ADDRESS 411-aw GEIrMME6Wky
APN
fWAM-045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
AMAI1,0RES, U
DCD DEV, WC dbA Dl~;E-Wr f;i'�1 E DEV,
7.1-•760 THOTMAY..1) i 0200
78.600 TUGI3WAI..' 111
INDW WELU CA 92210
LAqUWA CA 92253
(760)-771-3345 0UN 21 fit?
USE OF PERMIT
SPR, - U31,013.3, UNIT 1(a PL-A'N 16, PTrfi',i I T WES NOT INC;IMUDE
K')04 SPA, BLOCK WAL,I,A, OR DRKf FWAY .APPRO.hC.H. 73% "MUC110,
IN PLnA'bf CHECK FUZ g)R.MULTIPi.Z ISSU.t 11C E OF SA.lAZ!a'I., -N Typf
TRACT CONSTRO`O'TMN 700.0.0 3F
ESIM., ATED C:f?i:'T OF CONF hl:WMYCM
M3.010.00
CONSTRUCTION CTION ME 101-000-41.8-000 334 W0)p
PILAXCHECK FEE 10l-000 439-318 t7&5I
IUI1;CHANICAt,PRE 101 -,000 -?21.000 53930
91, W 31' Is;AL ME 101-000-420-000 Vw.00
T'LUMBINO VER 101.000.4.19.000 3I° SIt
STRON10 PAOTflCYN FEE . Iw'p', 10 1,, 01-000-2.41 000 $.:+.80
DI7"JELOPER IMPACT FErs $450.00
-
D e LM Mt -PAD MW
S0100
r ,AL F�.£eft.L'7L�R EST,:1'F!Y..+� VOW�Er�P
MAY 0
UAAar�'i
3 1UUZ
CITYOF�►gUINTA
F7NANCEDEPT.
RECEIPT
DATE
BY
D F ALED
e
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade - 2 -a
Return Air
Steel
Combustion Air
Roof Deck p •
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation - o -.-- 57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath _ • o Z 5 7
Drywall - Int. Lath ffod s-
-Lc�
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines - O Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection a2. 7 o
Encapsulation
Gas Piping
Gas Test f3o�p S
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) / -OZ-
COMMENTS:
Standard Notice of Work Completed and Not Completed
NOTICE - All reccommedations may not have been completed. See below- Recommemedations not completed.This form is prescribled by the Structural Pest
Control_ Board, with whom a copy must be filed by license within 5 days after completion of work under contract.
THIS IS A NOTICE OF COMPLETION ONLY, NOT AN INSPECTION REPORT
ADDRESS OF BLDG STREET CITY: DATE OF COMPLETION
PROPERTY 47-800 Gertrude Way La Quinta CA 92253
INSPECTED: CO. CODE - 33 08/0$/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 :
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: 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
soil pre—treatment was • r•rm• on this nronerty in accordancei •n • :•. • •n
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.
AT21:1020030313
INSULATIO`` CERTIFICATE IC -1
Si,c A -dr:ss
Nrml: Numbzr
DCscriptiou of Installation
1. ROOF
1 nlckn:ss (irC Cs) 1 J
CEILING
T f:=,d. RCS1S:3 1CC (� Vd!UC) 3
Bat' o: E1ar:!:et T.;rt ;tj!; 5 E:_-� Vic- c �X\� "r Xl odUs
Thickr.css 0n.c` s' Ttc=2.^sistar.c (R It-, c) ),
Looe Fill Type Br -rd /1 06:t'1 �4-1
Contractor's r:i- installed weight/i:' — lb f nirr_-t t:-liekness (�i� inches
Manufacturces installed weight per square foot to ?thieve T11=—mal Resist`�ce (R-Val::c) )
3. EXTERIOR WALL
A.
Material Brand Name
Thickness (inchcs) Thermal Resistance (R-Valuc)
19. Exterior LL.)CA0
Material Brand `a:: C Lnn.LL
Tcic'lcness (inchcs) ;a)' ---2 Thermal Resistance (_,-Value) — 1�
RAISED FLOOR
;�3terial
Thickness (inc`:s)
SLAB FLOOR:?ERi`fETER
N'atc:isl
Thickr,c5s (inches)
Perirnctc: Insulaticn. Dcpth. (inches)
FOUND. -.TION NV A LL
i�l.atc:iai
Thic'utcss (inchcs)
Declaration
1 t1 C:- i1 1 CSiS[3f.CC (R-Valulc)
B, -and- Name
T; cr:�,_1 Resistance (R -Value)
B:-a:.a Na
r.e.T.:=: Re5:5:al.t:e (�'1-V31L'C)
I 1Cf.'Cy c2r::r' t113! L-,_ 3b, -VC Ir•Sta31tcn .vas irs.all-d Ln the C_:'=: -.t3.. _._ 3`J._ !oCa::Cr1 ... With L5: C. i .-n!
Er,er,Z7: Ej-i c;er:cy S:cr:4 for r'sid-ntia! buil--ii-.ss (Titl= 24, ?an 5, Ca:i.'ornis Coco c: Reg' !a ens) as indica"_•d on tF.e
Cc::i:�cate crCon;.!.3 a ptic3'rle.
I:c:n
-na:,:-e, Da:c
S:, .-.-. , Da.-
(Co. \ane) O:'.
Cc ::hal Cc-:-3:-Or (Co. Nave) OR OWr.c:
1-s:alliq Scb_on, actor (Co. Nara) OR
Ccn:ral Cc. -2c or (Co. Name) OR Owner
Ips:3111-� Sc` -:3 3c:or (Co. Name) OR
Cc:.c:_! Cc, -.Z:1 -!or (Co. OR OA'nrr
S
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: 47-800 GERTRUDE WAY U-16
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203.-243
Occupancy Group:
R-3
Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210.
By:
! dot Date:
Building Official
POST IN A CONSPICUOUS PLACE
STEVE TRAXEL
03-21-2003