0203-261 (SATT)N
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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 C•`F3 mc() ; = 9130103
Date_ 47 —122 Signature of Contractor—
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: 1.
( ) 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 FUND- Policy No. 1600642
(This section need not be completed if the permit valuation is for $100.00 or less).
(}!S. 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 3hose.provisions.
Date:Applicant �L��t•:r
Warning: Failure to secure Wor�drs' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the •building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) /�Aih Date
` BUILDING PERMIT PERMIT#
DATE VALUATION LOT 020.1-261 TRACT
JOB SITE�
APN
�y�
ADDRESS 47-8M. 03,�d•iAUDE' 1 !1 A 5.
&W-0304WN
OWNER
CONTRACTOR / DESIGNER / EN INEER
Mtttt//apps,yY1)
JD DEM., VC dba DLfZ'r 41EyI DEW
'i4 -T60 T3IGHW'A.Y 1110200
76-600 111
INEIIXAN WaLs CA 92210
LA QMNi'A CA. 922 ti ,
(Md,YM-3345 mxlt Z1st0
USE OF PERMIT
SFA - Iii.'!`1t'3. Y17, UN 34, PLAN Bpi . P ?,RA I DOES NOT YNC:1;lIM
P004 SPAS, BLOCK WAL[.3, OR 8'!1MsaYA7P1t7RO.t d.K 5%.RE1D1rG"4"8011$
YN PIAN CHI=1 PYA? FOR MUI,:T8KX ISSUANC:Z Ore SAME PLAN TYPE.
TRACT CONSTRUCTION 700.00 SF
Ft�,"7C MIL10 (;0fi6'rCSF e.OMITAIWICTION
n,,C9a.om
MaDMEWhIMARY
, NSTRILICT)ONFEE 101.000-418-000
P3 -AN CKPICIZ VIEF, 1011-000-439-3I8
WHIANICAL FUI 1 Ul -0004,21.000 MAW
TILEC!RICA'L FFY. 101.4kCl0420-000 $59100
iPLl71t:1Li1NCi FER 101- ID -41 °1-000 U181 so
STRONG 140TkO a IMF, P RPSID t 01-0010,'A 1-000 sn.RD
DENFLOPER. IMkPr,. T FER v,4ago
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LWti PR.>�RPAYD �
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MAY
CRTYO
RECEIPT
DATE
BY
DATE NAL
INSPECTOR
•. "N**01
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — p
Underground Ducts
Forms& Footings _p
Ducts
Slab Grade —2Q— 2r
Return Air
Steel
Combustion Air
Roof Deck , p L 57
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing Cj • .az $
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath — - o c_ S
Drywall - Int. Lath — 4.9 Z 7
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection ftrl. ,�Z �%
Gas Piping
Gas Test 'v
Encapsulation
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) /a• d Zi
COMMENTS:
INSULATION CERTIFICATE IC -1
Si.. Adc!r,�ss
Description of Installation
PrrmI: Nu -torr
- -a
1. ROOF
Thickness (inches) \3t( Rcsis:ante (R-Va!uc) 34�
CEILING
Bat' or B1.ar.•.;et Type
Thickr.css (inc'.-s' t� (R- aluc).
Loose Fill Type�
Contractor's ri installed wci3, /f:= ,k-- lb Nfinir�_rn t ckness (b � inches
Manufacturces installed weight per square foot to achieve The =mal Resistazce (R -Vale)
3. EXTERIOR WALL
Material tel_. _S BrLnd Na-c�� � � UnAn( c i ( O. _
Thickress (inches) �� Thermal Resistance (R -Value)
B ..Exterior LA-)CLUO
Material Pl y'A±S Brand Na -c t
Thickness (inches) Sj' 0 T e.^ai Resistance (R -Value)
RAISED FLOOR
Mmerial
Thie'.encss (inches)
SLAB FLOOIL'PcRI`1ETER
iv'aterisl
Thickncss (inches)
Perirnctcr Insulaticn Dcpth (inches).
FOUNDAMON ViALL
Material
Thickness (inches)
Declaration
✓ , N
T i._...,il R csistar.cc (R-Valuc)
B, -2nd, Name
T cr:;,ai R. sistance (R -Value)
Ti e.T..L Res:s.anu
1 1cfCJy c2ra th3t t.'.. 37ovc irsuhticn Nis tns:al!_d Ln th. C-.! .-- _. _._ 3,0',2 !oC3:i0n is ccr.`c--t3 wah Lic c'.:rrr..
Er,era, E j�cie�c� Sror��r� for rcsidenti.3! build,&s (Title 24, °a- Ca!; ` mia Cod: or R:g'.:!abcns) as indiea��d ca the
CC: :31:; CrC0... -1.^.0 , µ'_.,, a. p1:c3ble.
L m =s shn _._, Ds:: i^st3ili^Z SL .cntr3t:er (Co. �3mc) G
Ccr.::ul Cor.tmctor (Co. ;:ane) OR Owns:
":3:..re, Date
Sid n ..._. D2t-
!-.:311ina Scbcontr-3ctor (Co. Mmc) O!
C,=a! Ccrtr2e:or (Co. N amc) OR Owr;.-r
I :alli: SL` Z 3c'.or (Co. n'3ro) OR
Cc-Mz! Ce, -.,,::.:or (Co. Name) OR Owner
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 47-805 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 :
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 • • u n •� • •• •
W[MMUMBOMIGre •e •C•. • •s
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,California 95825-3280.
AT11:5220030313
have
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: 47-805 GERTRUDE WAY U-34
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-261
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
VN 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