0203-241 (SATT)U)
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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'S RIC 9�Oi(r.4
Signature of Contractor
Date 4,L-4-10,22-�__.
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.
( )` 1 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 ST.Aa E FUND Policy No. 1603610-01,
(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 provisions.
Date: Applicant^ -x - - 1,�A �• !%
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; att,
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) r. AAS k Date _43 fle -/,52_'.
BUILDING PERMIT PERMIT#
M03-241
DATE ! VALUATION LOT.TRACT
,3,7020 B7,U114 21,3601
JOB SITE
APN
ADDRESS 47-812 GERT#rUDE WAY
1 649-00-045
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Nam Lom, , .1..Lv
IsC0 ,D9, i., INC &.a 17OWC 0111. ',S DEV,
74-7601-I(GHWAY.11.1 #200
78-600111GHWAY 31.1
M LNXTW1:ad.IX CAA, 92210
LA QfRNT1A Cry 92253
(760)771.3345 CB 2190
USE OF PERMIT
W012. D
VArk. 811X0, LI%1IT 14, PIAN )A. PERMIT V4.lTeSNOT INCLUDE
P0014 SPA, ITWOIC.1>a(ALL OR DRiV',LONAY APPROACH, 19 % REDUCTION
TH PIAN C'&3I!= FEE FOR kbS'!l" f1PLF, yq;SUA.19CIr tall SAME FLAN TYPE }
TP,AC T MN9FRUC110N SF
OAit,thOWCA RPORT ;313.40 SF
CONS'T'RUCTION FEE 101.000416.000 $338,50
r
PJ AN'CHW11K 11!:I.? 10I-000-439-315 W-93
bv9ISC:idJ4]'WAL PER 1014000-421-000 $39."
[+`.I.,If.CTRIC,AL. PTV, 101 -WO -420-000 $65.46
f'
�
PLUMBM0 FIDE 1131=000-419«000 $88.30
STRONG MOTION FE - RESID 101-000•-215.001 14.533
DEVELOPER IMPACT FRE SI, Ib4,4p
py
.��L r��+5 w p ,r�,-,y�JW ,{�,y, Yet- S T) �,p CW
SUB-TOTAL
. SUB- A �./ d�AL C0H1.��kU(_` �.!0k AIN i) .iyl.Pil.^i t,�irGASertp4 t
Qf,�l
U2`,?M' I.14
LEN r-RH-PAM P' .9
8E{3 oo
EKWfff FEES DV. INA NOW
S2,243,34
MAY 3 2002
CITYOFLAQUINTA
FIIIIANCEDEPT.
RECEIPT
DATE
BY
DATE F ALD
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—per
Ducts
Slab Grade
Return Air
Steel
oAS
Combustion Air
Roof Deck
,p z
Exhaust Fans
O.K. to Wrap
f
F.A.U.
Framing
Compressor
Insulation
- o Z 57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(- (o -4 y
Drywall - Int. Lath
.—/?.•0 2 %
-rLCG y7�
8'•O-`
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
C'
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection�a
Gas Piping
•o2�eo 2 5i
Encapsulation
Gas Test
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 Ax
Utility Notice (Perm) r Q 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 47-812 Gertrude Way La Quinta CA 92253 08/08/2002
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
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
Signature
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Estimated Cost: $
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
IN'S LATION CEPMFICATE IC -1
z!:r Address
Nrml. Numer
Dcscriptioli of Installation
1, ROOF
Ti-,ickr:ss (ir.c1--sJ
CEILING
73 Qn,n 1 ,tLam.
Ti:,=,:i tZcsl5:3ace a!ue) 34
Bat: o- Elan'. -,v Typc ?Yat -p E.a_a Name
Thickncss (inc`.,s` Iw" T h-: a' ^sistar.ce
Loo_c Fill Type �a �t� B"- ' A DO,t'l %-�2-1
Contractor's rni installed weight/i-- lb �4in....- t t*lickness 1L..7 inches n
;`lanufacture's installed wei¢ht per square foot i to ch:evc T;.e.-rtal Rcsist`�,ce (R Vale.) k� - S-6
3. EXTERIOR WALL
A�,Y t,.x-Us ax(o-P1cwt� � 3
Material 'e)!�-S Brzrd Name un Y1 C O _ _
Thickness (inchcs) _ �%�— Thermal Resistance (R -Value)
B . Exterior l,t_.GAO
;Material � ClBrand `a.^..e (c.�
Tt,ic',crtess (incht!s) 375 T e=ai Resistance ( -Value) - 1�
RAISED FLOOR
;✓;lte:ia
Thic'.cncss (inchcs)
SLAB FLOOIL'?FRi`fETER
Mat�:isl
Thickness (inches)
Perimeter Insulaticn Dcpth (inches)
F0U\DA. TI0 N WALL
hSate.ial
TF:ickncss (inchcs).
T:._....3i RcSistar:c (R-Valsc)
B,-2.id Name
T`cr: ,sl Resistance (R -Value)
B;-aN
Ti.e.T.:_'': Res:s:ance (R-V31Lc)
Declaration
I hcrecy eer.ir' th.3!abo� e ir-slm'cn %v1s Ins!ali_d in th_' :!C.-.t2� loci::cn in t.5: e: rc. .
Ererg; Ej,cier, for r:sidcntial buildL,gs (Title 2-., Pan 5, Ca•.i.cnia Cod: ss indieatzd ca the
Ccni:i_atc crCon;.!:a-c
SL.D cn=3,::or(Co.lane) GR
Cor.; -3c or (Co. lune) OR O'-'rc.
i
F,11 . s :3: rC, Datc l-,.allina Su``:onuactor (Co. Name) OR
Cc -al Ccr.:rac:or (Co. ; i3nc) OR Own:r
S:;^ t , C3~' ,._ x�or (Co. N3,^c) OR
Cc -c -a! Cc,-.,,. 2.!o, (Co. tia.;,c) OR 0,xm--r
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: 47-812 GERTRUDE WAY U-14
Use Classification:
Occupancy Group:
SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-241
R-3
Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address:
Building Official
City:
74-760 HIGHWAY 111 #200
INDIAN WELLS, CA 92210
STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE