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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
i'GS3�5 R ce 1.6.
C 9130103
Date 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 START& FUND Policy No. 1603616-02
(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 with those provisions.
Date:Applicant—,----;. %(-q t',f,fA
w w "1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.'
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to .
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees n
2. Any permit issued as a result of this application becomes null and void ' U
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this City to enter up n
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)
.,e is7p _ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 3-'M TRACT
SQ02040 W.U] 13 28,601
JOB SITE
ADDRESS 47-1818 G1*RTA'%UDE WAY
APN
649-03(3-`f9c,
OWNER
CONTRACTOR/DESIGNER/EN &NEER
116-imAW1..0 RE -15, .L11
DCT) MEV., INC ckia DWERI' MES DEN.
74-76013METWAY 111 #200
78.600I-WWW.AY I I 1
]WIXANWE-LU CA 92.2 10
1,.'k QulwrA, CA 9211,15.14
(?60)77 :1.3345 MUlt 2180
USE OF PERMIT
OI)+Tf3T,.E? FAMLY XTMM.GD
30A. - BLDO.7, UNIT 13; PlAW IA . PERMIT 'DO&S NOT I'1df;I.UDE
ICOM 19IvA, BWCK WALTA OR. DisWYFWAY A2'PiaOA0,1, 75% RRIA107f(YN
114 PLA14 CHECK FZE FOR WIL':"I.PLE IS SUA11110E, OF SKME PLAN TYPL
TRACT CoNsTRUCTION 700100 OF 1
CIA42AC.0LIC ARPORN 373.00 SY
ESUMATRD COST OF C°0MMUMM
•y,pl�yy yypp,�•�99 �,p v .req p
S-1l.�.lk1U:S.6.6 Ifl .$+.h,f3lJ�.El�1 .
GCi-P8;3! RUCT104 FEE 101.000.418.030 DaR150
PIAN CHEC%; FIEZ 101 x000-439411$ $97,95
MECHANICAL, FIT 101.000.421.000 $39.50
91.=TRICAL 1qt I7, 101 -OW -420-000 $6146
PLUMBING I -RAR, 101-000419-000 189,.50
STS IX10 MCOTI014 FEE .=10 10 101-5100-21,1-000 $4.53
1)I?"VELOPM, IMPA,C'1 FEE $71569.110
}
SUS -TOTAL CC)N91iiL7CT1!:ON- AND PLAN
12 AI.34
LROS tPM-i AJD ITEMS
$0.40
2001
tWYORAQUINArTrA.
RECa DATE AL INSPECTOR
.2 a�
�L
INSPECTION RECORD
OPERATION
DATE,
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— O
Underground Ducts
Forms & Footings
Ducts
Slab Grade
B
Return Air
Steel
Combustion Air
Roof Deck
O.
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
—c 2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
a Z
!G r7c.J
- 3—moi 5 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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
—p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
,7.4 L
Encapsulation
Gas Piping
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
Utility Notice (Perm)Z7. 37o . p Z S'l
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 47-818 Gertrude Way La Quinta CA 92253
INSPECTED: CO.CODE -33 O8/O8/2002
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 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
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:
9
Recommendations completed that are considered secondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks:
A soil pre-treatment was performed on this property in accordance with Structural Pest Control Rnard regulations.
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,Califomia 95825-3280.
AT21:1020030313
I'� StiL. T ION CERTIFICATE IC -1
-7 i,,,, Ar'ar:ss Perm!: Numbzr
Description of Installation
1. ROO;
Thic'�ness (ir.c .cs) 13'' Ti..r t : Rcsis:ante (R -Value) 3�
CEILING
Bat' o: B1.an.':et TyreyYlk(j E:_ Nam,,c
Thicucss (irc.`.es` �3" Tr:e ^ =: ^sistarce (R 'aloe)
Loose Fill Type Brand /I OO:t'l %fit
Contractor's r -i- installed weigh:/:.- A _lb �4irir- _ -t kr,ess lt�yinct es
Manufacturces installed weight per square foot to achievc T c7mal Resistance (R-VaNe)
3. EXTERIOR WALL
A. �!7l �e�t —v, t,Jd-US 9\6'"/U0 'P 'A 3
Material Py".{ BrLnd \amt YCLc) t 0. _
ThicSu:ess (inches) �%�— Thermal Resistance (R -Value)
B . Exterior LA -)CLO Lon j -t
Thickness (irches) 37o-
1 : e.;.,ai Resistance (R -Value)
R -WISED FLOOR
Thic'.cncss (Inches)_
SLAB FLOOrLYPERIMETER
M. etc:isl
Thic%ness (Inches)
Perirnctcr Insulation Dcpth (inches)
FOUNDATION NVALL
Thic',cncss (inches)
Declaration
Li:ard N_..._
T is ...._, R csstar.c (R-Valuc)
B,—and— Name
Thcr:mal Resistance (R -Value)
T%e T:a! RCes:s.anu (R-Valuc)
I hcrC,y c2rti(,r t!13! tLC 3^0t•c IrsulatiCn L1 a: _._ 270•._ !oC3:IQn i:1
intra: E tCr2r,c� S,art,� r1 for rcsidentia! builc�.gs (Till_ 2�, °a- 5; Ca:i:anis Coi'c o,`Regula^;ens) as indicatrd en the
Cc i:i_at of Com; a; piic3h!e.
„
1!.-1 -s S;f2r n1rC, Ds:. JnSfa:!ir S:.b.cn 3C!or (Co. N3mc) C,
Cor.:nc'or (Co. Mrae) OR O -r.::
Date
S1', ...-. , Di: _
Scb:onL-actor (Co. lame) OR
Cc -:-.-a! Ccr.trzc:or (Co. Name) OR Own:r
Ir.s: ili Sc`cor. wor (Co. Name) OR
Cc -.=72! Ctrs:ictor(Co. Name) OR O•h-n_r
A -3v
0
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:
Use Classification: SINGLE FAMILY ATTACHED
47-818 GERTRUDE WAY U-13
Occupancy Group: R-3 . Type of Construction: VN
Owner of Building: MIRAFLORES, LP
—/--&4-1
Building Official
Bldg. Permit No.: 0203-240
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