0203-259 (SATT)LICENSED CONTRACTOR DECLARATION
U I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O j M License # Lic. Class Exp. Date
LU; 76,8595 ncawllp 9130103
oZ Date �+- �r - Signature of Contractor
O rl ..
J U
C:) OWNER -BUILDER DECLARATION
HUJ r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
W License Law for the following reason:
Z_ ( ) 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
L
O N Date Signature of Owner
Z WORKER'S COMPENSATION DECLARATION
CL
'9T CD I hereby affirm under penalty of perjury one of the following declarations:
U') � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q I have and will maintain workers' compensation insurance, as required by
p V QSection 3700 of the Labor Code, for the performance of the work for which this
0 H permit is issued. My workers' compensation insurance carrier & policy no. are:
oo Z Carver Policy No.
KYND
KD 46a Jdl -fl2 .
(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 all 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
3I subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with,those provisionsate: A licant C~�� - %� 1rn Al�
Warning: Failure to secure Work' 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 complyy 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) ` �.• -fA0 �� 19V Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (W3 -2+5D TRACT
JOB SITE
APN
ADDRESS 474W �C?'r + TRU.D : WAY
6'"�9 x-'04 9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
744? 60 HIGHWAY 111 #200
78.6010 MA'3HWAY I I I
INDIAN WWI; CA 92.210
LAQUNTA, CA 92253
5Cj17Y.,3a4 CRUf 21 so
'
USE OF PERMIT
AT11.4.0 ID
S�'.A. � .F;,.:iBGLIt� T)'t+fi'I7' :i�, k�l,.t•2�1 Iii . I�TC'`fLAlT!'P LiC711i:5'�4Ct'e TT`tCTA€I1�1v •
POOL, SPA, OLOCK WAU,+.Off: URXiP'EWA APPROACK 75% U DUCTION
TN PLAN CHECK TE�.Tw''. FOP, T<JF'1 LTITa'U.". ISSUANCE Or SAME PLAN TYPE.
%atAVI' CONSTRUCTION 700,00 SES'
k?'it�8Ell d'FRT, 1MM'"Y
C ONST PUCTICYN FFE 101.000416,000 $xAUD
`mdiw clim. Irpm 101-000-439-318 1.78.$1.
AA$C'.WfICAL I`E 9 101-000.421-000 $39.0
ELFCTWC L. FSE 101-000.420-000 $59.00
PLUM1 YHORFS: 101.000 -419 -WO 1181.50
STROVID MOTION Tr Ut • REMD 101..000.24 a -000 $3.901
DEVELOPEi. IMPACT FFR $1,560.00
z ti�iJ13=1 t'. X155:. t.'IG4Id�1:T�:vSC�.IC�1+1'.Pi�?E✓1,1F�...�,,3� C'.�i't.,�°TC
�"2,t �(�.3I
MAY U 3 2002
MYOFLQUINTA
FIN ,
RECEIPT
DATE _
BY J
DATE INAL D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS "
Set Backs . $ dZ
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel — --r9L
Combustion Air
Roof Deck / -o v
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 / - t!o • 0 2— ,$ 7
Drywall - Int. Lath y 7
.o L ST
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 —Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection
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) / O • 0 ?j s
COMMENTS:
INSULATION CERTIFICATE IC -1
ritc Addrns
Nrml:.Numbzr
Descriptioii of Installation
1. ROOF
i
Thie<ness (ir.c}
Reds:!Flee (R-Va!uz)
CEILING
Bat' o: E!ankvType
Thlc'kncs- (Irc- -s' l� ri 1Ge:'T:'_-' ^sis:ancz
Loose Fill Type jErand
Contractor's r -i installed wcighyp: k- )b
Manufacturces installed weight per square foot to achieve T;.c.rmal Rcsistazce (R-Valuc)
3. EXTERIOR WAT L
A. �)t �e�tL,/ t,.X ' S c-'> o)X(o—P\Cw>e� "2A3
Material i6(Lft� Bn-nd \amcL Uin ACU) c � ( n . _
Thickress (inches) Thermal Resistance (R -Value)
B . Exterior t,tiC•l&o
Material y�G� S Brzr.d'Name (t l L
Thickness (inches) 17/70— T e=ai Resistance (R -Value) - 1�
RAISED FLOOR'
N:aterisl _
Thick-ricss (inchn.)_
SLAB FLOO?UHRIMETER
iv�at�risl
Thickness (incises)
Pcrir:•.ctcr Insulaticn Dcpth (inches)
FOUND.'.TION ViALL
Ivl.atc:ial
ThicI'm css (iP..cr:cs)
Declaration
B, and Na:- e
T i:c-- si Resistance (R-Valuc)
Band Name
T; czmal Resistance (R -Value)
B-3r.a N27.—,
Tr.z.-m. a! Re S:s.ince (R-V31uc)
1 hereby e-r.:Cy tha! t _ a-,OVC irsular,en ..-a, ins!al!--- d in the c _:!_:-- 3: _.--- 2` o•. - !oca::en ... ccr.IC.Tna ,cc with t.5c e-rr....
Energ; Ej-tcierS -1 1 for r_sideneia! buil^'i-.SCs (Title 24, =an S, Ca!i.cmia Code : iZeg_l_ ens) ss indiealt.d ca the
CC::1!ICatc. C`'CCrr��:3-- µ ;lppl:c]Sle.
Ds:. 1-,!a11irSLb:Cn'; 3.:Cr (Co. Nam-) GR
Ger_r31 Coct-3:ror (Co. Name) OR O•++r,^_:
rC. D3tc 1-..allirg Sub-on-=m:tor (Co. \amc) OR
Cc -:hal Ccn!rac:or (Co. ; amc) OR 0•x•ner
S!, t DZ!Sc`c,,= 3c:or (Co. Nano) OR
0:-^"I (Co. Mrnc) OR 0,A -r,, -,r
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 47-821 Gertrude Way La Quinta CA 92253
INSPECTED: CO.CODE 33 08/08/2002
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 : 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:
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 : $
Inspection fee : $
Others : $
Total : $
Estimated Cost: $
70.00
0.00
0.00
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.
AT21:0920030313
, 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: 47-821 GERTRUDE WAY U-32
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-259
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
Building Official
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE