0203-239 (SATT)LICENSED CONTRACTOR DECLARATION
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
l�fJ Professionals Code, and my License is in full force and effect.
0 CY) License # Lic. Class Exp. Date
r- LL1
r- 768395 B C 8 1A
oZO Date1-J. -40 Signature of Contractor
r- U C) OWNER -BUILDER DECLARATION
W W r I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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).
+ cY) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O N
Q WORKER'S COMPENSATION DECLARATION
C) 2 Z 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 LL. compensation, as provided for by Section 3700 of the Labor Code, for the
Oro � Q performance of the work for which this permit is issued.
Q C> (,' 1 have and will maintain workers' compensation insurance, as required by
Q C) Q Section 3700 of the Labor Code, for the performance of the work for which this
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier SUMS FUND Policy No. 1603616-02
J(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: t-
� '(o !✓ Applicant—
Warning:
pplicant Warning: Failure to secure Workers- compensation coverage is unlawful and
shall subject an employer to criminar 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) I.• • it YA . f� Date G �A -0. �.
- BUILDING PERMIT . PERMIT#
DATE VALUATION LOT ' TRACT
136,Ui 2 2i3s 01
JOB SITE
APN
ADDRESS 47442e4 f-ERTR>rME Wk' Y
649...97,�i,1 AS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
By iA kZ :. I,1r
1�CD DEW, �, dbru S:�,URZ - t,.,,E" T_ > DEV.
74.760 MSxX•ii➢JA,Y 11.10240
7€ -600 HIGHWAY I 1 ?
INDIM WEDS CA 92210
LA QU1NTA CA 92253
(760)771-3343 CEIL0 2180
USE OF PERMIT
8—OU? FAMMY.F!'3TACIED
SVA,,, BI.M 4 U141 t' 1.1, PLAN IA. IdP,3 MIT DOES 140T rNCLU.0X
PO 04 SP& .t IA)CK VVALM. OR DRWKWAY APPROACH, 75% RlE1i1'CMON
111 PIAN CHW* ftZ FOR MUI;rl?LL ISSC3.7t14CF. OF SAME FLAN TYPE
TRAI.'I' CCN:1`I UC ION 7000 SF
(€ RACIFYCARPORT 3'/3.810 SIS
A:.1.i J.YRd",8.Y`l.ID '1--L./n, (.k' ('110M.k.C4.1. r-MOd'Y
�8�yt7.+�w1J�i3'
7ryiMI1iM FIT Glubiwakill
C 014STRUC;T J.ON .FEE, 101.000.418.000
P1,AN `HECK FF., 101-000;*439,•31$
MUC°HAINIC'..fl IL FR9 101.000.421..000 sn.50
EIACTRICALL, "KE 101-000. '620.000 $65,46
P1.10b4MC1.1,7BP 101-000-419-000 U9.50
ST1'.01`-40 MOTION �M w RESID 10) -000-•241-000 U.33
D3I6TL:I,4.>i EIt IMPACT FRE 9x,569.00
SUS -10 AL C`;OA�7t`�'t3C,710)4 AND Ir.I)1 C1-7 ,'K
$2,243.34
- ISM PRY -PATO MUS
�ie�.0i7
Y1r1. L 3P]MWr.MES_ DUN NOW
$2,243.34
_ MAY 03 loy
CITYOFLAQU1NTi4
FINMCEDEPT
RECEIPT
&- 02.
E
I DAT51NYLED
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
p .
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
o i
Compressor
Insulation
/ • O Z-,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Tilt rav
a y6 -o s. Tj
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
U.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
o ?_—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
EL CTRICAL 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) /,? p Z
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 47-824 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
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
• • u • r•ur • •� r • •• • •.r •� • C•. • •�
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.
AT21:0820030313
IN'SULATION CERTIFICATE IC -1
Sitr A a --",S Nrml: Number
�7OTisJ�r/!.
Description of Installation
1. R00L��
Thickness (irc'.cs) NJ r r T;::*,,2. Resis:arca (�-Va!u:)
2. CEILING ;�� �
Bat: or Elar:';et Tyre s' Y. i Era -d Namc
Thickncss(inc` s` (3" The:. ^sis;ar.c (R :aluc)
Loo.c Fill Type' Cc t) Brand , /1 DOa'l i'�4 l
Contractor's I'i- installed wei3h /2!= �lb �4ini ^� t:sickness ?Zinches
;tilanufacturces installed weight per square foot to Zchivve The.—.nal Resistance (R-Veluc)
3. EXTERIOR WAW L
A. ` t,Jyl�-c-�lS
Material La',t�t,1 --) Br2-nd Name Mi [ r �,� 0- _
Thickness (inches) 6/q Thermal Resistance (R -Value)
13. Exterior U...Cjko
Material Br•Lrd Name t �
Thickness (inches) tea' O Ther -mai Resistance (R -Value)
RAISED FLOOR
Thickness (Inc`. -s)
SLAB FLOO.%?-7RIMETER
;v`atenel
Thickn,--ss (inches)
Perirnvc: Insulaticn Depth (inches)
FOU\DA-.TION NVALL
\latc.ial E. -a-.' Via:n,,
Thic'u c s s (inches) T .ez a' Resis:arca (:'.-V3lue)
Declaration
1 =r: --y CC'' Iha! !:._ 3JCC'C IfSL13[7Cn 1v1i lns.3l1eC lrl C_.!C:',s ]: -._ 3�J'•7 !OC3;;Cn I1 CCr.�C 1a3Ce WItl1 Cie Cu'rr.n!
Ererg,. E-lef;c� Sror'.-1 fJr residentia! build -.,Cs (T itl_ 2 , °a- 5, Cali:cni3 Co o: Rc3ulaCens) ss indieat-d on the
CC;:1.1:3t:: C°COmrl13` µ a. plicabie.
S,i2r _._,Ds' 1-5:3'.11 Z SLC 1 � 3,:'C r (C 0. M ri 0R
!y
Ger.cral Ce-t�:'Jr (Co. Aare) OR Ownc:
Date I-,:2ilir.a, SL!b:onsacior (Co. \arc) OR
Ce -c: a! Ccr.:rae:or (Co. ; 3mc) OR Own:r
Da._ Ir.s:3i!i-; S -`--CO=3c'or (Co. Name) OR
C, 2! Ccr.::.::Jr (Co. `.3 ,c) OR Owner
C_� c i
C.—. -,-11 ..csistar.c Val'-uc)
B,2nd Name
T<,cr:,,al Resistance (R -Value)
I
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: 47-824 GERTRUDE WAY U-12
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-239
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