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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
768591 �< R CS I41C / 9x0/03
Date ,_per_ m ' Signature of Contractors j
�l
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
Sec I. -
on 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 "$ PATE VU-k1O Policy No. 160.306-02
(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—
Warning:
pplicant Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the ;Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter:Upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) —' -A 04 J!4 Y Date t� -i
W
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203-237 TRACT
. )'- 1,.. • WRIO)w WIU10 215411
JOB SITE APN
ADDRESS `i7 -M. Cti�"O ERIME WAN' � 649-0304M
M
OWNER CONTRACTOR/DESIGNER/ENGINEER
iewAn,C%IOW, LP 'D(.:D ID V., WC 0yE} x)FV.
74.7601.110 WKf311 #200 78.60019Cs.21WXY. I11
IkY1 lAAt�l `4"1IrE , ch 92210 1_4. Q23:@d'1A CA �Z2.53
(160)771,,3345 (T -VI 2160
USE OF PERMIT
5011.iY1R1 JiA1GiLLE:iYAMC57. )
SFA- i3I.,DO.5„ UNIT I0, PIAN IB . PERMIT DO&S NOT )NCLU
P001, SM f11.C1(:K'Vr1':ALIA OR fait.W1AY A:1'1aROA.CU '6% C ION
Rid PrJUR C,Hl C"1 ' FSE FOR MUVr)PIA, IS0U.AJ-ICI, OF :tAMIW� PI..P►N TYPE.
TithCT CONSTRUCTION 100.00,11F
::,d°�'l1V.FA.' :(1,3 C:C;'n C�'.Ef.' Cf�:C1'1�'"��RUC'�'1QN
d-,smJ�>J►.�N_i
(�' '�'$',�
.�.�r UMIT moi, ~ S�✓MIAMY
P
('1101 lYRUC"T3L)I.11I S
€01.0100.418-; 00
$:143MI
PLAN CHECK FIDE
I Q 1-ClDO-•� SSI 3 a$
�is�. � t
MEC1iANICAA. PER
101-000-421.000
$34.50
E.LZCTRICA1, FPt
101-000.420.000
$'.i�;.0a
PI,UAWHO PER
101.000-415,4x000
M—to
STRL J40 MOTION FE R - RESM
101-000-241-000
$ 3.so
i. gFs"ii'EI,C.yP&P..WPACT FRE
IST ~- 1'AL. Ceti ;3TRUC'ii"C�A �,� D :i�y3, AX i ZR�, x'2,180.31
to
3 2002 Fmr• s Duk' Now V._180111
LIQUINTA
CEDEPT
RECEIPT DATE ? BY: DAT FIN ED INSPECTOR
�
r,�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Q
Underground Ducts
Forms & Footings
--
Ducts
Slab Grade
Return Air
Steel
--
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap-
• p 2
F.A.U.
Framing
/ •� Oz Si
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
6_ -7
DII - Int. Lath
TiG
Art
9
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
— gyp,
Neater Final
Water Piping
Plumbing Final
Plumbing.Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
,Q7/
Encapsulation
Gas Piping
Gas Test
Appliances
;X_ j
Final
COMMENTS:
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 t 607
Utility Notice (Perm) . .O j S r
- - -
INSULATION CERTIFICATE IC -1
:z A?'ress
Nrml: Numb,,r
Description of Installation
1. ROOF
Thic:<r,-SS (ir.cl.cs)
CEILING
Ti:cr,,,_: Rcsis:sace (� Va!uc) 34�
Bat: o: B!an':et Type
-Z (U
�� .1'1 (�L(�c
Thic'kncss (inc`.-s' ^sistar.ce (R'luc) �1
Loosc Fill Type j`CC �t� Er -rd /I 06 - '!
Fay-<,
Contractor's r -i- installed wcigh:/7:' _lb�firir^�-t t:tickr,:ss ld_ inches n
Manufacturces installed weight per square foot to achieve Thc.—mal Resista_�ce (R-Valuc)
3. EXTERIOR WALL
A. Jte�( LY t,;Xt S c7
Material UY.L-,1 _s 3rand Name aA'kz-,-, U10 A-1 c '� c 0. _
Thickress (inchcs)— Thermal Resistance (R-Valuc)
B . Exterior tA!_)C ao
Material Bard Name�-
Thickness (incht:s) 31/__2 T enmai Resistance (-c-Value) - 1�
RAISED FLOOR
;✓::iter iai
Thic:cncss (inc`-ts)
SLAB FLOOR) ERI`IETER
M,3 t L',- I a I
Thic ncss (inches)
Pcrirncter Inselaticn Dcptl, (inches).
Yid FOU\D,=.TION %VALL
�` hlatcrial
Thickness (inchcs)
B, nz� \:..-_
Titc.- si Resistance (R-Valuc)
Banc Name
T<cr. ,al P.esistance (R- Nalue)
✓.Sr.4 �:......
T'.—!=-: Res: s.ds:c: (R-V3luc)
Declaration
I h:rr-.y ccr::Cy th3t L:_ 3,7ovc insu131:cn `vas Ins:ali=d Ln C_:!=.-- 3: ._ _,Lo•._ !oc3:ien in coni., _ w; 1h ti: cL'rr:'
Er,era; E„7iciere/ S;ord.r� for r:siden.tial buildings (Title 2 :, t,-6, Ca'i.oni3 Coe. �,`Regala {ens) as indica"_'d on the
C^a1:: CrCOr^.�!:3'C
r
SL':entr3.tor (Co. N3n-) GR
Cc :crel Cort-3ctor (Co. Nine) OR Owne:
I:c:n . ,
�. a:L1fc, Datc
1-.:allicg Sc':_ontractor (Co. \3n:) OR
C: =rat Ccr.trac:or (Co. N3nc) OR Own:r
S: `_concrwor (Co. Nanc) OR
C .._. a! Ccr.,:actor (Co. N.3mc) OR O%A-,-, ---r
A•36
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 47-836 Gertrude Way La Quinta CA 92253
INSPECTED: CO. CODE 33 08/06/2002
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 dace : 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:
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 1L1Ly in accordance with Structural Pest Control Board regulations_
Signature t
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
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: 47-836 GERTRUDE WAY U-10
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-237
Occupancy. Group:
R-3
Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
Building Official
POST IN A CONSPICUOUS PLACE