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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
7; 3 95 1 ca .M : 9/30103
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.
() 1 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&TAT1x FUNDPolicy No. 13 lfFllS-�
(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 tl ose provisions.
Date: f'•'Applicant
5-0 02- ,
Warning: Failure to secure Workefs' 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. r.
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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees. I
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 witK 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.
b
Signature (Owner/Agent) .— r t✓� <+' ��'✓ Date
BUILDING PERMIT PERMITN
DATE VALUATION LOT 0203-256 TRACT
B51 U9 2 601
JOB SITE
APN
ADDRESS 47-040, QXRTLI.t. M. WAY
M99 MG -04 5
OWNER
CONTRACTOR / DESIGNER / EN &NEER
1 J3� fLA1i,CDP"F3, LP
MID .L3.EX, kTC dba lu £.1ZT CITIC, 8 MV,
74 v 1601RG1:3:47d'AY 111 000
76.600 HKO-E VAY l i l
IAN UvXMLS) CA 92210
LA fd[MITA CA, 92253
(76q/71-3343 MR 2180
USE OF PERMIT
aThfGLE, xAMiL'Y AYEA.ACIMD
SPA - UL.DO o -y UNIT9, PLAN ,tit. d'aLKi>'111IIT DIDES' NOT ANCLU Dia
1'001, ON,, BLOCK WALLS, OR ,1',ji1,1VEMAY ,r PPROACl ,fit;%, TEDrUC iow.
iN PL A I CHECK ME, E FOR. MUL`9'ii'il E VSS1SANCf, OF SAME PLAN YPE,
TRACT C:Oi'aO'f:RUCTION Q;!?ft S&F,
E 1�M`6.". I) COV Uri, MIXYL 11'CMO
361010M
'm"A ty
CONSTRUCTION FEE 101.000.418.000 VAMP
PLAN CI'iii:CK FERC 1 O S -000.439-31 5 .51
VELI MICAL"U 101.000.47.1.000 SASO
ELLE,C'R RICIAL VEZ 101 -OW -420-000 08.00
PL UMOM0 ;#71E. 101-000-419-000 MIN
STRONG MOTION r-'f;E . USID 101-000-241-000 $3. K)
DEV}1'LOPER,1n5PACT ME - s1;"MIXI
R
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:3I &T( NAt OD11=0 C1.iC' N AMI MM3 Ct `..K.
LHISS TlmZ _PAM IMJ
1$0.00
AY U• 3 2001
c1TYOFLAQUINrA
R7NANCEDEPT
RECEIPT
DATE pA :
BY /::
DATE F ALINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — —
Underground Ducts
Forms & Footings p
Ducts
Slab Grade
Return Air
Steel 4 -- ..
Combustion Air
Roof Deck —o Z 57
Exhaust Fans
O.K. to Wrap
F.A-.U.
Framing
Compressor
Insulation - 31.a z,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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 Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection a� ,a 7
Encapsulation
Gas Piping
Gas Test
Appliances
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
i;
Final
Utility Notice (Perm) 5z
hj
IN SULA T IOC' CERTIFICATE IC -1
Sitc Addr_ss
Description of Installation
1. ROOF
Thickness (ir.cr.cs) 1 J r r
CEILING
Perml: N'umbzr
Ti;.r ,,-1: Rcsis:zace (R-Va!uc) 3S
Ba:t o, E.ar.'.:et Types 7.,�fj E:� �' Namc od(L(
Thickr:css (inc`.:S' 13 r' Thelma'^sistar.c: (R '.aluc)
Loosc Fill TypcErand . ')
Contractor's r -::i installed weigh /2: )C lb Nfinir :n thickn.ss lb_ inches
Manufacturces installed weight per square foot to zchievc The=nal Rcsista_rce (R -Vale) 2
3. EXTERIOR WALL
A. b!,{ii^' t.XS c� o�X(p—�C'Wlo 3
Material L. S 3rzrd Na= c >>1X�� 1(]_tClc )c 0- _
Thicicr:ess (inches) Thermal Resistance (R-Valuc)2
B . Exterior LLiC U.o r,
Material P-)ca�5 Brar.d Namc ;c _l..( T
Thickness (irchn) 3�— T ermna: Resistance (R -Value) - 1�
RAISED FLOOR
;✓;,l!er i�l
Thi6cricss (inch. -s)
SLAB FL00'Z'PERI`fETER
M atL,:isl
Thickness (Inches)
Perimvcr Insulation Dcpth (inches)
FOUNDAMON ViALL
iti1.atc. ia!
Thic'tcncss (ir.chcs)
Declaration
T i:c:-:ai r.csistar.ce (R-Valuc)
B, -2,1d, Name
T<crmai Resistant: (R -Value)
Tr.e=al Rz:s:S:anc! (R-Valu'c)
I hcrrby CCr: Ih3! t:._ 3Jovc lrsulation .tits ins:3lied Ln th_ .. _:!=.-.t 3: _._ 2�o-.z .oca::c❑ L5: e'aT.n.
Energy E rciere�S,ar •Y --I far residen(i3! budd•i .SCs (Title 24, Pa- 5, Ca!i:oni3 Cod-- ); Reg_la :ens) as indica"•d ca the
Cc: il5z t: c'CO,T.P!t3'C W _.. Z��i1::.15!=.
COS
Itcst S ' f -._, Dare lnsta,lir:z St I.cnr3e:er (Co. Name) 0:
Ce :=ral Ccc:ncror (CO. N3rie) OR O'-r.c:
FC., ,-,
Date
Sid ..._. , D3._
l s:ailir.g Sc�:ontr-3ctor (Co. \3r -,c) OR
Ceacra! CCCti3c:or (Co. i 3mc) OR Owr.:r
S'l:'con�-3ctor (Co. Nara C) OR.
Cc^�-' Ccr.;:s.:or(Co. tia;;,c) OR Oµrrr
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 47-840 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 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:
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: $
r ---
70.00
0.00
0.00
i
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,Califomia 95825-3280.
AT21:0820030313
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:
47-840 GERTRUDE WAY U-9
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.:
0203-236
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