0203-256 (SATT)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
768595 71 CS Hic 9130fU.4
Date Signature of Contractor
I
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 S'TATiiFUN D Policy No. 1b030ki� G�
(This section need not be completed if the permit valuation is for $100.00 or less).
/1 certify that in the performance of the work for which this permit is issued,
1oshall 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: -- —v Applicant �-,!� -j9±l 11-T?P
;�e
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)
Date �•--+��
BUILDING PERMIT PERMIT#
DATE VALUATION LOT !'!"- TRACT
5 /, ��� � ��ii 131S1T29 28601
JOB SITE APN
ADDRESS 47-845 GY,12TI MN WAY (A9.0..34'035%
OWNER CONTRACTOR / DESIGNER / EN (NEER
MMAFLORW, 1,P
74w'760I314iUMf'R` -1 I 1 #200
=LW 13vMLS C>A. 92210
USE OF PERMIT
SUIRG is FAIVM "
DC ✓ DEV., IN c dba tvils`Lrt c `4'R ms DEV,
78-600 HIGHWAS I i 1
.T..A. QUINT. C11. 922$3
(160)771-3345 f"BI.=f! "neo
SIVA � OL�it V. UNI ?91, PLAN IA . PF;.PMkT DX= NOT INC:LUM.
P004 SPA, OLOCI -WALL,% OR illi:tV13WAY APP13OACH. -75% RI?iDUCTJON
IN i''1.KN CHRCK FEZ FOTO MU1,?1PtX ISSXI A'NCR OF SAME PIAN TYPE
TRACT OONSTRUCTION iftoo 3F
C)"iADFUCARtPORT M. .00 S I?
EM dJ.9'i['JA.6'ID C()k7R OF (11O SI4.0.'416. d A.\.I'AS
4-5,2110,80
qy •p�q p y,.
,Y-�i1,iVa1.A..S:I7�fLOY IJ-'Y1U.'��
CONSTRUCTION PRE
101-000-418-000
$138,50
P.W4:.:ir'1ECK PEE
101 -WO -439-318
MS.'S
MECHA:MAIL FFIE
101-000421-000
MD.%
PI.EVrRICAL EEK
101-000-420-0-00
3165A6
PL1JMMTHO
101.000.419=4300
W."30
STRONG MOTION FEE • RM1D
103.-0,00-241-000
VA. 153
DEVEWPER IMPACT FEE
v,560.0o
Rt.3B-T WAL C'C111WRXIMMON AM PLAN CH80C,
MAY U 3 2002
CITYOF La►QUINTA
PERMIT Fns My, NMI -
BYI D 3%Ni Igo 3
�� �f INSPECTOR
« /
S2,24134
$0.00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ oZ
Underground Ducts
Forms & Footings
_ S o
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p . . o Z S7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
- - Azo 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
/ , p y ,T
Drywall - Int. Lath
v
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P1bg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines jJ
—/gyp
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�L c>%
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final
CO MENTS: �3d
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)
�� �p
INSULATION CERTIFICATE IC -1
�itr.�c�'rss
Description of Installation
1. ROOF:, 1��
6�Z .li� S
Thic:<nes� (in,.::cs) ,j'(
Nrmnl: Numbzr
Qrin
T,::T.;i;_. Rcsls:ince
CEILING
Bat' or B!an:•:et Type :"y'lk--D E:s-a �a "n
Thick*:css (r•c'-s` 13" The �* 3: ^satar.ce (R- :aluc)
Loosc Fill Typc' ,-)t/1\ Brand
Contractor's t~i ir.s:allzd wcig`!/f'' k-- 1b t'.f;cncss lQ- -;� inches
Manufacturees installed weight per square foot to achitvc T;.c.,,,al Rcsista-ice (R-Veluc)
3. EXTERIOR WALL
A. �, t,, ,LU, c- X(O--PiC'�-i'lo ' -' 3
Material V.--�-s Brzrd Na -c i
Thicicress (inches) _ — l hCrrnzl Resistance (R -Value)
B . Exterior I,tWG.LO
Material PSC. S _ Br ---d Name
Thickness (inches) T::e.^a: Resistanc_ (R -Value) `(� - (?,
RAISED FLOOR
.'+r. peri al
Thi6cricss (inch. -s)
SLAB FLOOP)HRINIETER
?v: ate:isl
Thickness (inches)
Perir-.e'er Insclaticn Depth (inches)
FOUND.=.TION %VALL
hSatc:ial
TY.1c'u:css (ir.chcs)
Declaration
B:_..- \:..._
T:......._, Rcsiscar.c (R-Valuc)
D, -and, Name
T<cr:;,al R^ !sistance (R -Value)
B aN
Tl.e:r.:a! Res:s:3s:c: (R-V3luc)
I h:r:cy ccr.;'5 • th3t l�C 3bovc irsulahcn `.v13 lr:s'31i.d Lrl !l :! J -.< 3'. :oca::cn In cCCLC"la,,cc w::h t.SC
Er,erg:. Ej-tcier.e/ Sroc .-r; for rsidcntia! builzii:,gs (Title 2-, '3 6; Ca!-, Code J: R:gaL ens) as indieat--d ca the
Cc l:..3t c`CoT�',
(CJ. NJmc) CIR
:7:.!'7i r (Co. A3rae) OR O•A•r.:.
Date
1-s:a!lir.g Sab:onsactor (Co. lame) OR
a! Ccr.:rac'or (Co. N3MC) OR Own:r
Ir.s: Ili-� SC'CO=,ICCor (Co. Namc) OR
C 2, Cc,-.t.3c!or(Co. Nam".) OR
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 47-845 Gertrude Way La Quinta CA 92253 08/08/2002
INSPECTED: CO. CODE 33
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:
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: $
Inspection fee : $
Others : $
Total: $
7O.00
0.00
0.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performed on this property in accordance with Structural Pest Control Board Regi lations.
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.
AT21:0920030313
, 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:
47-845 GERTRUDE WAY U-29
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
VN
Bldg. Permit No.: 0203-256
Land Use Zone: CR ti
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE