0203-234 (SATT)H
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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:PS595 B Ca Pric
� W30103
Date J'0 '12 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.
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 �3TXfF BUND Policy No. 1603616.02
(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. Y
Date: Applicant
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) � %2/ ti f,?)& Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT - TRACT
134, TJ 28601
JOB SITEAPN
ADDRESS 47"852 (YERX',It�•i17IJE WAY
649-W^.045
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Alf ile F41�L' f }}f, LP
DLZ°X:;d., WC tiv!i DEWR"I C,'!`l37BiF,
74.16x013,10 STAY I11 4200
78-600IUGHWAY I I I
MIAN WELLS Cdr 92210
1"'t Quam. 0.251 922S3
(760)?71.3345 CB114 180
USE OF PERMIT
ONGLY Fe ULY AITAC:
SP.A - B11)(14, UNIT 7, PLAN 18, PERMIT DOES NOT INCLUDE
P001, SM i3Y,AX1,'.W.ALIA, Oil DPI%TFWAY 1 RPROAC14. 75% REDUCTION
IN PLAN CHECK FEL FOR Mt1V1'1PL3rr 1gSSUA14C OY S.R,R9T+; PL A►3 T ;+ PS.
TkAC a CONSTRU'C CION 700.00 911
:t mufft ) CO�;t' OF CONFINUC111170 ,
�k3.SD�E3.t�
CC'DN 13'RUd`HOW F E 101-Ot*4118.000 434,
PLAN CHWX FEE 101-00(1439-318 �ta.51
KEC'HANIC.AL x7F 101.-000-121.000 g34 50
ELECTWC A1, "M 101-004-420•.100 li�fi.ao
PLUMBI'3 O Fi1E 101.00(-419.000 %K50
S'fppfgC3�+t(� I OTION FF -E - M- YD 101-000-241-000 $3.80
K-R-"�C'�'3'.f L C 0 UC"ri� ON' 10am, PUN, C,HO X,
$2,180.31
1=3 PRE -PAW FMO,
PAY DIft
r a
2001
WYOFLAQUINTA
F1 1i DEPT.
'RE EIPT
DATE
BY
I DAt INAL
INSPECTOR
0, •
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL -APPROVALS
Set Backs
C9_
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— O Z
Return Air
Steel
Combustion Air
Roof Deck
16i - j, .o t. '97
Exhaust Fans
0. K. to Wrap
6 'd -a -e L>7
F.A.U.
Framing
40 . o 5>
Compressor
Insulation
S7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
•m •-
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Z 57
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) O.OL 57
COMMENTS:
I. SliLA T ION CERTIFICATE IC -1
Si,. 1• dr:ss
Description of Installation
1. R00=
�'a:trial �x�s
Thickness (ir.c=c;}
3
CEILING
Pernl: Numbtr
J�
dzz
A11Y 111 -in -7
P,csis:aace (R-Va!uc) 3
Bat: or E1arnl:et Type � �5 E:a Na -;c �� -, ��
Thick(irc`. s' ��" T:.:Ma. ^sistar.c (R '.aloe) X325
Loo_c Fill Type �B"--nd
Contractor's rni installed wcight/ft' A- lb �f:.^.iT�-t t ckncss 7 inches
Manufacturces installed weight per square foot to achieve Thc,mal Resist-nce (R Vel e) �2 - `)$
3. EXTERIOR WAT L
A. i.x�(s ax(o-4�Ic'wt o 3
Material s 3r2-nd Name LID ifl c 3 t � � 0- _
Thickress (inches) (06IThermal Resistance (R -Value)
B . Exterior u-)Cluo
Material ?C�t�s _ Bmrd `a..-ne
Thickness (irch2s) a' �:? Tr:e.^a: Resistance
RAISED FLOOR
M aterisl
Thickncss (inch: s)
SLAB FLOOR —ERIMETER
N.at�risl
Thic:kncss (inches)
Perir-.eter Insulaticn Depth (inches)
FOUND, -.TION ViALL
h1.atc: ia1
Thickness (in.chcs)
Declaration
i;:ar_ N_:n�
......II Rcsistar.cc (R -Valle)
BztaNae
T`,c,mal Resistance (R -Value)
i✓.�na Na...,.
T'l-2 .a; Res:s:an ce (R -V311 -1C)
1 here' -,y ecriry th3! t. -.L 3bovc irsular'cn ins:all_d in the 'c�::_.-- . _._ abo.e !oc3: cn M, cor.fc a ;cc wit% LSc ecrr.n:
Ererg,- Ej'icier.e� S;o�::.r� f- residenti3! buildings (Title 2:, °a.. 5, C:a•.i.cnia Code �`RegaLdens) as indiea�t-d on the
r
1112
It_n -s St,2n Ds,: Ins!s:lin3 Scb:cnt 3c'cr (Co. Nanc) CR
G: :_-sl Contractor (Co. Nine) OR Ownc.
�-a:_rc, Datc
S:; ...-. , D2._
fns:allia� Sub:on�actor (Co. Name) OR
Cancra! Ccr.!r_ctor (Co. N3mc) OR Oxr,:r
Ins:311in7 Sc`.con-3c!or (Co. Nang) OR
Cc.._.a! Ccr.,._:!or(Co. Name) OR Own..
C - r: , amu= 2..,, 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 47-852 Gertrude Way La Quinta CA 92253 08/06/2002
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:
Recommendations not completed by this firm
Signature
Cost : $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Estimated Cost: $
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.
AT21:0720030313
, 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: 47-852 GERTRUDE WAY U-7
Use Classification:
SINGLE FAMILY ATTACHED
0203-234
Bldg. Permit No.:
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
CR
Owner of Building: MIRAFLORES, LP Address:
Building Official
74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE