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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
7685%5 B ca MCI, 9130103
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.
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 SMATZFUND 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:
Date: 5 1 Applicant 1_� ✓-+- Aa,e4 G
f a t.
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.
t 1 ti•
Signature (Owner/Agent) Date • ^-f�""l'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203'232' TRACT
$45,420M 4s US �kiC*ti 1
JOB SITE
APN
ADDRESS 4I••064 G11=Yi'171 WWAY
619.0.1%)_ 4.5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
M2A MORF,B, LP
1)U1) mzv., nic &a lCfnsM. --I C ufl-,s I)E-v ,
'74-160 PAORWAYA11 11200
78.6001I1canuFid I31.
W1DIAN WELL CA 92210
ul, QTJWA CA. 922N3
(760);71-3345 MDR, 2.180
USE OF PERMIT
, • UL.D30 3., JA IT5f PLAN 1A, PERMIT fyfJl. S HOT INCLUOK
P004 SPAb I3WC<1;:'bi1'.1 AIA- cel `)RUMAY')V1'PR&CF1. 1X14 REDUCTION
IN PLAR C,•MCK RE FOR M ULTIPLX ISSUANCE OF SAME PL.A14 TYPE.
TRACT C'ONS'TRUCTION W. Do Sf
yARAc 1EXA11.3rORT 31/310 IST
V sF"�1VI'i: rED (110ST OF COO UCTION
45,320,861
P110.1i:1T 1:':;01, S1'SMM%I RY
CONST RUCION kh119 101-400-418.000 1;388, 9D
PL" CHECK FEE I01a000-439-:718 SA1.85
VIECHANIC:AL nu 10I.000-421.000 $39.50
yfitJ.:t✓9'3:.iCAL 112 '101 -000 -420 -OW $65.46
PLUIVI1 THOFER, 101-000*419-000 128,90
S` RONO MOTION 1x81? - RESf0 101-000-2011-000 $4.58
1)C!V FWPER IMPAICT FEE
WB- 101AL cGCy1•P kl'ycllo)m AN13 PLN CARC:K
$ 2,7A3.34
IMS :t''k�.'!1-PAM MIS
$0.00
:";PIS' yMIS DUA. ,NOw
;2 `
MXY u 3 2902
WYOFLAQUINTA
FINANCEDEPT.
RECEIPT
DATE
BY
DATE F ALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— -
Ducts
Slab Grade
:-r- Z
ReturnAir
Steel
Combustion Air
Roof Deck
4i 37
Exhaust Fans
OX to Wrap
Z $7
F.A.U.
Framing
L
Compressor
Insulation
142 - —s-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
L S7
Drywall - Int. Lath
- •Z 4r---
�Oy
/G uJ
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
7-5(2-o2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
�a. 46 o --
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) 7i 7
COMMENTS:
,
71
_ .0 - --
INSULATION CERTIFICATE IC -1
Sitr A n•ss
Description of Installation
1. ROO;
Thickness (ir.c-cs)
CEILING
Perml:.Numbzr
T;: Rcsis:zncej(:�Na!ue) 3S
$at: o: E:anket Type Ulk�`D E:ani \_:,c a .n ()& LQ
Thic'u:css (inc'-s` l3" Th,t=a. F6sistar.ce (1 -Valu
Loo_c Fill Type �Cc t� -rand nA 01:t'1 �4-t
Contractor's rni installed weight/f" Xlb ....... '_ n t kr ess lQ_ inches
Manufacturces installed weight per square foot to achievc Tl.c=nal Resistance (R-Valuc) Al
3. EXTERIOR WALL
A.ax(o—Pic'wt o .3
Material *?Y__) 3rartd Na -c UO Al t) t � � O
Thicicress (inches)'%�— Thurnal Resistance (R -Value)
13 . Exterior huClao r
Material 1�G.S _ Brand `z:::e('t T
Thickness (inches) T e.^al Resistance (R=Value)
RAISED FLOOR
�1:;iteriai _
Thic:cncss (inch. -s)_
SLAT; FLOOPUPERINIETER
Thickness (inches)
Perirnce ce Insulaticn Depth (inches)
rFOUND.A.TION WALL
itil.atc:ial
Thic'cncss (ir.chcs)
Declaration
B ar.. N -:-e
T:. ...._1 csisranc_ (R -Value)
Bznd Name
T<ermal Resistance (R -Value)
I✓. an. \'a...,.
T%-!=.ai Res: .an C: (R-Valuc)
I hereby ccraf,r that t�_ 3bovc irsuIa6or, %, -as Ir:S:ali_d Ln th= `_ u 3: _ IOC3::On la C011, 'IaaCC with LiC Cl=cn.
Ener ; FJiciz,:Scor 4 d for residenti3i buil i-.grs (Title 241, -a- 5, C3!;:cri3 Co": o. ?U:g_la,`,im) as indieat--d on the
Cc:'i:i_at;: Cf Cl_,; ianc , u applic3Sl:.
(C3. Namc) OR
Cc,-.:. �d Con: -3z -or (Co. TNarne) OR Own e-
I:c:n
Date
Sid Dat_
!-;:ailing Svb:on^Lr=oC (Co. 'Name) OR
Cc-cral CCr.ii!C:Or (Co. i 3MC) OR Owner
I7a:alli;.7 __..0..:.3c!or(Co. Name) OR
Cc.. -.a! Cc,.t.a-%Dr(Co. Na„ �c)OROwner
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 47-864 Gertrude Way La Quinta CA 92253
INSPECTED: CO. CODE 33 08/05/2002
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
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 t`
the Structural Pest Control Board at : f
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.
AT21:0720030313
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: 47-864 GERTRUDE WAY U-5
Use Classification:
SINGLE FAMILY ATTACHED
Bldg. Permit No.:
0203-232
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
Building Official
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE