0203-253 (SATT)U)
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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
78�5�'S 13 E;8 k1:4C� �i3�"0�
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 I1'ATT FUND Policy No. 1603616-02
(This section need not be completed if the permit valuation is for $100.00 or less).
I'/f I certify that in the performance of the work for which this permit is issued,
hall 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`. v
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. G'
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, inde
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and v I
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancelle i
I certify that I have read this application and state that the above informati n is
correct. I agree to comply with all City, and State laws relating to the bui Jing
construction, and hereby authorize representatives of this City to enter pon,
the above-mentioned proPe'rty for inspection purposes.
4.
Signature (Owner/Agent)- �� �� %- Date
N
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 02CL 1_2+5;1 TRACT
JOB SITE
APN
ADDRESS 47• 01 UDE WAY
649-0,40-f.2
OWNER
CONTRACTOR / DESIGNER / ENGINEER
mmal C a;, u,
nCD BXV.,1.9Ca dba 1NJS8I j11 C1Tie8 DEV.
74.76011[011WAY 111 #200
78.600 WGREWAY I I I .
INDIAN WMUR CA 92210
LAQuwt, CA 92253
�t3 71 • i�4 3 C:1r; X 2180
USE OF PERMIT
SPA a 113. V. 1% UNIT `d6, PLAN IS , 1}E9MIT D01010OT [NC".L'.UDE
P001.4 911,A, ,B1k " K,,WAL,i,% OR DRJV t'',%VAY" :VPRC?ACH. 15% RI:,UUCTIOt1
IN PT.AW CHECK FETE IPDP, Mi31,TI.PL E, ISOUANCE OF SAME, PLAN TYPE,
TINCT CONSTRUCTION TION ",70.04 UF
E8'1°11V%( TED COST OF CC3N.S":C;R63C;'110K
:3i3.d3kY3dIi�Y��>'s'�j
C`•ONSTRi.+t':3'1.ON ftYr, 103-000-410-000 S343100.
PLAN 01FLA ME 101.000-439-318 .5.1
MECHANIC.AL, FM 101 -000-42"1 -000, S39.9S1
ZLECTRICAE, FEE 101-0001 420.060 $59.00
PL,trM SM0 NEMA 101.000-41:1.000 5st50
STRRONf3 MOTION FEE - RZ31D 101-000-241-000 S3.ii
Elp '"VEWPER. IMPACT FEE SI,5ts9.410
ry+ .
'SETS. -TOTAL 0014 =XYCY10X AMD PLAN 03DWX
u,180.,n
YZES PRE -PAM 171M,
$0,00
d TW.3L^JL PKMft'.TFfZ1CD1N. NOW
NA, Y � 3 2002
(C F W QUI
FINANCEDEPT
RECEIPT
"'
BY
DATE NALID
INSPECTOR
UNI.
�„
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
$T
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
— wiz
ReturnAir
Combustion Air
Roof Deck
p - j, 0 2 5T
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
O • o -,p Z_ 57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-o C_ St
Drywall - Int. Lath
t. a z. 5
Iil7`7iG 1�✓
Sao • (6 - a z S 7
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
I
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
1.2 , p Z
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)
COMMENTS:
INSULATION CER- IFICATE IC -1
Description of Installation
1. ROO:
L.C�
Thickn,-ss (ir.cl:cs) \3/(
CEILING
Perml: N'urnbzr
n n , L�.
T; c- :_: Rcsis:aace (R-Va!ue)
Bat: or B:an':Ct Type bs- `5 E:s :�' \a- c ��`X\� ��.Yl (�L(� Q
Thickress(inc.`. Tre:rr:a: ^sist3r.c (R- aluc)
Loosc Fill Type \a k1\ /1 OQ,('1 i'j-a-t
Contractor's r i- irs:allzd wcig Jit= �C lb �4i.^.ir^� t:Zick ess 7 inches
Manufacturces izi-stalled weight per square foo; to achieve Thc.,,,al Resist`,ce (R-Veluc) - A -6
3. EXTERIOR WALL
Material PS6�5 Brand Na -c
Thickness (inches) — Thermal Resistance (R -Value)
B . Exterior t uG o
L.aterial Bard `a^:.e
Thickness (inches) 3' T e..- ai Resistance (R -Value)
RAISED FLOOR
:✓:aterial
Thic'.cncss (inch-ts)
SLAB FLOORIPFRIMETER
N. ate:isl
Thickness (inches)
Perimc:cr Insulaticn Dcpth (inches)
FOUNDATION NVALL
Iv1alc:ial
Thickness (ir.chcs)
B: ar? \ c.. --
T is ..., l rCsistar.c (R-Val.lc)
T ermnal Resistance (R -Value)
F.es:s.anc: (R-V3!uc)
Declaration
I h-.r,'Jy c=ra C" that f - 3'JJvc IrsuhtiCr. `.t1i Ir,-:31!Cd Ln th_ _.!_.- - ]'. _._ a�3%z !oc3::Cn in CCf:�C".13riCC W:!h L5.' CL'r7.,..
ErerZ; Erie,:S;nr 4 for r--sidcratia'. buil-i:.gs (Till= 2-:, =a'6,Ca!i'crnia Co& J; rZCgula ices) as indica" d en the
CC�-!i:l:at; C. Corr;ii3^c , u a piic3'-I_.
=i t)9:. 1^Si3itiG: SL �:Ci1tr].;:CC (CJ. Nam,-) O7
Cont--3:.^Jr (Co. N3me) OR Owr.:.
L',-11
:3na:,.re, Da:c
1-,:ailir, Sub:one-actor (Co. Name) OR
Cil:"a! Cc,-,irzc:or (Co. i �3mc) OR O'x'r.:r
s::t-,;t(Co. Namo) OR
C:-^ ! Cc,.t:?::Jr (Co. NanC) OR owrl_'
INSULATION CERTIFICATE IC -1
5 i I c ArdrC,S
Description of Installation
1. ROO;
Thic:�^ess (ir.c.cs� � J
1r
CEILING
Perml: Numur
Ti'.:r��: Rcsis;srtc: (R -Value) 3�(
Bat: or B!ankv Type Era. -.d Name -Zk�,��
Thickr.css (:Pc'. -s' (3" Ther?:_: ^sistar.ce (R-Valuc)
Loosc Fill Type Fr"t
Contractor's rni- irs:allzd wci3h /f:' _lb fi ':n t�ckness 10- inches n
Manufacturces installed weight per squar foo: to zchievc The=nal Resist rce (R -Vale) -A-6
3. EXTERIOR WALL
A. blC e ltLv i,oLkAs o�)c(p—P1Cwt� 'PA 3
Material PS( --S 3r2 -^d N=c 1 [ (0 -
Thickness
O_Thickness (inches) �%�— Thermal Resistance (R -Value)
B . Exterior u )C. e'o
MaterialC�. _ Brzr.d Name ;t
om
Tcickness (inches) 3' Ti:ennai Resistance (R -Value) - (�
RAISED FLOOR
Thic`.cncss (inches)
SLAB FLOOR RERI`1ETER
M3t�risl
Thickncss (inches)
Perir-eter Insulaticn Dcpth (inches)
FOUND.A.TION NVALL
i�t.atc:iai
Thickness (ir.chcs)
Declaration
Band Name
T'Icr:nal Resistant: (R -Value)
is -a Na...c
Ti.er:::l Res:s.ancz (R-V31uc)
I hcrrcy ecr.;fy that lL_ 311-Jvc Irsulat:eC trs.3lled url ]'. !oca;icn in ccrL-rna,-,:t: w:I`t t.SL cuxrer!
Erer,�7: E�Icierc/ Scon�'.r', for r:sid:r.tia! buil ci-.�Cs (T itic 2,, Fa- 5, Ca'i:cris Cod: e`Rcgala ens) ss indiea�.-•d ca the
CC::L:I=a C erC1.n ia::c �-_.0 aopl:ca'--le.
l n
5t2=r.,D9:c (Co.INanc)rR
CCr. C:'dI Con:mztor (Co. Nagle) OR O'j-'nG
n a:.;, e, Da:c
1-.:'ili;:g Sch_oncmctor (Co. Nam--) OR
C -,.-.::al Ccr.:rae:or (Co. ti3mc) OR O'a•ner
I.7.,.1!!i-, SU'-C:M-- Or (CO. MMC) OR
Cc-^r:t' Ccr.::]L:or(Co. Name) OR 0,xr_r
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:
47-869 GERTRUDE .WAY U-26
Use Classification: SINGLE FAMILY ATTACHED I Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction: VN Land Use Zone
Owner of Building: MIRAFLORES, LP
Building Official
0203-253
CR
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE