0203-230 (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
768,595 B CS ?G 9/30103
Date G-54'1) 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
S coon 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 STATE FUND 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 p ovisicns.
Date: �?^ Applicant tbr�
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 q
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 herebyauthorize representatives of this City to enter upon
the above-mentioned property for inspection/purposes.
Signature (Owner /Agent) rf� I. All f ` �`Date '-7
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 020X2V TRACT
2. $45,320n B2, 'tJS U601
JOB SITE
ADDRESS r.SS 47-876 GRMUDr. WAN'
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
N im -ewjas, .0
DCD Dii`iT., WC dba D SERI. Ci'1r[& a DEV.
14-760MCM'U AY 111,4.200
76.600 H1C3MAY 111
INDIAN WEUS C'A. 92210
1A Qi. NTA CA 92253
(`160)771-3343 C".t�aX 7,180
USE OF PERMIT
SPA • B1:110.7,1.NIT%, PLAN IA. Ibl?..1214If r OES WI)T INCIVIDE POOL,
SPA BLOC'S WALIA ORDW KWAY A.I' ROACH
TRACT CONSTRUCTION 700,00 SF
GARAGIFY ,ARPORT 37106 Sig'
RNMUTE v1 C O&M OF C:ONUMUCTCON
43,370.E
CONSTRUCTION FEE 101.0,0 -41.8.000 t33Ii,.v
RAW CHEM* FEE 101-000-439.319 S.331A0
It RCHANICId,YBE 101.000=421.000 S39150
ELSrc:'t MIC A1.6"EE 101-000.420-000 $65,4b
1?1.".3�BITi0 PIsP: 101-0€+ 419-M
STRONG MOTION ME • Y'lESUD 101-M-24.1.000 x.53
DEIEWPER IMPACT YO." v's,60.00
'M DEPOSIT 430.00
Mai-T(YTAL CX��*IJ C-11014 D PLA14 CMCIC
$z,30 ra.89
- LES2 FRE -PAID ;
R
'N
. 00.00
AX.:1Mn1 1 UMS DU. OW*
$2,206.89
Iv�l�1 U J 10U2
CITY OF LAQUINTA
FINANCEDEPT.
RECEIPT
DATE -
BY
DAT INA D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings-�-
Ducts
Slab Grade
_
Return Air
Steel
Roof Deck
_ _ _ 6
_
1� Z
_ Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
�fp -/7"0 Z5172
A . II(If A> Z
F.A.U.
Compressor
Insulation
p • ' OZ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
`� v
704 J, w
ld -//-eo Z $
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
_
d
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/� .2 .QZ �1
Encapsulation
Gas Piping
Gas Test
o Z S
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 O
Utility Notice (Perm) ! 8 •OZ� S7
COMMENTS:
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 47-876 Gertrude Way La Quinta CA 92253
INSPECTED: CO.CODE 33 08/01/2002
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:
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
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Estimated Cost: $
.-
• • u'� • r•w • •n this nronerty in grecirdanceRpSt Cojitivil:•. • remilation.
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.
AT21:0520030313
, have
IN'SULATION CERTIFICATE IC -1
cit. Ar_'d'r_ss
Description of Installation
I. ROOF
EYL�j�S
T hickr.ess (inch:cs) \31(
CEILING
Perm:'N'umbar
T;;.r,,-,: Rcsis:ance (R Va!uc) 3S�
Bat: or B!an :et Typc ? 122.t� Bra 1�
Namc � i�� � in (,U
Thickncss (inc.) h,-7 :'_: ^sistanc,-(;- al c) {L -a7)
Loo_c Fill Type CL Erand
Cor.tractor'9 ri- installed wei3hJrt' A—_lbMini^un t: iekness lC_ inches
Manufacture's ir,-stalled wei tht per square foot to echievc T;.c.,:�,al Resistazce (R -Value)
3. EXTERIOR WALL
a.��e-ft�.,�
Material Brz^.d \a -c Uja mac) c (0-
_
Thickness (inchcs) _ Thermal Resistance (R -Value)
B . Exterior LA.)Cluo
Material Bard `z.^:.e c -LL
Thickness (inches) Tcermai Resistance (at -Value) - (�
RAISED FLOOR
�aterial
Thickncss (inchcs)
SLAB FLOOPUHRIMETER
Material
Thickness (inches)
Perir-ctcr Insulaticn Dcpth (inches)
FOUNDATION N ALL
iv(.atcria!
Thickness (ir.cr:cs)
Declaration
Rcsistar.c (R-Val.tc)
B:—and— \ ar e
T, cr.mal Resistance (R -Value)
B:-ara Na -c
Ti.e.T..a' Res:S.ar.c: C-Valuc)
I hcreby c.r::w that t:._ 3'ovc irsulation 1ti3i ins:all-d Ln ?"::: .:!_:-.a ':..._ a�3-.c Ioca::cn in con"Cretan:c With 6c
Er,erA; Ej,c;e.".c� Sroc�.�� for residential buildings (Title 2-., Pan 5, Cal;' -.m;3 Comic o: Z g !a ens) as indiea�rd C.1 the
Cc'i i_at� c:r Co r.;'. t c , �-_.. a piicable.
lr.sta'.lin: SL.1-cnt:- actcr (C3. Sam,-) O
Cc .:nal Ccr.:mc:or (Co. Aare) 0R O•++nc:
�1
Date
Au,:_,, 2-3;
1-,:allinP, Subrona-ctor (Co. N3mC) OR
Ccn::al Ccc:r,-c:or (Co. ; iamc) 0R Own. -r
Ir.s:alli S�`ccr. wor (Co. Nave) OR
Cc-"�-2! Cc,.t:sc:--r (Co. Name) OR O•xm:r
h-36
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:
Use Classification: SINGLE FAMILY ATTACHED
47-876 GERTRUDE WAY U-3
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-230
Land Use Zone: CR_
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE