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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
768595 B CS i C 91310103
Date Signature of Contractor j._ I .rie f�r,•!rb.
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 STA'T'E FUND Policy No. 0 160:3616-32
(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 '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.
Date: Applicant �--i 'r�� 1�' 0
Warning: Failure to secure Workefr Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions' set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of'this applicaton agrees to, & shall," indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize, representatives of this City to. enter upon
the above-mentioned property for inspection purposes: .
Signature (Owner/Agent)
Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTS -fix TRACT
M1010=1 28601
JOB SITE
APN
ADDRESS 47-877 (.31ER'II:LZUf,DE WAY
649.030.045
OWNER
CONTRACTOR/DESIGNER/ENGINEER ti ;
I�1,i12AEW RM, It P
1X".I;i IUI^M, INC, dba I7E8M;'I' (J:9'S I3.E.V.
74- ► 60 TRCHWAY .1 114200
78.6Ctt1:El:fi`rI�WM" ' I 'I 1 %
.WDiM WELLS CA 92210
LA Q1.ISNTA CSA 92253
('760)'17 1-3:345 C$I 0 r3 £ISS
USE OF PERMIT
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81'/IE`lU( , 3h1i
,
SMA " BLDC1.13, ON -I T 2� PLAN Iia . PEIZMI T OON3 NOT rUCIAID
P0014 VA. BLOCK WAL L,4 OR I)%.tVWAY APPRt7!>tC:I-I, 76% ItF'DYJt;` 1010
I'N Pf. AA1 CHECK FZE FOR MCJL'1'I7< LE 1SSUANCF, OF SAME PLAN 'P` PZ
TRACT CONSTRUCTIC(I IV
j f
X911MKFED COST OF MWIRUMION
X010-00
CONSTRUCTION FEE 1.01-000.4le-000 $343,00
PLAN CHWX ME 101-000.,139-318 $1&51
MECHANICAL FIFE 101-000.421.000 $39,30
MEC:T.RICAL. "X 101-010"20.,000 $X03
PLUMBI NO RE 101-000-419-000 $89,50
S'I ftUNO MOTION FE " RESID '101.000-241-0010 $190
DESt'ELO iM IMPACT FEE $069,00
- ca
RN -TOTAL COia�'Ti'� UC,T109 AM PLAN CTMOM
$2,180.31
LS IJR�-P1D: 1
$0M
YERAIrf 11TES PAX now
3 2001A
L".Ry
UIN
war
MO�RECEIPT
DATE
BY' DATE FINq�E�
INSPECTOR
/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs ff =�
Underground Ducts
Forms & Footings V—_5
Ducts
Slab Grade O'.—
Return Air
Steel Qom—
Combustion Air
Roof Deck .o 2— rj7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation O .t1 S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath !— / ' OL 67
Drywall - Int. Lath
/ -r-ri to /d (G•o i 5
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral , a 2�
Pool Cover
Sewer Connection
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) /2. j d L $
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 47-877 Gertrude Way La Quinta CA 92253
INSPECTED: CO. CODE 33 08/06/2002
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:
Cost : $
Inspection fee : $
Others : $
Total: $
7O_(1O
0.00
0.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks:
A soil pre-treatment was performed on this rolLY in accordance with Structural Pest Control Roard regulations.
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.
AT21:0720030313
have
I''SULA T ION CEKTIFICATL IC -1
Sitr Addr_•ss
.-_. ..--. / -
DCscriptioll of Installation
1. R00;
Thicknes_ (inc :es) \j'r
CEILING
Perml: Number
$a!! o: E!ankv Type 1VY.1kt5 E:an d Nam,c -X�n�
Thicu:css (inc'-s' 13" Th:-7mz. ^sistar.ce (:- -a 1.
,
Loo.c Fill Type T �tx�Jt'� Era -,d /1 DD:tj
Contractor's rni installed wcightli!' A- ]b M. -;:: -MtAlicknss - 7 inches
Manufacturces installed weight per square foot to zchieve Thc.,c,al Resiva ce (R -Valise)
3. EXTERIOR WAT L
A. j-) x(o— cwt ';;?'A 3 ..
Material Brand N2 -c a )k�z1 t i 0 -
Thickness
Thickness (inches) ��— Thermal Resistance (R -Value)
B . Exterior hc.)CdLo
Material P lttF _ 3tzr.d `a cLnn u
Thickness (inches) 3' T emlai Resistanc= (?,-Valve) - 1�
RAISFD FLOOR
I�j!eri�i
Thickness (inches)
SLAB FLOOR/PERI`1ETER
N.at�,rial
Thic'rncss (inches)
Perirnc!cr Insulaticn Dcpt; (inches)
FOUND.'.TION NVALL
iV1;.atc. ial
Thickness (inches)
Declaration
B, n.j N --,--
T i1 C. I ---''I Resistar.0 (R V31sc)
Bi -and N a-ne
T, er.nal Resistanc: (R -Value)
I hereby c2r:1 f'• tha! l.:_ 3Dovc irsulancr.. % ai it:s!3i1_d Ln tl?- C.-:!C.'.t a: -._ .'.`;O'.0 !0C3::Cn ... W:th Lhc
Energy Ej-icie,;Sfor residentia! bui! - ings (Title 24, P- 5, Cali:
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:
47-877 GERTRUDE WAY U-25
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP
-1--&4-1
Building Official
Bldg. Permit No.: 0203-252
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
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