0203-229 (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
1/68595 E "MC 9,30/03
A`
Date •Signature of Contractor, T
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 STATE nXND 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:_-' -. R Applicant ��� A- E ,e*, �
—mac
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. Y
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 "r
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)
Datef a ^1�;,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT =3_229 TRACT
r', �:353,�i,tt.CiO i� 1, U2 28601
JOB SITE w
ADDRESS 47-082 GF.W.MUDE WAY
APN
649.030.045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
AbMAF1.. R a9, LP
DCD DW, INC 4a DEA% 'f CMES Dom%
74.760111U 'WNAY.I) I #200
78.600IIICHWAY 111
W.DIAIT WELLS CAS 92210
LA �:A 92253
��+jT))�}3+}i7'�ay,7 V q G /�
(760) l CiO3343 0M.1 61so
USE OF PERMIT
MOLE Y 40 Y' AT'kiAc7 )
�
:,PA. i31,1XtA, UNI -17, PL" III . PKRNIT l:ORPSVat INCI., D
POO.1.� SPA, }3LOt`.3' 1YAi.U, OR Iyjlt"tFOWAY h1Pi'.ROACH, 771% REDUCT IOIN
IN PIA. N CHECK FEM FOR Il5l71.^t IPI..? ISSUAY4CR int' S.AMF. PLA14 e Y'PF
TRACT COMB`) RUCT1014 i(II►M H
GC�OI'010 �'t>1V��"3°.��:EI£'°Sl~0ti
',18101.0.00
y�j� 11'yyq9����pp gg �id� q¢pps1 ryYy�qp S�RgN� ��yyt2��"I�1'.rA,IT-D
,►" wLG. P.C6:L.iF M.Yi.. LIiJd1'31�/ AItd,
C011STR CTIO Fig 101 -OW -418-000 SX4100
PL,/AN CHECK FEE 10 1.000.43.9-318 M31
MECHANICALFF',P 101.000-121-0U0 $30,"O
ELFXT13ICAL VXY 109 -0'00-420-000 MI. 00
P€.IaMMIN') PEI, 101-000-4W-000 $89.54
3T'RONO MO` 1014 FES - RESID 101.00-241.000 $3.130
I)w�`.�EWP,ER IMPACT ME �i,3ti9.!!ii
K) ',-3: OT YU, C014ift'l) MW A2« D ` 1.Kff CY.WX
$2,180.m
ISMS PRE, -PAID FISM
$O,W
I.,
PY-I Ir FKE8 DUE NOW
MI.SOX
"VZAKEMPT
RECEIPT
DATE '
a� 4(- • is s
`BY
k`1
DAT FINA D
?C o
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-t9L
Underground Ducts
Forms & Footings
041
Ducts
Slab Grade
— C9W;W
Return Air
Steel
Combustion Air
Roof Deck
p .
Exhaust Fans
O.K. to Wrap
Q- C e6 vF.A.U.
Framing
o
Compressor
Insulation
•o z 5
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
,ZQ. v zi5,07
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste L
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. Z
Encapsulation
Gas Piping
Gas Test
/Z • 42 .o z s7
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) 10 •O Z S�
COMMENTS:
I N AULA i ION CERTIFICATE IC -1
-qicc Address Per;:;!: Numbtr
4! � k
" �- � �
l�ZZ4 �D
Description of Installation
1. ROOD
Thickness (ir.c;-.cs) \3(( T Resis:zace (R-Va!ue) V,3S
2. CEILING
Bat' 0- B1.ar.::et T s�'y (5 B -a Na -,c Ln n (�dlu
Thic''k css(ire.`. s` Thee: . ^sistar.ce (R- 'glue) �%
Loo.c Fill Typc &b A 001ti
Contractor's rni installed weight/f:-k--_Ibfir.i ^� i t kness ib_ inches nn
Manufacturer's installed weight per square foot to zchievc Thermal Resist`nce (R-Velce)
3. EXTERIOR WALL
A. ��e-lt�„� L,>4- t, i--) dxlo—P1cw� ":2 3
Material PYL-�Brad \a -c xl,((O- _
Thickness (inches) — Thermal Resistance (R -Value)
13, Exterior IVO —
Material Br2r.d 'Name
Thickness (inches)3' T-e.ai Ressta^ce (R -Value)
RAISED FLOOR
Mmes i_i
Thie'.cncss (inch --s)
SLAB FLOOR HRI`1ETER
Iv'at�risl
Thicness (inches)
Perlmvc- Insulaticn Depth (inches)
FOU\DA.T10\ V ALL
NI.atc.ial D --- a \a-
`
Thickness (Incite_) Ti.e.T.._i Resis.ance (R -Val -,,c)
Declaration
hereby coif;• th3! t.`.c a Jae irsulvicn v. -as installed in th:- _.._.-- _. _._ a`o•._ !cca::en in eonrC mancc with t.4e e,_rrcn!
Er,er E�icienc� Star. a:r� fJr rsidenti3! boildi .gs (Till= 2,, Pa- 5, C3!i:ania CO C J`Regu!a ens) ss indiea�rd cn the
Ce:'t!icati. Cf Cor^�!13-.0 , .• i_rC l; til:C1'Jle.
I! m
Co-::7:'Cr (CO. Aare) OR Ownc.
i
:and \_- e
T .._....sl Rcsiscar.c (R-Valuc)
B znd Name
T'cr:�,sl Resistance (R -Value)
t!c:n . na:.:rc, Date Scb_ontmctor (Co.'Name) OR
Central Cc-:r2c:or (Co. i;ane) OR Oµ•ner
:_..• S:� ..._. D3S::�--czn-3c!or (Co. Nam,? ) OR
Gc..-.'! Ccr. :.__..-,r (Co. N.:,,c) OR Owner
C m - -. _ t 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 47-882 Gertrude Way La Quinta CA 92253 08/01/2002
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
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Estimated Cost: $
.-
• •re treatmentm• r•w • on this nronerty in perordangeControl i•. • •n
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,California 95825-3280.
AT21:0420030313
, have
11
Certificate of Occupancy
City of La Quinta
z.
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
47-882 GERTRUDE WAY U-2
Bldg. Permit No.: 0203-229
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
Building Official
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By:
Date:
POST IN A CONSPICUOUS PLACE
STEVE TRAXEL
03-21-2003