0203-251 (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
763395 B CS 111C 9/30/03
Date ` fes' �� Signature of Contractor `�`?'
n
U '
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 VrA. ETUND Policy No. 1603601-02
(This section need not be completed if the permit valuation is for $100.00 or less).
S 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: Applicant -- 41 �'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"a nd 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] %^ f t - Date � �
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 02d3.251 TRACT
._ Z810I00) rS 2 2U%6 28601
JOB SITE APN
ADDRESS 47-W, i GEM. R, A'AY CA9-030.045
OWNER CONTRACTOR / DESIGNER / EN INEER
WRAFF 0RES, LP mm Driv., we dba mr-A r anvis riLnr.
74.760HIC91.WAY 111 4200 7£3--6(* 11MWrY I 1
N%W4WELLS CA 92210 LA QUNT A. CA 972-53
<76q)-771-.3345 21vo
USE OF PERMIT
M't3.1 E FA_NW 1;' AMP.t'.'%M
SPA -131,DG Id,, UNIT 24, PI. AN 18 . P1;WIT ]DOES 14Cs'f 1NCL;fJT12p
PG14Yi� S I6, T.tJC:2;. �dA2MLs, t�Ii 10 1V ` dA AP:Pttt3.F:i"1 I. 'i,' % 1 2)>,rC1(ON
fN 1iE, M CHECK Fri V, FOR A `UVfIP.LE 1S3tJ.A` QZ Off' SAME PLAN TYPR ,
TRACT CONSTRUCTION 700:00 SF
�v
�Ct1�rLt3'YA1, C01+TU7i2 UCM_TC2N ARD In.4ti � �,C f �2y0 90,:31
Q IAER;U PP%-%',A&D :l"*23,1±.S $0.00
_�� i J I
MAY U o %
WYOFIAQUINTA
------ FINAMCEDE". '
RECEIPT DASE BY:.-' DATE FINALEV FINALEINSPECTOR
I
CONSTRUCTION 2�%'t�
101.000.41€ 000
S143,00
FLAN CHECK FEN.
1011.000 439-319
872.$1
Ci'1M11CAL VES
101-000.421-l. 00
fiA4g
1'L.LeCTRICA.C, P'tf E
101 -000420-000
$11B.00
01"U''Mrsy, 4) k`a
101.0€ 0-419.000
W..%0
STRONO MOTION &1%t - REST 9
101-00e0-241-(#00
$3.80
D RVEII-1Jr'RR iMi?ACT FU,
�v
�Ct1�rLt3'YA1, C01+TU7i2 UCM_TC2N ARD In.4ti � �,C f �2y0 90,:31
Q IAER;U PP%-%',A&D :l"*23,1±.S $0.00
_�� i J I
MAY U o %
WYOFIAQUINTA
------ FINAMCEDE". '
RECEIPT DASE BY:.-' DATE FINALEV FINALEINSPECTOR
I
'INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
g - —v�L
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
_
-s
Return Air
Steel
Combustion Air
Roof Deck
p , o Z S
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
. az $�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath�/=
!0 2 --
-Drywall
Drywall - Int. Lath
• Ov
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 APPROVAL7
�1Electric
Waste Lines Tir
Gas Test
Final
Heater Final
Water Piping
T
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
i 57
Encapsulation
Gas Piping
Gas Test
l? . /(o • 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)3O• o z $ 7
COMMENTS:
INSULATION CER- IFICATE IC -1
Description of Installation
I. ROOF
Ma:cr:-; &-LAI
T hickr.ess (ircccs) ,31(
Nrml: Numbu
T11 -i Resis:aace (R -Value) 3
CEILING � _
Bat' o: Blan`:v Type �5 E:' -a Namc
Thickness (nc`es` l3" The: r!: a: F6sisIar.ce(R�'aluc)
Loosc Fill Typc`Cc�t� Bra td /I OO:t'l
Contractor's r -i- irs;ailed wcighJf'' A— 1b 'M:ni ^art t:1ickncss ld_ inches
Manufacturces installed weight per square foot to achievc Thc.-,,tal R--sista_nce (R -Val -c
EXTERIOR WALL
A.
Material L S Brarid Na- c akz-,-, UJO Aq c t 0 _
Thickness (inches) Thermal Resistance (R -Value)
B . Exterior LL)GLA.o
Material G. Brand Na ;e (t ,u
Thickness (inches) 3' T,ermnai Resistance (R -Value) - 1�
RATSED FLOOR
Thic:cncss (inc`.cs) _
SLAB FLOORYPERIMETER
!'`/�32erlal
Thickncss (inches)
Pcrimc:er Insulaticn Depth (inches)
FOUNDikTION NVALL
Ma t C. i a 1.
ThiAncss (inches)
Declaration
Lei: and N
Ti;......ai Rcsistar.cc (R-Valuc)
'3;2,'1d Name
T, crmnal Resistanc: (R -Value)
Tl.e r.i R-zsis'ance C-V31u'c)
hcre"y eer;iry tha! irsulat.er. % as ins:allcd in 3: ._ abo•._ !oca:;cn is eocfc-na .ce wi!h t5e cure:.!
Energy Ej,cienS-1 for resid:ntial buildings (Titl_ 2-', =a- 5, Cali `onia Cod-- ). Rug_la;'m) as indicat---d ca the
CC: i.'I]atC Of COmr!,,-
5,i2 _._, Ds:. I s:3c11 2 Sl .cntr3c:cr (Co. Nanc) G
Ger._ral Cort-3ctor (Co. Tune) OR 0•,wr,:.
17,:211ing Sub:ontractor (Co. lame) OR
Central Ccr.!rac:or (Co. , ianc) OR O,x•n:r
I:_... S , D. Ir.s:alli S-,;`con-ac!or (Co. Ivsm ) OR
CC.,.-ctor(CO. tia;.,c) OR Oµr,cr
F1 -3U
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 47-8$5 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:
Recommendations not completed by this firm
Cost: $
Inspection fee : $
Others : $
Total : $
Estimated Cost: $
70.00
0.00
0.00
Remarks
• • u • •u� • •�this nronerty in accordance•� • C•. • •i
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.
AT21:0520030313
have
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: 47-885 GERTRUDE WAY U-24
Use Classification:
Occupancy Group:
SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-251
R-3 Type of Construction: VN
Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
Building Official
By: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE