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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 # , Lip. Class Exp. Date
768595 B CS LUC Al 9130/03
Date ���_ -h% 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). •1
( ) I am exempt under Sectiori , 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.
j( �1 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 3TA1'Z FOND Policy No. 1603610-02
(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: 5 .0642, Applicants
Warning: Failure to secure WorkersCompensation 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) t. �•t�!�. `� Date—D�'A�fi
v
u I BUILDING PERMIT
PERMIT0#2��228
ES7ii1 :'Y. CtL 9f 011 CON.S�'.� U OxN
P Aii t9 $36D
}
DATE VALUATION LOT
r[1, a.c�.i3cit,
TRACT
t31 Bt�C'(T1
JOB SITE
ADDRESS 47-M CKYURVUE WAY
CONSTRUCTION FZE
APN
649-030.045
r
P1.A:N C;H ?Ck FEC
101-000-439-318
OWNER
CONTRACTOR/DESIGNER/ENGINEER
101.000-4Z1-000
i
IMML022FS, LP
X3CID DEV'., WC &a 1JFM,,V.V Cr= T3:W.'
74-766 MIGHW.AY.111 aOt3
7Sa ;40'f C413Vt1 ? 313
$58.00
CA 92210
u,Q INTA.
CA 92253
SK6,50
(75f)�771a 345
C 1.4 2180
USE OF PERMIT
=TLE :FW�gU A:2 ACHM
DZVELOPEFd. IMPACT FEE
SQA. • MR,I)0.:1',UNIT 1, PLAN t H . Plaltit6 r DOES NOT TNCI UDE
�i1Sk�,t�tl
P004 ST.A, I WCK 4NAIs X. OR DMEWAYAPrsROACH
I' ; I:)EPOSI?'
'BRACT CQ48 TRUC TI+91•I MOD SF
ES7ii1 :'Y. CtL 9f 011 CON.S�'.� U OxN
P Aii t9 $36D
CONSTRUCTION FZE
1014*0-418.000
IM3,00
r
P1.A:N C;H ?Ck FEC
101-000-439-318
MCHANICU,FER
101.000-4Z1-000
%31),51)
tl'IXCTRICIA L 1v1?',
101-000-420-000
$58.00
PLUMBING FRE
101-000.419-000
SK6,50
STRON€1 MOTION PEE a RESII3
101-000-241-000
$3.130.
DZVELOPEFd. IMPACT FEE
�i1Sk�,t�tl
I' ; I:)EPOSI?'
4:M.t I
'P
ffuD `T°Qrx,.C°ta' °!°kz'i1"G'1':%ow AwD A.'a ak wig:. s ,4 2 S. ',$,I
— -• 2„&93 1'231; 7F AM P:Ma' 42"OU0
"MAY32 Z DoTn
Z
WYOFLAQUiNITA
RECEIPT I DATE ��BY DATEF ALE7 INSPECTOR
r
k.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
_
Return Air
Steel
—u 12
Combustion Air
Roof Deck
O . Z. O Z.,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
br.
Compressor
Insulation
AV -aS' , p2,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
47
a ��c!
♦e �!•oj s
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
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) 49 • 'o Z •57
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 47-888 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 : 03/13/2003
Owner's Name and Address:
Copies sent to :
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 tre t— t was • r•rm.• on this nronegy in accordance.with Structural Pest Contr• :•. • : •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,Califomia 95825-3280.
AT21:0420030313
, have
INSULATION CERTIFICATE IC -1
C,... ';/ S 1_';1_:iI::5:-..
Description of Installation
1. ROO:
1'a:cri�! �x'�ttS
Thic:<ness (inches) j r
Nrml: Numbzr
Aa,aoi
Era_` .._ p_
(rl •n l l L
T;;;�,�: Rcsist�nce (R-Va!ue) 34i
CEILING
Ea': . o: E!an!:et T}Fc �' Y.� E,,_a Name
Thickr.css (inc`zs' (16 r' The:. a. F6sistar.ce (R 'atue)
Loose Fill Type a -rand
Contractor's rii installed weight/ft- ,�- lb �4i. ^� i t:Zickness int} es
Manufacturces installed weight per square foot to ?thieve Thc. nal Rcsista_�ce (R-Vel_c) - S-6
3. EXTERIOR WALL
A.�ylf ('[��+' I.JCiS ZZ)
Material L,a/1—. , 3Bra d Namc
Thickness (inches) %�— Thermal Resistance (R -Value)
B . Exterior U -)C. Lo
Material Brand Name t U
Thickness (inches) T,er:;a: Resistance (R -Value) - (�
RAISED FLOOR
Mmeria,
Thickness (inc`,cs)
SLAB; FLOOR/HRNETER
Matz"nal
Thickncss (inches)
Perimver Insulaticn Dcpth (inches)
FOUNDATION WALL
Kate. iai
Thickness (in-chcs)
c:a-d N.. -
T:._...,;i Rcsistar.c (R-Valuc) —
3, -and- Name
T`cmn2l Resistance (R -Value)
E.s-a Na
TC^-T.:_i R�s:S.anu (R-V31L'c)
Declaration
I ccr:;C; that Ir-su!aticn Nvas ins'.ali_d Ln 2. !oC3:i0n 17 Cor.r___n ,:_ W;,h LSccL'IT�'.
Er,er ; E�7cier.C� Sresidcnti3! buildings (T itl_ L-., o,- 5; CYi.cr ni3 Coy,- of Regulaens) ss indieat_,d ca the
Ce^i;l_ate o�Com;.!ia-c , w-_.. a piica'ole,
o6 "A '.2& _Xz/
1 71 -s 1, 2r Ds:. i-�iai!i 4�:cn�a<:or (Co. Nanc) CiR
G"._.�d Contractor (Co. N3me) OR Owne-
I:c.'n
-.na:_rl', D3:c
Subcontractor (Co. Nan-) OR
C-,:-,--. a! Ccr:r3c:or (Co. i araC) OR OWr-r
S_`C:;= '.or (Co. Name) OR
C:-.-.3! Cc,-.,._-tor(Co. Namc) OR Own:r
A-36
0
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: 47-888 GERTRUDE WAY U-1
Use Classification:
Occupancy Group:
SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-228
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