0203-249 (SATT)LICENSED CONTRACTOR DECLARATION
I I hereby affirm under penalty of perjury that I am licensed under provisions of
16— 6Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c-4 r,n Professionals Code, and my License is in full force and effect.
O crj License # Lic. Class Exp. Date
I LU 768595 Z? 8 wlxC "-i /%rT cIIA0103
r—
r.'.-
Z Date " �'' �� Signature of Contractor
o
J U C) OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ IZ License Law for the following reason:
Z( ) 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).
C () I am exempt under Section , B&P.C. for this reason
u7
N Date Signature of Owner
O N
O)
Q WORKER'S COMPENSATION DECLARATION
C) ZCr I hereby affirm under penalty -of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
CC 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier$TATZ FUND Policy No.
coolfit+3aiti•(+2
�
O
J (Thi 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'sha11 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 prov,isions of Section 3700 of the Labor
Code, I shall forthwith comply wlth)thoset rovlslons.
: &Z
DateApplicant .,sr sv!�
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 orp 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 i
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to,cancellatio iD
I certify that I have read this application and state that the above information
• correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this City to enter up
the above-mentioned property for inspection purposes.
i
Signature (Owner/Agent)"'- /� ��? Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT O W?3-.4'49 - TRACT
G ,c.� X45, X2(3. 9 .31 IU22
JOB SITE
APN
ADDRESS 47-90:1. C&W3:N7:iMWAY
lri��-E,��B•�1•�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Mrp" ►3?'LoR.-PS, LP
D(M DEV., xr C Biba D.'E6 r Vr WIM, UEV.
74.760 RIGIAVAY 111 0200
78.600 JWvi3WAY I I I
I A 92210
LA QUNTA CA 9225
Q60)7? 1-3345 =4� 2180
USE OF PERMIT
:ilr.,{i, - Ici,.iDO, I t UNIT Zit, PLAN IA. Miv9IT %DCJPS'NOT Ihdlwl.,U08
f'004 0 .A, 91.« CK 1/v°A5,1 S. OR; D I IaWAY APPROACH, t YO RBIaUt;'I'IOU
1'N STAN C}iFrK FEM WOR MMI, PIPs: w ISSUANCE OFS.A. ME PLAtN TYI• F-,
TRACT (NSTiUCIM4 700+y0ry0 V
:ARACTFICAYPOR f ,
J /2.V sIC
ATEA (';�DFf OF CO.S�'�'I ITC110.1?
45 ,a,101_ -V0
y�py�)q�gyvy� gy, y � q,Ur7i,T11
AWN,
JrAaLS1A/.LT.3 .U�'�,il.��.� r76�iIu'.iARAr
CONSTRUCTION FEE 101«000-418.000 $393,10
PWI ::P#WIC FEE 101,000.439.318 $8'?Ifs
M1;:C AerIC.&.0 FEE 101=-000.421 DUO $39.$0
FLECTti.I A,L PEE? 101-0190.420-•040 $65.44
PI,17Ivia3fl O I:`RE 101-000-419-000 $38.-s0
S7'PONQ NOTION FEE • RESID 101-0000 ?AI -000 $0.33
MR SDI"1' R IMPACT -ME
t�
F•
•`�
8 fIb TOTAL,' �019SIi3.FI'f"x"1tDN AND PLAN 010704
$2,243.3.4
1=9 PIRE-PAD3, MIS
$0.00
TOTAL P.KIMMUKUPS DDEINOW
$2;,143,34
MAY 3 M1
RE E = BY DATE FINALED INSPECTOR
FIR ANCE®E U-1 fc, _M 2. ly -x/-03
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�_—p_� _
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
-� q �-
Return Air
Steel
_
Combustion Air
Roof Deck
, c Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
%�
Compressor
Insulation
Q- jp _o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ - -d7 z S
Drywall - Int. Lath
E
—off
-OL
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.;L7.p
Z 7
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) .0?i s
COMMENTS:
i.NSULATIO-N CERTIFICATE IC -1
5itC Ad drCSs
Description of Installation
1. ROOF
Thic:<n-ss (ir.c .c5}
Perml: Number
4:1,
L c! 7:�.-.
1 i:Cr t=: RCJIS:_ 1CC (R Vdlu�) 71
CEILING
Ba'.: o: E'.ar.:•:et Type
Thickness (inches'
Loose Fill Type Er - d yA 00 in
1b �^^t:ic_ss (byinchesContractor's n i- installed wci3h /r:' kn
Manufacturer's
installed wei¢ht per square foot to echievc T;.c.m ,al Resisr:..nce (R-Vel::c) �' A -6
3. EXTERIOR WALL
A. b/�e.�lw I.JCLS C� o�X(p—PlC'�-Yl� 0��3
Material i66—� Br2-nd Na -c
Thickness (inches) _ Ti crural Resistance (R -Value)
B. Exterior uoc ao
Materiel (� S Brzr.d Na7:c (t t
Thickness (inches) TI:e=,,ai Resistance
RAISED FLOOR
;J.iterl_i
Thic'.cncss (inc`.-s)
SLAB FLOOPUHRIMETER
Iv`at::: ial
Thic.'.ncss (Inches)
Perir-.e:er Insulatic:l Dcpt': (inches)
FOUND, -.TION ViALL
ititatc. ial
Thic'kicss (inches)
Declaration
rJ, d \�...-
I ....si Rcs stanc (R -Value)
B ana Name
T crural P,esistance (R -Value)
Enna N3 -„
TI:e.- a: Res:s:a::ce (R-V31Le)
I h_re"y eer.;ry that tie 3JJl'C Irsulalicn tk1s Ins:3lled Ln :Lc 3: ._ _ J'._ !cca:ien in eonfc"ISncc with Lie current
Er,era•: Erjicie .S;or. 1 for residcntia! buildings (Title 2,, Pa- 5, Ca'i
.:cri3 COL'-- of Regala,`im) ss indica!--d ea the
CC:'.ltl_3IC Cf COi?'.r!11nC u i -.t SCFI:cabk:.
r
n _.-, De:.. ins* -Di (Co. Namc) GR
Ce ral Ccr::�c or (Co. Name) OR Owr,:.
D3tc
1-s:ailir.g Su`:onrrzctor (Co. Name) O.R.
Cc-c:a! Ccr.?,2c:or (Co. , amc) OR 0,.vr::r
1:.s:aS_`co actor (Co. Name) OR
Ccr.t:.::or (Co. Namc) OR O,�vn_r
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 47-901 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: have
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
• • IY"1 •-r• ��-• •� • ••- • •.1 •1 •i•. • t- •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,Califomia 95825-3280.
AT21:0620030313
b
Certificate of Occupancy
City of La Quinta
Building and Safety Department �°eMo,TM
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:
47-901 GERTRUDE WAY U-22
Use Classification: SINGLE FAMILY ATTACHED
Bldg. Permit No.: 0203-249
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: STEVE TRAXEL
Date: 03-21-2003
POST IN A CONSPICUOUS PLACE