0203-248 (SATT)9i•
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
76859;5 D 08 mala / 91,70103
Date Signature of Contractor
r
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
Sa'ction 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 ST.A'TF 1SL�Aifi� Policy No. 16Q381Q A
(This section need not be completed If the permit valuation Is for $100.00 or less)
( ) I certify thgein 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• ,� _ Applicant , •5
Warning: Failure to secure Worke s' 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 Appllcatlon 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, Indemnity '
& 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 Vold 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) ! f ° Date --- _ .-
" ` BUILDING PERMIT PERMIT#
DATE VALUATIONLOT .' "3 TRACT
i,32 �;1 Li21 23dJ1
!� v .W
JOB SITE
APN
ADDRESS r -� U.i»; WAY
649- i W--"5
OWNER
CONTRACTOR/DESIGNER/EN INEER
MW,FLO RES, LP
DCD I2EV.,114C dbsa =1-a- x' MUS DEV
74-760 HIG WAY.l 1'1 #:00
78.600 MOH -WAY t 11
bwLew NVI E US CA 92.210
TA QYT A CA 92253
(760YPI-3345 C16L41 21so
USE OF PERMIT
9DIGLE F10AI—L Y A'iIACM
SFA " 81.1)0.11, UNIT 4, PLAN IA. PFP°-MIT .DOES NOT INCLUDE
P004 SPA, BLOCK W&LLA OR DUVE:WAY APPR.C7.ACK. '755`,11 1)LICT1c72F
1'N PLGi14 CIO= FEE FOR MU1311'1. E ISSIUANC'E OFSAME E PW,4 TYPE {
TRACT CONSTRUCTION 70,00 OF
C A11.A.CiMA"e: F ORT 37100 Sit
ESTMATED C09..r OF C:t)OW RVII7170N
45520.
PHUT M Who MY
CONSTRUC.MO 1 fts 1101-000-1131000 5396.50
PIAN C HLIClr: 'N'1:W z 101_000_439_318 $87.3e
1U1ECHANICA1. F ER 101-000-421-M) 139,50
Lr1.1CYPICAt, FEF- 101-000,420-000 $65.46
PLUM1394011 PEP, 101-000-419-000 $0$,50
STRONO MOTION VFX - RESID 101-000-241-000 $4.53
1'JE1`EbOP.ER 1Iu PA.YCT FB& A1,S A:LZO
E7V-i.3"l•�il.d'}J�. 4i4J,L1CDELf.{.��nJ.\./iTi 1N.Y , E'.L,�r"kE'�i b4..C"a,L�W:�,
cf 2,22'A3.34
$0,00
Pti�'� U 3 2001 .
WYOFLAQUINTA
REbEIP r1rilipliVillabVEFTBY
DATE FI ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
c9
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
$
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
�f
Compressor
Insulation
c • c -d z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Unes
Party Wall Firewall
Exterior Lath
-O L 5,7
Drywall - Int. Lath
PG u/
�m —/C •m y 5 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
_
Waste Lines_ c
Water Piping :�
Gas Test
Electric Final
Heater Final
Plumbing Finar
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
���Z%e ?, %
Encapsulation
Gas Piping
Gas Test
• 7-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) �_ -492—i%
COMMENTS:
INSULATION CERTIFICATE IC -1
Si,. Ar_ss
: ,7_i:•:5:-
Dcscriptioli of Installation
1. R00;
Thickness (ir.c .c;) \31f jr'
2. CEILING
Nrml: \"u:-.ou
$at: a: E:an.';et T;;'.c '. is E:, , Via- c k "n ,,n ot_(� Q
Thickr:css (inc`.'s' (3" The:^:_: ^sistar.ce (R- wluc)
Loose Fill Typc`CC,�t� Era -a' /1
Contractor's rni- installed weigst/f:= k- lb tAlic kness ib_ ;S inches
NI3.nufacturces in -stalled ,Y-.i¢ht per square foot to zchievc Thc.,r,al Resista_�ce (R-V!11'_e) Al
3. EXTERIOR WALL
A'w� t,,-,CJAt, o(D-�C'c-rio 3
Material L, J Bre-nd \a --c Unnc t (O _
Thickness (inches) 3%�— Trermal Resistance (R -Value)
B . Exterior luCULO
Material C� Brzr.d 'Na—c
Thickness (inches) S7Z? T ermai Resistance (R -Value) - (�
RAISED FLOOR
V;.A!eria,
Thic'.cncss (inc`.-s)
SLAB FLOOR/PERI`IETER
?�aterial
Thickness (inches)
Perirnver Insulation Deptl: (inches)
FOUND,ITION WALL
Thickr:css (inchcs) Tce.r.:a': Res:s:arce (R-V3luc)
Declaration
I hcrcy ccr.:`y that insulaliCn N3i In5.3ii-d Ul !oi3::0n in With t.5c
Er,era: E ,cier.c', S;er.1�r.' f: r residenti3! buil-di-.Ss (Till= 2-., =an 5, C3!i.3mia Cot: 3f Regula lens) ss indieatid on the
CO:'.Iti=3l:. OfCo^�!:3'- u 07�i1:C1'Jle.
1 m
S, i. _. _, DsS.`l-;cnt-3cter (C3. ;:3nc) OR
Coctr3cror (Co. Nine) OR Ownc.
1:C.M , �':3: rC, Date
rrs
T'i -=--'l Resistance (R-Val.ic)
B, 2,ld \ zi e
T"cimal Resistance (R -Value)
1::,:2111ng Sub_on-u-mcior (Co. lane) OR
Czn-c a! Ccctr3c:or (Co. , 3mc) OR Owner
1 5:1i1t'� S-,,;ic:;.^.'3c'.or (Co. Namo) OR
C..._.e; Cor.;._....: (Co. tia.�,c) OROw•n_r
A -'c
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 47-909 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 : 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:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performed on this property in accordance with Structural Pest Control Board regiilations_
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.
AT21:0520030313
, 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:
47-909 GERTRUDE WAY U-21
Use Classification: SINGLE FAMILY ATTACHED
Bldg. Permit No.: 0203-248
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