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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
�f 55a? BCa 1t^.'�i ,. MR 0/03
Date 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:
s ( ) 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.
XI 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 FUND Policy No. 1603016.02
(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 %iR_iIthose provisionsa
Date: �2 Applicants
r1 .
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 thecost 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) •� �f'—bate 7�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 02h 1-2AS TRACT
28601
JOB SITE
APN
'ADDRESS 47-917 GF.RTiIZZIDE WAY
6494)30-045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1'arf%AFLC),IC 3, LP
PCU DEV., INC dbs 13E.51..+R. (� lei L'I:ts'tl'.
`14-760I11011WAL III #Z00
78-600F.I+a"1HWIff 111
51+1'MANtNA ,S CA 92210
Q`LY3ATA CA' 92233
(760)771.33.45 G''13LO 21 so
USE OF PERMIT
R Nti LE F-MMY ATfACIRZ
SPA., Hl.,DO.y, UNIT14 PLAN aR . PPMAI!' DOES N0T .,T.ICI..UDX ;
POOL, PPA BLOCK 'WALIA OR DRUMAY AP}'ROACU, M% P.M. UOTION
IN PI:!) N CHECK r3E FORiNiut'fIPLE is�+S[dE+a?di'L' OFA Sf�IA � PLAN TYPF_
TRACT CONSTRUCTION '3 ACO a3t
ESMMAM COW OF C01149MUMON
4"t7A1��"f�%iC7'i0't3:�E1�: • ?.U'i�G►0�3R�1��CCIti �`,�?;s.i►�&
PLAN [:. Wrl. MIX
Mr.:c:1i"IC°AL. P R 101 -000 -421 -OW
X.LECTI:'IC L it %
PLUMMOWTIF, 1011.000.419.000 Si&SO
5 ff?.tM13 idl[5't.ION ME . RE ID 10.1-000-241-000 $3.90
0KVFbOPFA IMPACT FEE
.. R'F'. f;F.
UIT&T OTAL (�;O.WfRITC-710 i ANTU PI., 9 CHECK
$2,1 go.,; $
MS I•' ?A1P .FEES
- S0100
MAY Q 3 zoo?
WYOFL!<1QUINTi4
FINANCEDEPT.
RECEIPT DATF� t
BY
DAT FI ALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— - '-
Underground Ducts
Forms & Footings
t3
Ducts
Slab Grade
Return Air
Steel
ombustion Air
Roof Deck
7/
Exhaust Fans
O.K. to Wrap
Framing
®. t ,a z
--,
F.A.U.
Compressor
Insulation
p a y 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ -o L
Drywall - Int. Lath
q . oto 1W
D -! -d e S
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Bectric
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
Gas Piping
A 5Z
Encapsulation
Gas Test
m 2. S�
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) /�Q,c� ?✓
COMMENTS:
,
INSULATIO`` CERTIFICATE IC -1
ci:r Addr_-,ss
/.
.. ,
Dcscriptioll, of Installation
1. ROOF
Thie:<^ess
:SCV.:it...
Nrml: Num' 2r
ct.;,,-T
2. CEILING
Bat: o- E:an':et Tyre s'"7.v�5 P. -an , Na.mc
Thickncss (ir•c.`. s� 13" Tiae:^:a. ^sistar.c (:- '.alue)
Loo_c Fill Type��Ct Fr --,d /1 0�1:t'l
Contractor's r -i installed weigh:/ft= lb t.1`ickness _ 7 inches
Manufacturces installed weight per square foot to zchievc Tcc.—mal Resista_�ce (R-V21,:e)
3. EXTERIOR WALL
A. ,�}u(t„� t,x�.is ax(o-Plc '-2'A 3 -
MaterialBrz,:d Na -c (( O- _
Thickness (inches) Thermal Resistance (R -Value)
B . Exterior WCU'O
Material Com. Brzrd `a..-ne It
Thickness (inches) 375— Therm -al Resistance
RAISED FLOOR
erte,
Thic.crtcss (inc` .-s)
SLAB FLOOR'?ERiMETER
N:at::risl
Thickn,-,ss (inches)
Perin eter Insulation Depth (inches)
FOUNDATION WALL
Katc:ial B-ara Na: -.,-
Thickness (inches) Tl.e.-ma': Resis:as:ce (R -Value)
Declaration
1 hcrehy her i:`y that t:-_ 3 ovc irsulat:cn ..as it s'31!_d in the c_:•.=.-._ 3: _._ado._ ioca::en is c ; f.-na ;cc with t.5c c' ,mn:
Ener; E� cier,c� S:ar.„ ara fir residenti3'. buildings (Title 2-, -a- 5, C3!i.cr-ri3 Cocc o: Regal_ccns) as indiea�,•d c.-1 the
Cc i:i_atc c.`Co^; •.ia-c , u a; piicihle.
11 (C3. NJfn:) 0*.,
Ger._. al Cor:-3aor (Co. ;:arae) OR O-ne.
B, and Ns -re
Rcsistar.c (R -Valu.-)
Band N a7..e
Thcrmnal Resistance (R -Value)
I:C.n , J:Ji:3: re, D 3tc
I'[1:211tG� SL:b-onu-=or (Co. \dGlc) OR
C:n::a! CCr.ir3c:0r (Co. ii3n1C) OR Own:r
L-
,.`c:;=3c:or (Co. Namo) OR -
Ccr.t:a::or(Co. Na -c) OR Ohner
A -3d
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 47-917 Gertrude Way La Quinta CA 92253 08/05/2002
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
Owners 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: 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:
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 yin accordance with the Structural Pest Control Board regulations
Signature
If you have questions regarding the work as outlined above,you should fust 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
Y
Certificate of Occupancy
City of La Quinta -
Building and Safety Department � F4Y
OF SSW
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: 47-917 GERTRUDE WAY U-18
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-245
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
-rdn
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