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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. 1
License # Lic. Class Exp. Date
-768595 3 C:SI? 9101173
L.}
Date `� "� f "� Signature of Contractor ! ' 2
�1
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.
X1 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. 16!13616-02
(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 pirovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions
Date: -o Applicant—
Warning:
pplicant Warning: Failure to secure Workers'�Compensation coverage is unlawful and
shall subject an employer to criminal (ienalties 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 t
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 iAspection purposes.
Signature (Owner/Agent) Date �-�,, t
r _ .o
BUILDING PERMIT Pi�
DATE VALUATION LOT �J `` 0203-'145 TRACT
JOB SITE
ADDRESS 79-7M
9,s W R110M, ii1ILLOWMr I"
APN
W-( 145
OWNER
CONTRACTOR / DESIGNER IEN (NEER
r m.)aRn, ITA
DC,) DEV., XC dbe NEWRT MES DEV.
74-760IRGR ATAY.111 #207
78-600 313 ��Ls 113
W -DI n%T VM" CA 92210
L. QUMA CA 92253
USE OF PERMIT
SPA, - 81,D0.iP, U1411 11-7, IP'l..i'U,1 1,8 . PEWIT DOES 140T NC1JJDE
I'°O04 SIk& BI.,t ,K i1►'aALI,% OR DRfV A Y : PPI),O,A 'Il, '.te % REDUCTION
EN PLAN CHEIM FEE FOR MUIMPLE 1SSU"CY'.: QP' u'AME Pt... N T`PVE.
`6'IIIACT CONSTRUCTION ?00,011 SF
CONSTRUCTION FU 101.0100-118-000 3 1 •.04
PLAN CHECK M 101-000-439-31
MWII'!MIL".AL ITKE 101-000-421.000 $39.50
E1 NXTRICAJ YX?4 01,.000-420-000 08.(w
P'1.tTMk1M I?ME 101.000.419.000 to&31
STI ONQ MOTION wa,F - ID 101-000-241X000 $3.20
DEVE ..OPM IMPACT FE
SUB, -TOTAL CORdW RL7MION'AM P1.,1•N f,.HeC".K
D LMS, PRRb D off) FI S
$0,00
MAY U 6 26012 i
CITYOFLAQUINTA
IF CEDEPT.
[RECEIPT
DATE
4� -/`2?
BY
DATE FI LED
. a
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -7-2
Underground Ducts
Forms & Footings Z ,p
Ducts
Slab Grade g —dZ
Return Air
Steel
Combustion Air
Roof Deck o . ! 7.0 ,Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath •oZ 1% 7
Final
Final3 l • 0 3 S7
POOLS - SPAS
BLOCKWALL APPROVALS
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 a—�g� 3 �7
Encapsulation -
Gas Piping
Gas Test O 57
Appliances
Final
COMMENTS:
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)
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 79_788 Desert Willow La Quinta CA 92253 08/29/2002
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 COMPLETION STAMP NUMBER
Notice of completion
Sent To and date
Owners 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
Signature
Cost: $
Inspection fee : $
Others : $
Total : $
Estimated Cost: $
70.00
0.00
0.00
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.
AT21:1320030313
, have
INSULATION CERTIFICATE IC -1
5itc Addr-`Ss
Prrnl: \'umber
Description Of h5tallation
1. R00
I`ta:.ria! 'i. /S
T hic'Kr.-Ss (i!:ci-cs) 1 J'r --
�_�^`
'Inc -7 „_: Rcsls:a,iice (R -Value) 3 !1
CEILING ;� j
Bat: o. B'.an'.,et Tyrc i?"Y.� E, _� �, - c �i�X�� M� ,Yl (It Q
Thickness (inc,`. s' l3" ^sis:ance
Loose Fill Type j�GC � -,and /� DO t'l iJ�r
Cor.tractor'9 r i- installed wcightdi lb I....... t`tickncss (d_ ; inches
Manufacturees installed weight per square foot to achieve T c. real Rcsis:a_xe (R V_l e)
3. EXTERIOR WALL
A. �)/�e t ,y t X ' S c--) o)X(o—P\cwlo'P�A.3 ..
Material PYJ�_j B. -2-,:d Na -c Un Ai () t (o-
Thickness
O Thickness (inches) ��— Thermal Resistance (R-Valuc)
B . Exterior t. o ' &o
Materia! P�C�t�S _ Brand Name
Thickness (inches) Ther;ai Resistanc= (?-Value) - (�
PRISED FLOOR
;✓;alerts,
Thick,ncss
SLAB FLOORR—ERiNIETER
Material
Thie..ncss:r,cnes
Perirnctcr Insulaticn Dcpt; (inches)
FOUND.'.TION ViALL
Katc.ia!
Thic'tcncss (inches)
B, N a e
T i..,....a! Resistar.c- (R-Val•uc)
Brand Name
T`cr.,,al Resistance (R -Value)
a .na Na:-,.
Ti-e=.a! ReS:S:aP.0 (7,,-Va!uc)
Declaration
I hereby c2r:f" th3: ! :_ 3bovc !rsuhticr.. %vas:r.s!sl!_d in t.:_ !oca::cn ;n ccn�:,,-.ia ncc w;,4 t.5c cL•,i.
Er,erZ; E„rytcie!:S--I for residertia! build.-.gCs ( T i!1= 241, Pan 5, Ca;i.cnis COL-:R:gu!a ens) as indieatid c:1th.e
Cc iratc co- r'.3 -c , u a; piica5le.
o �11S�d �'�
^s 5,12:' =r_, Da:.. Ins:a!1ir SL`.cn' a.:or (Co. INanc) OR
Ge ;_:al Con:-m.:or (Co. ;pane) OR Own::
l:c:n ».
I�
Jna'-:rc, D3:c
S:� .ct_. , Da,_
1^s:zlling Su`:_ontmctor (Co. Nar rc) OR
Cc;tcral Ccn:rac:or (Co. ; 3nc) OR Ow•r:cr
Ir.s:alling Sc_con_ icor (Co. Namc) OR
Ccr... -::or (Co. Nane) OR Own -_-r
1 36
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: 79-788 DESERT WILLOW STREET U-1 17
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-345
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: 05-01-2003
POST IN A CONSPICUOUS PLACE