0203-301 (SATT)U�
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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
768595 13 CS wI4
9 U1t3'
Date Signature of Contractor
OWNER -BUILDER DEC RATION
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
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 V T.A`!'81U*ya D Policy No: 16436,16.02
(This section need not be completed if the permit valuation is for $100.00 or less).
"(y)'•, 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 wii&those prouisiorfs.
Date: ~o nU2Applicant � ✓ !}
Warning: Failure to secure Wd kers' 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 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 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) I• rO r" 3 � Date
BUILDING PERMIT PERMIT#
DATE l VALUATION LOT OrM'301 TRACT
"� _ U�41d1.Qtt B37073 28601
JOB SITE 1
ADDRESS -79s wram ♦ffW.O!ir mm
APN r
649AVAMS
OWNER (/
CONTRACTOR/DESIGNER/ENGINEER
mm.Alm)o i, ,1 A)
DC D DEV, , WC dba DEOMT C M—P DRV.
74.760 FI101AVAY 111 O1r0U
7tt-6001nCr> AY 111
WniIM WL?UA CA 922 J 0
LA QTdWA C.A. 92253
(760)77#1-3345 CLIA ZI80
USE OF PERMIT
OWME
SPA o SLOO.'r, UNIT 7.4 PLAN 18. 'PtlRMIT IODES 3+ OT INCLUDE
P004, SPA, BLOCK WALLS, OP. Drltii'SfE,1pIAVALPPROACH, 7% RM?UG1 JON
IN PLAN C;N1EWX FtE FOR A41P%M1" LE ISSUANCE OF SAME PLANA "t`YPE,
TUCT CONST. XTION 70100 317
OSI ' Q�1!r '�:ONSSTRV(7r.�ON
s�ypy yxxy; ��r�v �gy�� �&�y t A 9NturJAWrED
.R"JS.bYJ1A'.Ri.�, f12 AYV1vrt�luSaS;1.
COtdwTRU(rrION F&E 101.000-•41.8.000 &,343,00
PLAN CHECK: ME 1€34-000-439118 X8.53
MECHAAiWAL.RE A01-000,421-000 $39,50
ELLCTRIC:AL PFZ 101-000.420.000 $Sko6
PLlIM£ )NO RP R 101-000-419-000 0.419.000 501156
S"TRONO MOTION FEE o RESID 101-000-241- DOO 91x.130
ial7tli%0PE1%'- IMPACT FEE $1:,569.00
rr
' SUR- a`rJl'A`A11. C OINW`liUC1:fON AND PLAY Y CY19('1Z
LESS 1'1tR-P 1 82
AC0,00
_
MAY U 6 2002
CITYOFLAQUINTA
RE — , BN DAT FINALED INSPECTOR
ro", ' 1
INSPECTION RECORD
"OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- 1, —pZ
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
-
Combustion Air
Roof Deck
/0. C 7-v -o S
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
/! • O 2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
r d L
Final
Final
,S= • O 3
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
26 �-Cp�
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
/jf.0 S7
`-
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) .m
rt
- =C — — -- -
INSULA T ION CERTIFICATE IC -1
Site Adaress
Perml: Number
Z i5 Aar i2Z Z
_,- 6-
_. ..__. �-7,Lt���
Dcscriptioli of Installation
1. ROOF
Malcriat: Ey'c" "5
13t
T Rcsis:ance Va!u:) 3g
CEILING t_ '
Ba'.: o: Elan:•.et T;rc �'7'.���� E:_-am,C
_,-,
Thic;cr.css (ir•c..•s 13 T.._...._. �sis:ar.::
Loe.c Fill Type /l
COntfaCtof 9 r l' lr tal!2d weigh /?:- -�- lb lnch es c�
'Manufactu:ces installed welzht per squa.c foo: to ach: -�vC 1.....;;,a! R:sistinc2
3. EXTERIOR WALL
A.
Matc:ial Pp(, 3:L.d Na-- Unn c %(((o _
Thickncss (inches) CG The Taal Resistance (R -Value)
B. Exterior ' 'CLUO r
`:aterial VyC: ttS B -n": N -Me �I
Thickness (inc---s) 3' � T _: -:a: R:s:stanc:
RAISED FLOOR
..A!e:i3i
Thi6mcss
SLAT; FLOOR'HRIMETER
Maty: isl
Thic r,:ss (inches)
Pcrlr c:c: Insulaticn Dcath (inches)
FOUND.'•.TION NVALL
N1atc:ial
Thickness (inchcs)
Declaration
T:._...._..,_sistar.c_ (R -Vale)
B, -and Na -me
T`crmal Resistance (R -Value)
? --a N.,:
ce:r.:a: Resis:ar.ce (R-V3lL'C)
I h:rcby ecr.iiy tha! t.`.: 31-lovc irsulaccn .vas ir:s:allcd in th. `-_.._.-._31_._ abo.c !oca::en in eor.rn-na with Chc current
Er,er ; E� der,c� Stun':ra for residentia! bull i .ass (Till_ 24, -a- 5, Ca•,iron:a Code or Rcgulaeens) as indica�ud on the
Cc:'iticaw crCo,..;. iaac , µ?_.c a piicable.
Itc n -s Sfgr r_re, Da:. Inst3!lir.z SLb:Cn� actor (Co. Name) GR
Gen --:el Cor.;�c or (Co. Name) OR Owne:
r -s
ignature, Date
lns:alling Subcontractor (Co. Name) OR
General Contractor (Co. , isme) OR Own:r
Irs:allir,g Subcontractor (Co. Name) OR
Gcaeral Ccr.t:actor (Co. Name) OR Owner
Forms A-36
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 79-795 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 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: 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: $ 70.00
Inspection fee: $ 0.00
Others : $ 0.00
Total: $ 70.00
Estimated Cost: $
Remarks :
•il pre-treattrient was nerformed on this nronerty in acc•rdance wit I St=turalPest COntral•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,California 95825-3280.
AT21:1420030313
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: 79-795
DESERT WILLOW STREET U-73
Use Classification:
SINGLE FAMILY ATTACHED
Bldg. Permit No.:
0203-301
Occupancy Group:
R-3
Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
Building Official
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE