0203-341 (SATT)D
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
Date 45...,r Signature of Contractor ti A?
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
S13ction 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 S1'AT& FUND Policy No. 16036.16.02
(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 with those provisions.
Date:_ -•' Applicant",
C_ --/
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 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 fo�inspection purp} ses.
Si nature (Owner/Agent) I'_/ -,(%., f Date
q
BUILDING PERMIT PERMIT#
DATE VALUATION LOT //2 WW -341 TRACT
f... r : L��t?IQ.61ti / J 28601
JOB SITE
ADDRESS 7_ 8EIsIi D.1 SEM, A111011 0%, 11 ..Mrr
APN
649-MO-;�..�1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
mwon,om, , LP
DCrD DEVi'.,11TO dba DESMT CHIES Di1,
744101:]TU1vCWAY.111 9200
7 8-600 1,02"HWAY 111
11v1'DIM %V.'T L3 CFS 92214
]:.A QuNr , CA 92253
('160)771:.334.5 C U 21 so
USE OF PERMIT
W '' M&Mx'WrrACE Er-:C'�
SPA -19LD ?. 57, UXIT 11% PIAIN ilii. FERMIS .i` OUS NOT IN u`i,UDE
POOL* SPA, BLOCK W.ALL.S, OR DRIVEWAY AFP11.OACH, 75% REDUCTION
D4 PtAIN CHECK PYIt FOR MULTIPIZ ISSUANCE OF SAMr PL.AV TYPE,
'i`.A,ACT CONSTRUCTION 40.00 OF
MST UTATED COST 01F 01ONS1':IiC47C;°i1ON
ft.RMUTPRT, SUMMARY
CONTP1tIJt"TION FFR, 101.000-418-000 MIN
PL,A'N CHEC:'eC. FEE 101:-00&--439--518 $'i1f.51
MC HANICAL FEE 101-000.421.000 MIR
FLECTRiC.sic PAR 101-000-420-000 $50.00
PL,ti$v BIND ME 101.000-419-000 238.80
STRO O MUrION PEE .R.ESID 101-000441-000 $31,80
bWLAXIP911 IMPACT I<&E $115690
Y�
��.r,�-�'1'�a.. �al��i�cr�s°�ca�1�A1�'91 � LA'E�• C:�:I�°�W
��,1 �aa,�
=30 PRE-PPIDIMW
�\�I
$0.00
D
TAL PUMM. ,8IYUN'.SOW
U 6
C�y OF Lp►QUINTA
FINANCEDEPT
J
RECEIPT
DATEBY
a`
DATE FINALED
INSPECTOR
O
4e
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
-
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
-J i S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/ . o -5
Final
Final
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 f-::'
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralPool
Cover
Sewer Connection
_
a l4. d "� 7
Encapsulation
Gas Piping
Gas Tests%
_
Appliances
Final
COMMENTS:
V
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Loa Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
INSOLATION CERTIFICATE IC -1
Ar_dr_ss
Perml. Numbzr
Description of Installation
1. ROOF
&ujd5
! h:CX mss (IrCi.cs)
13" -
1 i:C�i?: P�CS15:3nCe (R-Valtl�) 3�
CEILING
Ba'.: o: Elar.`.et TyF.c21" Er' �'^c � L 0
Thic,cr.css (inc.`.,s` I3Tte ^ a: ^sis1.ar.ce (R- Value) -�f (
Loose Fill Type �OC,Jt'� Brand/1 O0't'l b_p�
Contractor's r'i installed weighYR C ]b fini _ a C.sickness -7 inches
N-linuffacturces in. -stalled weight per square foot to achiL-ve 1 r.c.iiial RCsislance (R-V!I'_c) A-6
3. EXTERIOR WALL
Matcrial P_�(LJA75S Brand N=c —�A lII O. _
Thickr:ess (inches) - — Thermal Resistance (R -Value)
B . Exterior U_.)clao L
Material r, )cad _S _ Brand Name Ln(ljl_
Thickness (inches) T e.,.,-. Resistanc= (R -Value) 1�
P-ATSED FLOOR
,!lteri'_i
Thic'.cncss (inch.'.S)
SLAB FLOOR!?ERIMETER
Nate;isl
Thic:<ress (incites)
Perirnc:er Insulaticn Dept; (inches)
Y� FOUND.`.TION `VALL
�` I�1atc: ial
Thicknc,s (ir.chcs)
Declaration
Band- Name
T`c.-.mal Resistar,c: (R -Value)
Tr.e.m..a! R�s;s.a^ :e (R-V3luc)
1 hcre�y cent.` • th3t t:-_ aSovc irsulatien v.as install:d in :`= c _.'c.-- _. co.= !oc3;;en is eonfcmianec wit`; t.5. v_r%--'
Er,erg:. EYcier:c/ S:or :cry for residential buildings (Titl= 24, -a-6, Cat.i.omi3 Coce o.'RegaLSens) ss indiea�id cn the
Cc :i:l:at;, C. Com;iia c , u -_re appiic35It.
Item -s S,izr JnSf3ilir SL4:Cntr actor (Co. Name) GR
Ge :c. �.I Cont -3: or (Co. Name) OR Ownc-
I:cm =,
-nature, Date
Dat_
1-s:=fling SL!b:oncmctor (Co. Name) OR
C. -acral Cc;.:rzc4r (Co. , i3mc) OR Ow•n:r
1-salli Sctco.^.c•3uor (Co. Name) OR
Gc- nal Ccr.t::c!or (Co. Name) OR Oµ-ncr
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 79-800 Desert Willow La Quints CA 92253
INSPECTED: CO.CODE 33 08/29/2002
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:
Recommendations not completed by this firm
Cost: $
Inspection fee : $
Others : $
Total: $
Estimated Cost: $
70.00
0.00
0.00
Remarks :
• • �� • r• a .• •n this nmnerty in arrordancet,r •n • .•. • Remilations
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.
AT21:1320030313
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: 79-800 DESERT WILLOW STREET U-113
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-341
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
—1--&-4-1
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