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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
1685595 B CS F`SIC:' 9130/03
Date C-°r..,.ia?, Signature of Contractor,=R—AT
tOWNER-BUILDER DEN
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 wgrk, 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 41•, 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 STATEFUND Policy No. 1543616-02
(This section need not be completed if the permit valuation is for $100.00 or less).
(o) 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: s Applicant .�
Warning:- Failure to secure Workle
ers' Compensation coverage is unlawful and
shall subject an employer to crimihal 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 for inspection purposes. x
Signature (Owner/Agent) ..ni /1A Aej Date
e--'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT, 0210,302 TRACT
- (-t CaRt1 HM74 28601
JOB SITE
APN
ADDRESS '�t�^i S, ly Mxler WMIlow SM-T
649-030-0415
OWNER
CONTRACTOR / DESIGNER / ENGINEER
?+ Ate. P , LP
DCD DEV., INC &-A 1D01-11'4 CIMS I�'e:�i.
74-160 HIGIAWAY-1 I 1 #200
78.600131014WAT 111
XND4%NWM1A CA 92210
LAQU,-NTA. C,A, 92253
0
k-/60)371-:3349 C+37att' 2180
USE OF PERMIT
SNOI,�FE AImMY
SPA a !3P..3MM, MI I i -M. PLAN 18 . PP"IT DOLM WOT rNC 1_JJD9
POOL, SPA, KoWK W.Ai.0OR DR.IVEti�',AY APPROACH. H. 1.5%JI3s;EKIcTION
IN PLAN CHECK �~'F.+-'� FOR MLI1 TIPIZ'ISSUANCE OF SAM 0, PLAid'TYT'Z
TRACT t; OIISTRUC"TIO14 7I0.00 IV
.) CO/Jy,4 Odd• 4ea+ICii7.a.iv�.t.'4�d�Oa.3'
Yyrrqq������f{qp r �q��t��,1�y:M.�ITM"-4.Cn'
il'fil AS.LY.iI .' �� EVTJ Vi.LVD.t,'►R
CONSTRUCTION RP, 103-000-418-000 5343,06
PL0 CHECK, FEE 101.000.4 39-318 M5!
MECHANICAL PRE 101.000.421 000 539.54
FAA eC'TRIC:AI. F .E 101-000-420-000 318.81
i'LLIMB1140 FEE 101.000.419-000 $0.9
STRONG MOT1014 FSZ - Rl, RD 101-000-241-000 Mo
D13VItrWPER. IMPACT FE
t;UD-TC1'EAL C1C).`s1'8'9.'RUM09 .A`t D PLAN Cki A"%
$2,180.31
LESS P-M.-PAW144.1110
$0,00
MRTiUT1IMS TJVIE NOW
MAY u 6 2002
CrIYOFLAQUINTA
FINANCIEnppZ
RECEIPT E
By
DATE FINALED
INSPECTOR
0
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings—
' oz
Ducts
Slab Grade
35 —
Return Air
Steel
S- '30 02
Combustion Air
Roof Deck
. / % v Z 5%
Exhaust Fans
O.K. to Wrap
ZF.A.U.
Framing 7
Compressor
Insulation
77.14 -.95--37-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
457
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater 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
,tri _
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) 1-.27-0 3
_=C
INSULATION CERTIFICATE IC -1
Sit: A'dr�,s
Nrml: Number
t-- U.11
Description of Installation
1. ROOF
\�a:cria� �x�,tt5 Bra Narn_ �l� ;n t
Thickness (incises) 13" Resis:ance (R Value) 3S(
CEILING
Bat: o: E.ar.':et T y p c Ei. d \a^c �� L
Thickr.css (inc`.-s' �3" The=!' sislance (R- '.aluc)
Loosc Fill Type`Ct ,�� >;ra-rand /1 Ot?:t'1
Contractor's rni- installed weight/f:- k- lb fir i ^ t4ickr-,ess j 7 inches n
Manufacturces installed weight per square foot to achieve Thc.-Mal R.sista-nce (R -Value)
3. EXTERIOR WALL
A. �7llv,� t,.XS ax(o'P1Cwt 3
Material P-D-1/itS Brand N c UO A-1 t t 0- _
Thickress (inches) Thermal Resistance (R -Value)
B . Exterior ltiC, L0
�:ateri3? Brzr.d 'Name 11
0 T-e.rmal Resista
Tcickness (inches) 3' nce (R -Value) - (�
R TSE.D FLOOR
Material
Thickmcss (inch; -S)
SLAB FLOOIL'PERIMETER
N:3t�: isl
Tbickricss (inches)
Pcrir^.c:er Insulaticn Dcpth (inches).
FOUNDAMON WALL
N1.atcrial
ThiCkPICss (ir.ChCs)
B, ani N
1 ti ....31 Resistance (R -Val ic)
B, znd Name
T, cr:-rtal Resistance (R -Value)
P,.an. Na-:.
Tr.e:m.a: Res:s.ancz CR-V31ue)
Declaration
1 hcr.1-y eer.iry that t`._ 3bovc irsulatien was installed in a:- c_:l_:-- V. zoo._ loca::en in ecnfc-mance with ttie e rrrr.:
Er,rrg:: E�+ �_ier.c� Srcrd:-J Cor residenti3l buildings (Tit12 24, Pa- 5, C3li:cr:li3 Ce�c o`Re¢ala,;ens) as indieatrd on the
Cc:'i:l_at, e:`Comr!i3.. , w-_.. a; plicabIt. o
r1k2- _._, Da:e Ins:a:lir SLb.cntr3c:cr (Co. Name) GR
Cc :ural Cor.: az or (Co. Name) OR Ownc.
I:cm =,
Date
Ins:alling Scb:onu-sctor (Co. lame) OR
Central Cer.:rzc:or (Co. i i3mc) OR Owner
Ins:ltttn. su`_G0=3ctor (Co. Name) OR
Cc.._. zl Cc,.,.,:tor (Co. Mme) OR Oµ-n:r
C _-_ 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 79-801 Desert Willow St La Quinta 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
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:
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.(1(1
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performed on this property in accordance with the Structural Pest Control Board regulations.
7x,
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.
AT21:1420030313
, 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
ollowing.
BUILDING ADDRESS: 79-801 DESERT WILLOW STREET U-74
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-302
VN Land Use Zone: CR
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE