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0203-343 (SATT)4A` (nz +"�' F— N U) w O =) M CY u7 ' W o Z (.00o � L) ww F— a U) Z co LO N ON U_ °) r► a Z lr ,Fa -O LL 0 J J mUU O d rn ,It Z_ o0 Z) r O J 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 76 sus n CaRIC, f� 9P304e3 Date � Signature of Contractor `'.�A '< OWNER -BUILDER DEC4�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. k) 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 STATE F"D Policy No. 103616f 021 (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 provisibns. Date: � �t -•�9 Applicant"-^ t �°�' 11d, 20e, Warning: Failure to secure Work' Compensation coverage is unlawful and ilf 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 for Inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT (YLTRACT :5,3200, � � //5 29601 JOB SITE APN ADDRESS 79.8134 DEa'KEff, WMLOW STM"T 649-030.0-15 OWNER CONTRACTOR / DESIGNER / ENGINEER VM Ai.."LOI T.,S, LP D(S) DEV., INC dba. DE MT tom'. T&H DFV. 74.760 W..GHWAY.1 I i iWO 118-15001I[ir W.44 Y 1 I 1 WDIAN WtLS Cis. 92210 LAQL1IP1"1A t..A 92253 (760)771-3345 •tM41 2180 USE OF PERMIT SINGLE F1!Ar1 LY ./til rAC SPA" 1-111,111-0. M; UNIT 111% PLAN IA. 'PEt2TAI T DOFF NOT INC:1,UTZ 110. 014 SPA, DWICKWALM OR DFtl'i P*WAYAPPR.OACH. '1`5%REDUC- IO14 IN PLAt•1 CHE•Cf'n FRE FOR MtJLT1P1;.ISSUANCE OFGAIMP ta"a.&N TYPE TRACT CONSTRUCTION ?00.00 V C.i.AE'.ACfLPlCAlrWORY . X03.00 SP EUMAM COST rM t>:i)INTSMUC.tION PYRWr YET SUMMARY MII€sRUCTION FRE 100-000-418.000 S 81els0 PLAN CHXCK FM 101-000-439-318 $87.35 MUCH.AWMAL FEE 101-000-421-000 $39,30 P'LEC TRICA.L . 101-000-120-0010 $69.46 PLtTMCl` 03x1? 101 -000-419-000 1189.50 STRO11 O M07ION FU - R.FSID 101.000-241X000 $4.33 DMA101<91ti IMPACT FEZ $1„imoo M1r i t 8'M -TO =AL. I�1'�a°TRX1'CKTTON AND PLAN +:: ECY '$2.,2,43.34 LUS PRY-41AID-10, if; $0.00 SAY 6 ZU01 r. P. rMRS XTE NOW 920,43:R44 CITY OF LAQUINTA FINANCEDEPT. RECEIPT DATE BY DATE FINALED INSPECTOR �' • to �/` � - l�t.a ,53.01 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs -Z - Underground Ducts Forms & Footings —ag Ducts Slab Grade Return Air Steel _ Combustion Air Roof Deck -o -?•a 37 Exhaust Fans O.K. to Wrap F.A.U. Framing _ Compressor Insulation -d L Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath (-ys- •oz 577 Drywall - Int. Lath Z -% Final _ Final ,� 3 - / ? BLOCKWALL APPROVALS POOLS - SPAS 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 /E' —�—� _ Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection r Pool Cover Encapsulation Gas Piping Gas Test _ - / 37-0 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) .c7 COMMENTS: INSULATION CERTIFICATE IC -1 Si;c Address Nrrnl: Number Description Of Installation 1. ROOF Jrr Ti;: : Rcsis:�nce (R Va!uc)V,3 CEILING t r Bat: or Blanket T,;rc E -a �'_-c�L1\� Thickr.css (irc' -s' l3 " Tr e ^ _. ^sis:ar.c (R aloe) Looe Fill Type OQ�t'l {��l Contractor's rni- installed wei3hi/f:' A- Ib �4ini^_ -� t:zic'..n_ss ld-� inches 'Manufacturces it -stalled weight per square foot to ach:vvc T c:mal Resistance (R -Vale) — 3. EXTERIOR WALL A.Ly t�SX(o-PiC'�rt���3 Material j Bra .d Na -c a ��1Z_,-I U(1 AClt c < <0- _ Thiekress (inches) lG _ Thermal Resistance (R -Value) 13. Exterior' 'CLD Material yP- C -&s Bn: d `a:ne LAO Thickness (inc'r.=s) j' T e.,.,_. Resista c: (:-,,-Value) RAISED FLOOR V .iteri'_i Th ic': ncss (inc`,.-s) SLAB; FLOORi'HERIMETER Nat�risl Thic::ncss (inches) Perimcter Insulaticn Doth (inches) FOUND, -.TION NVALL 1.1;.atc. ial Thickness (inch. -s) Declaration Ti:c.--31 esscar.ce (R -Value) Banc Na -::e T`er.;:_1 Resistance (R -Value) Resis.anc: (R -Value) 1 hreoy ccr:ify that t: 3So%•c irsuIat,on .vas install.d in the c_:t.=.-- . _._ a`o•.c !oca: cn .,. ccr.fc iaacc with tic currLc: fres; Ejicienc� Srer�.'r1 for residcrr.a! buildi-.&s (Title 2 :, -a- S, Ca!i.cnia Cod: o`Rcgal_^ens) as indiea�id on the CC: iI I=ate. CFCOTr!i"n u'_... a?FC-13bI r lt_-i a; SLbccn':3crr (Co. Dane) OR Gc;.c.%l Cor.-,mztor (CO. ?:ane) OR O-r,c. F'.1_ , — I® "na:.:re, D3:c Sid Da._ 1-,:zlling Sub:ontmctor (Co. Mrnc) OR Cc:icral Cor.trac:or (CO. , 'ane) OR Ow'n:r Irs:31�Ir Subcor:_actor (Co. Narnc) OR G...-. _! Ccr.,:l::or (Co. \3mc) OR OµTer 2-_3 A-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 ollowing: BUILDING ADDRESS: 79-804 DESERT WILLOW STREET U-1 15 Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-343 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