0203-303 (SATT)LICENSED CONTRACTOR DECLARATION
y 1 hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O License # Lic. Class Exp. Date
IQ LO
LU
C5 Z r� Date Signature of Contractor—
(00
ontractor (0O
OWNER-BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co License Law for the following reason:
Z_ ( ) 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
LO
N Date Signature of Owner
OC\J
CL Q WORKER'S COMPENSATION DECLARATION
p Cc I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () '1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have ana-will maintain workers' compensation insurance, as required by
O L Q Section 3700 of the Labor Code, for the performance of the work for which this
0) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier
S`iE 1Lq4D r Policy No. i59SdEd-D
co
C
J
(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: x^a •.. y. l)1 Applicant. r✓ ! r i
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 for�inspection purposes.
Signature (Owner/Agent) +�- ��� i�►!a Date'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT `§ TRACT
A-- !1- - r v� 91J� �.t�(} U60 i
JOB SITE
APN
ADDRESS 79-i�.)7 .ITER Wr WILLOW aSIXTI. Lu
6494M V)45
OWNER
CONTRACTOR / DESIGNER / ENGINEER.
M:(p"..t R , u)
1Y+ DEV., W dl)a 1 US.FRT CTi°tM 131 4'.
74=760S15CITWAY '111 #Z00
78.600INGJ WAY', I I
INDW4 'b' EUS -CA 92210
LA Qti1 ffA CA 922D
(76(.�MI.3345 C 41, 21 t310
USE OF PERMIT
EiINCiT..EFAMILY'.�1.° ACTM
SIPA. • kt'aAXLS8, UNIT 7% PIAN 3,0L PERMI Y T2OMS WT 114C1..Lt09
POOL, SP6.;,.1Hk)C°K'Wtlf:M OR. DRUMNAY APPROACH
TRACT CONSTRIUCTION
��4.itAf;�.lCA��.FtOK'd' S4t1.t16 Sir
JyCsynn.dY..G,}$9d' Mti✓A1?vf, o R. r41N\9Y:�.SiA1YsmoN
59,019.W
$aT.i'3A..lTJ.A:d.SS J7.1r.CSC i9 o.J19RtY.L1fW�ii'lt
CONSTRUCTION ION YU 101.000-41$,.000 $459.50
PLAN C14VZK WE 101.000-4:39-318 $409.29
MEC A, YS2 .01-000.421-000 139."
If%.Ir.C.!'R.IC,AL'Yk1f, 101 -1000, y20-000 V3.52
PLUPr4BINO ME 101-000419.000 $88,50
STRONG NIOTIO14 YEF, -. R=11D 101 -00a -22A.1-000 $3.90
DEVELOPER IMPACT FU, 1I.5boto
FEEDTP€ 0111' •.C1�i90X.t�?39��i1� ��SUt+.nw
p ` QT06111 TO RUG'TION AND VIA CME C11,
VMS Y'RE-PAID 1IZZO
rb,frwl.21
4.100.00
MAY u 6 711111 ,MOWJ."EVS-OVE. NOW
CITY OF LAQUINTA
FINANCEDEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
�i
OPERATION
DATE
INSPECTOR
OPERATION
. DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2
Underground Ducts
Forms & Footings
v --
Ducts
Slab Grade
Return Air
Steel
C9L
Combustion Air
Roof Deck
(p e e?.o ,S 7
Exhaust Fans
O.K. to Wrap
..fF.A.U.
Framing
' 7%/
Compressor
Insulation
! . , v L
Vents
Fireplace P.L.
Grills
Fireplace T.O.,
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.�•�
Drywall - Int. Lath
• LZ -2 Z Y!
Final
Final I .a' (-03 S7
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
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
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) ' , d
'COMMENTS:
INSULATION CERTIFICATE IC -1
Jitr A�dr^ss
Perm I: Nu-1bzr
r. L,—
Description of Installation
1. ROOF
Ex's ffI
Thic<r.ess (inch, -5) \31(
CEILING
B-an.�
Ti^;r� _i Rcsis;aace (R -Value) -_2
Bat: or B1,an':et Tye e Ivy,, -H-75 E. -a a Nam.c --ZkriCA ,n ()&U
Thickr:css (inc`-s' The:*r_: sistancr (R- '.aluc)
Loosc Fill Type _ �a ,>>� Brand /1 OQ.►'1
Contractor's r::i- installed w6ght/ft' A— 1b Mi ni^:urt t�kness inches
Manufacturces installed weight per square foot to achieve Thc.—mal Rcsistance (R-Vel::c)
3. EXTERIOR WALL
A.
Material Brznd Name UJD Aq c t 0- _
Thickness (inches) Thermal Resistance (R -Value)
B . Exterior LA-)CIU0
Material Brand NL. --.c x—L
Thickness (inches) 3' T ermai Resistance (R -Value)
RAISED FLOOR
;.ra!erial
Thicimcss (inch: s)
SLAB FLOOR/PcRi`IETER
Natensl
Thickness (inches)
Perimc:cr Insulaticn Dcpth (inches)
FOU\D,=,TION \ ALL
M.atc.ial
Thic' ncss (Ir.ch:s)
B,?r.d N -^me
Kcs;stance (R -Valle)
2nd Name
T<er.mal Resistance (R -Value)
B-ar.a N_...,.
TCe.T.."-i Res;s;ar.ce (R-Valuc)
Declaration
I hcre'y eer.ify that tt-- 3_ovc Insulation \tits ins:311_d L*1 :} _-.';C:-.c ]: in. cc. fe-1a nee with Lhc carer..
Ererg: Ej-tcienc-`, Stnc.'.r. far r_sidential buildi-.gs (Tit1= 2•:, -a-6, Cavi "--m;3 Code o,`R.¢oL ens) ss indiealtd on the
Cc:'I:1_3tc crCOT�!t1'
1!cn =s S,i2n _._, De:e lr.sti:lin;� Sc.b:cnua...cr (Co. Nanc) G
Ge :c. al Cor.;-.3aor (Co. mane) OR 0+'nc.
Ua;c
lr.s:alling Subcontractor (Co. lane) OR
Ce-r_:al Cer.trac:or (Co. ;:amc) OR Owner
Ins:alli Sc--conzwor (Co. Name) OR
Cc.._._. Ccr.t:actor(Co. Name) OR 0,A -r, --,r
A 30
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 79-807 Desert Willow St. La Quinta CA 92253 09/04/2002
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
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: 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:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70-00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pr .-treatment was performed on this . in accordance with Structural Pest Control Board Regulations.
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.
AT21:1520030313
.x -
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: 79-807- DESERT WILLOW STREET U-75
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-303
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