0203-344 (SATT)LICENSED CONTRACTOR DECLARATION
I• 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
04, Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
w LO
7Ci$sS� B C$ W(C'1 9t'30103
oZ r— Date Signature of Contractor io
�Or,�
J U C:) OWNER -BUILDER DECLARATION
W W r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
d 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).
co () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
0)
d Q WORKER'S COMPENSATION DECLARATION
p z I hereby affirm under penalty of perjury one of the following declarations:
LO 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U �(M), I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
IlH permit is issued. My workers' compensation insurance carrier & policy no. are:
co 5 Carrier STATIC MID Policy No. 160,16-16-02
�a
Q (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 ro.JiSions Y
Date: 1 1 Applicant �` a' 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 0
2. Any permit issued as a result of this application becomes null and void it
work is not commenced within 180 days from date of issuance of suc
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"
(V!
BUILDING PERMIT PERMIT#
DATE VALUATION LOT.5e /1/ 0203"344
J-- W1320so
JOB SITE APN
ADDRESS w4m morm wmLowsrRuT
OWNER
bli",C La , LP
74.7601 -HO . HAY 111 42.00
Mtlkm `NEL-1Z CA 92210
USE OF PERMIT
MGM FAMLY' AITAC'`H1^'T]
CONTRACTOR/DESIGNER/
TRACT
2.86-01
649-0.10-045
DCD DEV., M-1 trot DESERT M, US 1YEV.
78.600MG11WAY 17 I
U,,CZ'uDrrA CA. 97253
(760)771-3345 CT -11,14 2180
SPA - IiL IItY RN tl141`3 116, F'LJa.N IA. YgEItMtT DOES "'f a?JICY,i2Y79
PONY,~ SPA, BLOCK WA.LYA OR DRIVEWAY APPRKd.ACH, 7,,WK aE.'t9iJCTIO
IN .PLATY CHECK FV, FDR MULTIPLE ISSUAWCE OF uAME P'l,AN TYM
TRACT CONSTRUCTION Moo OF
CMAC .VC.h,Ytf"ORT "Mao SF
FSTMATKI) +CO'4r ' OF C:0.NhTv RUC`! 0_W
FE"1T1' SsVE 1AWARY
CONSTYatl CT10i4 M
101.000.418-000
`a30&.99
PL&N CHECK FEE
101-000-439•-M
Y1bE+; HANICAI, FRE
101-000-421.000
$39.90
F-12ICTRICAJ. MLE
r' 101-000-420-0.00
$65.46
PLt3MBIWO F99
101.000.419.000
SUM
STWN0 MOMP, FElt • Yp.F..SID
101-00.0-Z4 4 -00
$4.53
DNEW PER IMPACT F
$1,460,00
SUB-1-r0l:.AL, L"i1x�'a'` RUC'II.0 H AN:1;'f 11LP9 CINUX
W U
Y u 6 2002
CITY OF LAQUINTA
FINANCEDEPT_,_
TCi`1°AL :I;'.00AU Iri' ''s Dull; NOW
BY / DATE FINrLED
$2,243.34
$0.00
,2.43,34
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
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -a f •0 2 g?
Drywall - Int. Lath 57
Final
Final Ida - O
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 l y'• d 3
Gas Piping
Gas Test 7 $ 7
Appliances
Encapsulation
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) ��
COMMENTS:
=C_ -
INSULA i IOC` CERTIFICATE IC -1
Sitti Address
Description of Installation
1. ROO,
Thic<ness (ir.chcs) �
CEILING
Perm[: Number
L c!
an rn
Rcsis:ante (R-Va!uc) 3
Bat. o: E!anket Type , r,;� E:a a Namc �� (�� n .n (�L�LQ
Thickncss (inc`. s' lav" Thea' cz
sisian
Loose Fill Typc�`Cca�t'� Br-- -'/1 DO:t'1%� l
Contractor's R;1' installed weight/_lb �4ini^� -t t ness �Q- int} es n
N43-nufacturces installed weight per square foot to achieve T c=,nal Resistance (R-V!lce)
3. EXTERIOR W a=L
Material j Braid Na -c to )1Lz 4.,10 n'1() t O _
Thickness (inches) Thermsl Resistance (R -Value)
D. Exterior i,oauO
:aterial R�C,.t+S Brand Name
-t.u�
Ti ic'Icness (ir.c:nes) 3' T eraai Resistance ( -Value) 1�
P—MSED FLOOR
M �teriel _
Thickness (inc`,es) _
SLAT; FLOOR!?FRiMETER
Nat�risl
Thickness (inches)
Perir..eter Insulaticn Depth (inches)
FOUNDATION `%A -LL
i�l.atc: ial
Thickness (ir.chcs)
i........a1 resatar.c (R-Val•�e)
B: -2nd Name
T<erma! Resistance (R -Value)
T%e T:a! Rests:ance (R-Wuc)
Declaration
I hcrcby eer.ify that
Er,er,K Ejrcier,c� S;�n�.-: fcr residential buildings (Title 2-, -a- 5, C.]'i.cnig Cod: o`RegeL,:cns) as indiea�t.d ca the
Cc-ttl:a(c, of C0 .; !t3^i u ^ aO�,l:t]Sle.
13
¢r —_, :. I ta!lir SLb:cn� ]c:cr (Cc. N]mc) COR
Gcr.:. al Cont-3aor (Co. Name) OR O•+ nc:
Datc
lrs:�llir:a Sabconsactor (Co. lame) OR
Ccnc:at Ccr.tr_c:or (Co. ;;]me) OR Ow'ncr
L-.s:]llir� Sctco=]ctor (Co. Namc) OR
Gc.._.,! Ccr. t:aztor(Co. Namne) OR Own:r
C. . CJ F 3 --_St 2-'J1 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 Desert Willow St La Quinta CA 92253 08/29/2002
INSPECTED: 79-808 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 I
Notice of completion
Sent To and date
Owner's Name and Address:
Copies sent to :
03/13/2003
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• nre-treatment wis nerformed on this pronerty in accordance•n• C•. • RegnIntions,
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
i g
City of La Quinta
F
Building and Safety Department
This Certificate issued, pursuant to -the requirements of Section 109 of the Uniform'Building CodeR
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: 79-808
DESERT WILLOW STREET U-116
Use Classification:
SINGLE FAMILY ATTACHED
Bldg. Permit No.:
0203-344
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