0203-337 (SATT)F1
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
'768595 13 CB 17iC � 9/30103
Date t, Signature of Contractor � ,. a � . ,, r
OWNER -BUILDER DECIy/4RATION
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
Sec ion 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 St' �►'I'I: r�1l, il? Policy No. 103610-02
(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 provisi6ns. r
Date:• ?mow_ Applicant—
Warning:
pplicant Warning: Failure to'secure Worke s' 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 fdninspection purposes.
l t�
)
Signature (Owner/Agent-r�? My,,�, Date A5
L"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 5 /0/%'6203-337 TRACT
�
Q / 20 �10
bCIV V
/ ] iTMN,9�.bV•C7V 28601 0
JOB SITE
ADDRESS .% `u � '�
APN
4F49 -•O` V4.5
OWNER
CONTRACTOR/DESIGNER/ENGINEER
bAM A FWr%9`i, I -P
DCD DEV., IWC d ba I.31?R.KR.*JT C=G DEE.
74.760 HIGH AY.1. 110200
7 B-600 IUG1 .A:1:7 i 11
W3[Aki"tJJ`FL.'Cs CA 92210
1.,At ungT.A CA 922S3
(760)773-•5343 cIVI! 21 so
USE OF PERMIT
81W01Y.FAR). A�, IAC'J
SPA --BLDO,S5,3AtT 109, PIP A1IA. PUNIT WES NOT INCLUDE
y004 3PJ%- RLOC/WAL4, iy1RI YWAiA RQtK 74% IuU , rht
114 PI.,AN CHWX FEE FOP. MULTIPLE+ ISSUANCE OF SAME P"A TYPE,
TRACT CONSTRUCTION 701 Do SIS
CIARAridCAi'3POWI' 374.00 SIS'
.11'BTIMSK1 ) (:0nCJS' CONI' .i;1RUC`• 'iilrN
4S,.3204190
FERWT trim ST3fI�.1�.'ARY
CaWSTIVO CT1014.,nTE 101-000.418.000 S31".30
PLAN' s ;:a'7 E FEB 101-000-439-318 $0.95
M CHANICAT�'0 k: 1{71•UtEU G21-£fU0 $X50
FLIM ITRICAL. Kilt 101-000-420-000 $65.16
PLUMBING FRF 101-000-419-000 419-000 sa,V
STRONG MOTION PEP.. - PXSXD 101-c1t -241.000 $4.33
DEVELOPER WACT FEE $11509100
'a 1!'UCTION AND d'iwt'"3J'�7 ISIMC1�.
$l•,ts'! 3.34
e r�S Fa:W.-PAID REFS
D
$0.0Z
MAY 6 20UL F.�rrFXEN7��NOW
CRY OF LAQUINTA
--FINANCE)EPT
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
"It
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
p.( Dov
Exhaust Fans
O.K. to Wrap
at
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
i
Drywall - Int. Lath
2 Z �aL�
Final
Final -/ s'7
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 Linesd��7
d
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)_ l - 0qt
COMMENTS:
INSULATION CERTIFICATE IC -1
5itr Address
Perml- ~umber
Description of Installation
I. ROOF
Thickness (ir.ci -5) �3'r --
Ti:z=:,. Rcsis:anc- (R -Value) 31�6
CEILING
Bar: o: E!an'cet Type y {S E:s. � Namc
Thickncss (inc`.Cs' l3" Ti e rr =: sistarce (R- 'alec) -?j�%j
Looac Fill Type Er"d
Contractor's rni installed weight/P: k- ]b 11i.^.i tt' ukness -7 inches
M3nufacturces it -stalled weight per square foot to achieve Tim= al Resist -ice (R-Valuc)
3. EXTERIOR WALL
A. &e I! ,Y l JCix.�S 02x(0-9�Co;:? A 3
Material Br2id Na -c
Thickrtcss (inches) — Thermal Resistance (R -Value)
D . Exterior L -)C f o
Material ?Yltt s Brand Name Linn
Thickness (inches) -�>'/O T e.^a: Res:stanc_ (R -Value) - l�
RAISED FLOOR
Mmeriel
Thic:cncss (inch --s)
SLAB FLOORRERIMETER
N.at::isl
Thickne55 (inches)
Perirnc!ce Insulaticn Depth (inches)
FOUNDATION ViA LL
ivlatctial
Thickness (iP..cr:cs)
R=sistar.cc (R-Val-uc)
B zad Name
T<ermnal Resistance (R -Value)
E -a -a \a....
'.-.e:r.:_: Resis. anc: (:Z -Value)
Declaration
I h:r:'cy certify that t;
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 79-812 Desert Willow La Quinta CA 92253
INSPECTED: CO. CODE 33 09/09/2002
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:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performed on this 1L Yin accordance with the Structural Pest Control Board regulations.
Signature
If you have questions regarding the work as outlined above,you should fust 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.
AT20:3320030313
, 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, 3"
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: 79-812 DESERT WILLOW STREET U-109
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building
MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-337
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