0203-304 (SATT)FI
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 -B CR HT.0 _qr30103
`w
Date � ^-'/� -L.7Z Signature of Contractor—
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATION
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
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 3T.ATE FUND Policy No. 1€91616-G2
(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 provisions.
Date: ? • Applicant,i • ''�
Warning: Failure to secure WorkersV'Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 37.06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at,
whose request and for whose benefit work is performed under or pursuant t$ D
any permit issued as a result of this applicaton agrees to, & shall, indemnif.
&•hold harmless the City of La Ouinta, its officers, agents and employee
2. Any permit Issued as a result of this application becomes null and voi
2)
work is not commenced within 180 days from date of Issuance of sch
permit, or cessation of work for 180 days will subject permit to cancellati n,
I certify that I have read this application and state that the abovd ihformatio
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) {1/ '011 1444 Date �:, 4/1
Y y�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 00-1-104 TRACT
0,0.19.60 10886 28601
JOB SITE�
APN
ADDRESS , Dni il7 .'C,A WILLOW FrH'TX,r
(549- (]1.045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A,41IR11 LORESI, LP
DCV DEEV., INC dba DESERT CTIT ES DE
74.7 60 HtCx`HWAY 111 #200
79-600 YUG INWAY 131
INDUX wMU7 CA 92210
Z.A. c LYkrrA CA 922S3
(761 0771«3345 MR 7.1 so
USE OF PERMIT
t aLE FAR{tt Y AT l�,k�.MEMD
SFA . f]Lf3.O 3A., Lt711T it1, MAN E.A.. PERMI .130PS WOT 114; LUDIR
P0014 SPA P.,LOCKWA1at,0,Olt I?lZ1VWftWA.YAPPRO.AIM, 75% REDUCTION
rN PLAN CiiiHCX Fft, POI . MI[IL'TIP1:X ISSU,AiNC;11: OF SAME PL" TYPE,
TRACT T C,'ONS R4, CTIM 892 -OD SF
is ARA.9i?�' CARPORT 540.00 SF
14MM .iii. M C'ogr OF C✓(�1�s1'.�LXi'6'''1��.3.1.�
,i113.ii1
�f77;;yy��p�+ qq.. ``���� yy�� $, gry'�g.�7y
P3��.4• 1.I PPIL` iYf+�.IVS.L "R
0 ONSTRU€','CION YU 103-000-418-000
PLtkN CHF";V,.� E. 1014=429-319 $102M
MFJm}iMWIC.f Lk.: 101.000,421.0009 13;.$0
W?,C4'1tlf;;.AL MV!, 101--000— 420-000 $75,!a
PLUMTH0 F91t 101.000419,1000 $39, %
STRONG MOTION FMO . MID 101 $5.90
0ZL,0J;TtIMPACT FIE $1,.560.00
..µ
%d I ; SiJl;'Y-'t)OxAi, COMRUCF,lOIN AND PLMi MR=
$2,340.24
r. En. PRE -PAM Xy17� 9
$0,00
TOTAL MIM IMES DUE NOW
�2,4wa>2•�
TYOF
O�PI
fxt
RECEIPT
DATE > ^ .
BY
DATE FINALED
INSPECTOR
M
.11,4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel F:�,—a --p
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
0 26
F.A.U.
7 1
Framing1
Compressor
Insulation , Z S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 2 •o •- s
7 S2 -/,f —79Z
Final
Final
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
10,
Gas Test
Electric Final
Waste Lines _� - S
Heater Final
Water Piping
Plumbing Final
plumbing Top Ciut
Equipment Enclosure
Shbwer Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection (. �j
Encapsulation
Gas Piping
Gas Test _ . 0 7
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 S
Utility Notice (Perm) • .d
COMMENTS:
C — — — ---5:
INSt`LATIO-N CERTIFICATE IC -1
cz A -dress
Description of Installation
1. ROOD
Thic:<ncss (ir.cl.cs)
CEILING
P e r m I : \'umber
Th; c:,� �: Rcsis:ance (R-Va!uc) 3Sg
Bat: o: E:anket Type E,-an� Name C.1' J(Ly
Thickncss(inc,`.-s` 13" Thea. F6sistan'aluc)
Loosc Fill Type Brand
Contractor's rain installed weigh /f:_)b N4ini ^_ -t t:Ziekress lb- inches
Manufacturer's installed weight per square foot to achieve TI-c.—mal Rcsistaice (R -Value) —A<6
3. EXTERIOR WALL
Material s Brand N=c
Thicicress (inches)- Thermal Resistance (R -Value)
B . Exterior LL)CI&O
N.aterisl Br2r.d Na^c t l
Tricicness (inches) 3' T:-e.^ai R:sista u.
RAISED FLOOR
Mmeria,
Thi6cncss (inches)
SLAB FLOOIL'?ERI`IETER
iv'at::risl
Thic::ress (inches)
Perlmc:cr Insulaticn Dcpth (inches)
FOUND. -.TION WALL
Nt.atc:ia!
Thic'u:css (inchcs)
B,an. Na..._
Ti,c...,ai Rcsisrar.c c (R- Val uc)
B, -and Name
T<cr.m2l Rzsistance (R -Value)
TI -z. -mal Res:S.ani.e (R-V3!L'C)
Declaration
1 hcre•oy ccr.i:'y tha: t::_ 3:1-ovc irshticn v js irs:all:d in the _:!_:-.g a: s`_o.= .oca::cn in cor. -rmarcc with t.5c ccr:c.
Extra: E�I_ier,e/ S:ac�.r.5 for residential build•i: Ss (Titlz 24, 5, Ca•.i:omia Co-: : Reg L ens) as indiea�id c the
Cc:a:I:alc C�COr^r!;3GC ui_.-C ICFi1:C3b12.
6)3
L�rn �, S,i2r r_r:, Ds:e 1-su:!i S�`:Cn�3c:er (Co. Name) GR
Cen_. al Contactor (Co. N3mC) OR Own:-
l:crn
D3:C
Sid n _-t.::c, Cat•_
1 -,.ailing Seb:onsactor (Co. lame) OR
Cc -cral Ccc:rac:or (Co. Namc) OR Own. -_r
l-.s:alli-� Sutco=actor (Co. Nama) OR
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 ow Desert WillSt La Quinta CA 92253 09/04/2002
INSPECTED: 79-813 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
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:
Recommendations not completed by this firm
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Estimated Cost: $
Remarks:
s*il • u • r•w'• •n • •• • •.i Peqt Control:•. •r-mdations.
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
, 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 ADDRESS: 79-813 DESERT WILLOW STREET U-76
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-304
VN Land Use Zone: CR 6
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS., CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE