0203-305 (SATT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
1 H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cel W Professionals Code, and my License is in full force and effect.
O d LO
License # Lic. Class Exp. Date
ro
Lu 768595 31 C8 4C M30/03
cZ r-- Date "�.,.T) Signature of Contractor
U CD OWNER -BUILDER DECLARATION
HLU r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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). '
ce) () I am exempt under Section ; B&P.C. for this reason
LO
N Date Signature of Owner
ON
d Z WORKER'S COMPENSATION DECLARATION
CD cc I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 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
O _ Q performance of the work forwhich this permit is issued.
m Q C) ( ) 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
li rn permit is issued. My workers' compensation insurance carrier & policy no. are:.
,It Z Carrier 5TAT& FUND Policy No. l�f13616•il2
d ,
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
1 subject to the workers' compensation provisions of Section 3700 of the Labor
••v7 Code, I shall forthwith comply with those provisions.,
Date: :-• - ta"1 Applicant ~") °p/ /J.A aE
Warning: Failure to secure Worker 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, indemnif' 7
& hold harmless the City of La Quinta, its officers, agents and employee
2. Any permit issued as a result of this application becomes null and void '
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and,state that the above information s
'
correct. I agree to comply with all City, and State laws relating to the, buildi g
construction, and hereby authorize representatives of this City to enterup n
the above-mentioned propertyxfor inspection
purposes.
Signature (Owner/Agent) Date s�:'U"'��
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203- TRACT
l{' • f �
JOB SITE
APN
ADDRESS 79- 8 1 S) DIMMr VM. OIL 0i STR .8F..1
6494 MWWS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INOWLRFS, Yat'
LXT7 DUV., INC eta 17I., .L�.zd.T Mr.110 D1,'it.
74*760 INGEWNT.111 #200
W-600 H[UHWAY=111
D1z.37A1 WkLis CA 92210
LA Qi.I'ai` rA CA 92253
f,".16OX171-334 5 Cmvi 2130
USE OF PERMIT
SPA - F.f1.�1'IC1,39, UNIT 1, PI—AN 2A.. PtRHIT DOES NOT „+]Cx..UDE,.
P004 OP.A, BIXICK WALL% OR iiltll' TRWAYAPPROAC.111. 75% "rtk.'DUCTfON
TN PLAN CHIXCK W2, FO111 MU1311x1.,E 1.MUA14CZ OF SAMZ P1,AW TYP&
T39.S'i.A.B CONS J5UCTA+.A 8.210 /i.
OxlltA.i it 0_,kitP0kT 5411.00 SF
t
IMMAM :OST OF CV.1 MV41 7.100
CONSTRUCTION RZ 107.000.418.000 f 159.SO
PLAN CHECK FEE 101-000-439-318 $102.33
MEC1LM1CAL kif?.8 101-000-421-000 099 50
Z1,RC:TRIC.ALIrP�' 101.,000.420-000 $7.5 2
t?UT WINQ YZE 101.000.419-000 $98.50
STRO D NIM1014 IT - Y-iLSID 101-000-241-000 $3.SKI
W FILOPE•R IMPACT T FER '51,569,60
.,ly.
MUR-TCYI:AI; AND X1JW CF1ECK
$2,340.24
LM)S RE -P R') P
$0.00
t -- `I' TAL I?EM1' FXXIS DU E 14 OW
$2,340,24
0 h
C1TY01FCAQU j TA
FINANCEDEPT,
RECEIPT '' DATE - °;
r s:,
BY
DAT FINA ED
t
INSPECTOR
_�i :, �
k,.�
S�4 o 3
4
Pil 61:j =10 o *j
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade — — Z
Return Air
Steel _
Combustion Air
Roof Deck p •
Exhaust Fans
O.K. to Wrap lolF.A.U.
Framing z L VCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 7•�Z� $
Drywall - Int. Lath t-pnr;-
Final
FinalS= (-03 57
POOLS - SPAS
BLOCKWALL APPROVALS
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test -v 3
Appliances
Final
COMMENTS:
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) c0
IN SliLA,i IO CERTIFICATE IC -1
Sitc Address
Description of Installation
Perml: Numbzr
1. ROOF (�
Thickness (inches) j'r Ti;:r ,_ Rcsis:a c: (R -Value) �j p
CEILING �� '
Bat. or Elan':—v Tyre ��7. E:an, � \a.^c
Thic'u:cs-3 (inc.`. s` _ t�" Thea. ^sistar.ce (R- 'clIue) -Z1%j
Looie Fill Type lCt s�� Brs:td A 001J�
Contractor's r -i installed wcight/ft- k—lb IM; -; _ i t *. Ii c'&-- ness ID - aZinches
Manufacturces installed weight per square foot to achieve Thc.—mal Resisf2z ce (R -Vale)
3. EXTERIOR WALL
A. v✓ t,JC�i'.(S o� x(O— t' lcWl o o� 3
Material j Brand N=c ����..j1 (1_mi
Thickness (inches) — Thermal Resistance (R -Value)
D . Exterior liiGtto
Material S Brzr.d Name _Loa -Lis
Thickness (inches) T ermai Resistance (R -Value) Q
RAISED FLOOR
r;3r
Thic-rtcss (inches)_
SLAB FLOOPUPF-RIMETER
N.at�,-: isl
Thic':ness (inches)
Perin vice Insulaticn Depth (inches)
j� FOU\DA'.TION NVALL
Katc.ial
Thickness (inches)
Declaration
l 11..,..,3! R_sisunc (R -Valu c)
Band'N-:,me
T<er.r,al Resistance (R -Value)
R-3r.a \:....,,
Tre.73: Rests.arc: (R-Valu'c)
acreoy ecr.ify that t::_ a'cv�'= irsuIarcr..•zs iris! 311_d in th- c_:'_: -.g _. _*a•._',cca:icn in cc an with t.5e ecr....
ErerZ, E ji_;e ; Sr�c a�'. far residential buildings (Title 2-, Pa -6, Ca'i.cMia Cod: o; Re¢ulat ens) ss indieat--d ca the
Cc i:i_at o.rCo,,,,a c , w-_,. acpiic3b1z.
Ds:. 1 ,:a:!i St`:cntr3Vor (Co. N3mL) OR
Gcr._. al Coctmc or (Co. Mr. -IC) OR Ownc.
I:cm
-ca. -c, D a t c
!-,.a!li-.g Subcono-actor (Co. \arc) OR
Ccr.trzc.or (Co. ; iamc) OR Ow'n:r
Ins:3ili-� Sc`cor. wor (Co. Namz) OR
Cc..t,actor (Co. N-3 ,e) OR Oµner
A•3o
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 79-819 Desert Willow La Quinta CA 92253
INSPECTED: CO.CODE 33 08/29/2002
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:
Recommendations not completed by this firm
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total:$ 70.00
Estimated Cost: $
, have
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.
AT21:1620030313
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: 79-819 DESERT WILLOW STREET U-77
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-305
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
4