0203-339 (SATT)i,j LICENSED CONTRACTOR DECLARATION
I 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
cel W Professionals Code, and my License is in full force and effect.
=) ch License # Lic. Class Exp. Date
LU 768595 6 CS MC(t. 9130103
t--
lY i
Z r— Date Signature of Contractor 4 �e -
CIO 00rl� f7
J U C) OWNER -BUILDER DECLARATION
HWa r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
U') () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
O N ,
Z WORKER'S COMPENSATION DECLARATION
O W I hereby affirm under penalty of perjury one of the following declarations:
H0 () 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 for which this permit is issued.
m Q C) (�1 I have and will maintain workers' compensation insurance, as required by
O LOQ 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 CarrierSTATE FUND Policy No. 16031610-02
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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 provisions.
Date:
.
. Applicant—
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 forInspection purposes.
J.�
Signature (Owner/Agent) Date"- ✓e M�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0` 0O'') TRACT
JOB SITE
ADDRESS 79-87A DESIM WJWaO'W S772MF
APN
(4.94030 -INS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
umm-1,0"Q ' EP
DCC DW, ,i,NC" dba DMXf MUM DEV.
M-760 fit: I�wm.i l i #fi'k00 ...
78.600 HIGHWAY 111
nMUXWEU.l8 C.:,'�, 92210
1.AQUIWIA CA 92253
('760)771-33$5 Wiz. CS1,0 2160
USE OF PERMIT
MIME, FAMILY ATfAC )
SF's. - SL41 i. 56, M,41T IIt, PLAN IS. PERMIT VOES 1gQT N2 CtATVu -\
P0014 JPA, BWCK WALLS, Olt. D RNMWAYAPNIO.A..C.H. '3% REDUC cr`X
rA PLAN C" 1C FIFE'FOR hgU1,TTPL;K' ISSUA NC01, OF SAME PLj%.N TYPE,
?`fi:kWT CONSTRUCTION 70.0.00 SF
: .nMATKD CG,D3rT OF CC?NIMUC."PION
*M,010.00
CONI'!TRL1CTIUN YM 101.000.418 -OW 9M3.00
;
PLA14 C:t•: WX VEY, ; 02-t"!!C?"� 39-318 $79.51
MECI1r'A1C"AllYFS 101-000-421-000 My'J
BIXIv` RIC;ALt",',E ;01-000.420-000 $58,00
I:'iAMING FEF 101.000.419.000 $08,50
STPRO140 MOTION Fn% - RESID• 101-000-241-000 $19.0
D1;r'614RaL.bPER, IMPACT PEE, st6savo
�e� ��`�r-y�1,�,q pp�f+�'yq )�\l �ry�'�'�j�f'�j'
CO.
'hab✓ "'l�i'.F:Y`1.EJ 5-,r`�!R^V•�iA VT�w �A'�,.f,[V AND S""J..J.'1A�T W.I"T.[,?CK
q �•j'�
IV de, FFf.
$2,180-31
LM2 Nt16l-PAIDS-R'a
MUD
�iAY u 6 1llQC
J
CITY OF LAQUINTA
FINANCE DEP_T� .
RECEIPT
DATE
BY.
INSPECTOR
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
--Z
Ducts
Slab Grade
Sp - -
Return Air
Steel
-
Combustion Air
Roof Deck
-O Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
, p 2,7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
. .oZj
two •d Z
Final
Final
_
dr" `8 3 57
POOLS -SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2„ Z —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ _
Encapsulation
Gas Piping
Gas Test
2$ • Q $
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) oZ -O
_ _ _ -_ .D _ - C _ . _ : "
INSULATION
.
INSOLATIO`' CERTIFICATE IC -1
Sitr Address
Description of Installation
1. ROOF
Thickness (in c..cs) \31(
CEILING
Perml: Number
S b L
T'i-;:Rcsis:ince Va!ue) 3S�
Y �Bat: o: E!an:•ceType hY-:�, �r ,Y) (� 0
Thiczr.css (:nc`cs' (3" Therrr:a: ^sistar.ce (Z-YaIL,cl ) -c
Loosc Fill Typej`G� �� Er sad r
Contractor's r::i- irstallzd wcighdf:= �_lb Mini ^:rl t:nickncss
_._inches
M3nufacturces in -stalled weight per square foot to ach:evc The.;nal Rcsista_rce (R-Valuc)
3. EXTERIOR WALL
A. C.7 (�' t,JC S Z-) X(0— C'wl � '-P A 3 -
Material S Brand N=c .Y1 (G- _
Thielcr:ess (inches) 61q- Thermsl Resistance (R-Valuc)
13. Exterior wCjL0 r
Material y�4,t%s Brzrd \a: e Lo � T
Thickness (inches) 3' 0 Ther -mal Resistance (R -Value)
RAISED FLOOR
�!a?erial
Thickness (inch: s)
SLAFj FL=UPERIMETER
Nat�risl
Thickness (inches)
Pcrimc!cr Insulaticn Dcpt; (inches)
FOUNDATION V'iALL
Katc.ial
Thic'u:css (irch.:s)
Tis ....sl R csistancc (R -Val ic)
Bund Name
T<crmal Resistance (R -Value)
B:3 -a \a: -c
T'.emnal Res:stance (R-V;lue)
Declaration
1 eer.:Cv that t`._ 3'bovc irsulatien was ir,s!311cd to 3: _._ a`_c._ !e•ca::en ccr.f.-ia ;ce witi tic eurrer..
Er,erg: E„7,ciene� Sror., :r1 for res1dcnti31 buildings (Titl_ 2-, Pa -6, Ca!; "--mia Code ss indiea�t-d on the
Cc::i:i_3t;,c,rCom;!ia- w-...-Cappiica5le.
Ite n Da:c l-s:a!Iir (Co. Nanc) OR T-
Ger._ral Cor .3zror (Co. Nave) OR OWnc:
I:c.n =,
Uatc
S.i .:r_. , Dat_
1.^.,:z!licg Sub-onoactor (Co. Mmc) OR
Cc:,r:a! Ccr,:rzc:or (Co. N 3mc) OR Own:r
Ir.s:alli Scbcon. actor (Co. Namc) OR
Ce^ rzl Cc; -.,,:azar (Co. tia.;,e) OR Owner
Cc-- s2 J; A-36
r . iJ __
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 79-824 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: $
Inspection fee : $
Others : $
70-00
0.00
0.00
Total: $ 70.00
Estimated Cost: $
■ . u . •■■■ . eTii ■Me RQUINGF.forefeliel i ■ . In . •�
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.
AT20:3220030313
, 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
ollowing:
BUILDING ADDRESS: 79-824 DESERT WILLOW STREET U-11 1
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-339
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