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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 CS kii ,\ � 9430/03
Date�-" - Signature of Contractor
OWNER -BUILDER DECLA ATION w
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 sun., rom Policy No. '1603.616-02
(This section need not be completed if the permit valuation is for $100.00 or less).
S1tf 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: 6� - "T70 Applicant \-(/14-�
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. r
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 purpose. A•
Signature (Owner/Agent) j t a' Date. - / ` r••(..
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0120_" TRACT
W91019160 B38,078 28601
JOB SITE
APN
ADDRESS 7,94125 DEET. T WXLOW vIRM
649-s 10-N5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
11a.�,c"�.x)Rn, LP
DM EV , JXC dba DEMMT C'MEB MV
74.70D 1•�0T1WA:Y11) 0200
7:,600 HIGHWAY I I I
�3iA1V" WILL19 CA 92210
LA QC:FMTA CA 9223fi •
060)771-3545 C13U 2180
USE OF PERMIT
SINGLE PAA,tIILY PJ" ,�ACT1)
SPA • 13Ld'Jt?.39, UNIT 7% PLAN 2A . PL�2'.lt IT 1'3tJES'NOT 114CLUDE
POOI,; S1'A, 8L, K WVVA1.,L% OR DR1V,V,%V Y APPRCAAC:H. M MUCTi';ON
1N PLAN FalIEC K PER. rOR 1;RC9I,TIPLE ISSUANCE OF SAlig 1tLAN'1"it"K
TRACT CC1kF,3' rUJC TION 892-N6 10F
i3APAC1E!'CARPOR'T 540.00 181F
EIM11E►+kATEsD WST Or CONST.RVC110N
59,019.60
SUMMMY
CONSTRUCTION TeEF '101-000-418000 00-418000 S00,S0
PLAW CHECK 1172 101-000-439-3118 SIOZ 9
•M9CH.ANIC"YEE 101.000421.000 S30.159
EL-1?ZTPJCAL FEE '1411.000-420-000 $75.51
"Pil' 31vI13i)i G MR 101-000-41-9-000 $88.50
MONO MC? ION NW, - :itESiC;i 101-000-241-000 $3.90
DIVEWPER NPAC:`t FRIF f 1,Sbq.t►0
•q
SP8 I.I �`c3"Tt :t G:R 2T�Li tC31 '.Arlo 1't C C!<
$2,340.22A
"DOTAL PER 1Y 11 LMS VIDE A 0W
. 0 6 71102
mC al-
CITYOFLAQUINTA
FINANCEDEP1
RECEIPT
DATE `2�. _''�,,
BY
DAT FINALE/O�
INSPECTOR
M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— o
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
A0 - S
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
(n -per
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
l Z - o T
Drywall - Int. Lath
Final
Final
'3
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
Pool Cover
Sewer Connection
�.-�( �—
Encapsulation
Gas Piping
Gas Test
_
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) ,D
INSULATION CERTIFICATE IC -1
Site Ad--Ir^Ss
Description of Installation
Feral^ \unbar
L
1. ROOF
Thickn—tss (ir.ci cs) \31f Rcsis:ancfl
CEILING
Bat: o: E!ariket Type VI Y11kt5 E:a Name
Thickness (inc`.-s) 3" Ti -::=a: ^sistar.c (R ''alUC)
Loose Fill Type c ,JV-\ Brand
Contractor's rni- installed weighJf:= -�-_lb Nfiri _n t: ickness _inches
Manufacturees installed weight per square foot to ach:e-vc T;.c.•,rtal Resism- ce (R -Val, --c) A-6
3. EXTERIOR WALL
A. Lle lii.,r
Material s Brz^d Namc akja un yi c
Thickr:css (inches) Thermal Resistance (R -Value)
B . Exterior LA -)6.0
Material Jr2r:d'• Name t
Thickness (inches) Tl:e=.a! Resistance (R -Value) - k2
RAISED FLOOR
�: at,etiai
Thic'.: ncss (inches)
SLAC; FLOORIPcRI`1ETER
Iv:aterisl
Thickness (inches)
Perimcter Insulaticn Dcp,,h (inches)
FOUND, -!TION NVALL
Ivl.atc:ial
Thi c' ncss (Inchcs)
Declaration
It. ....31 R csistancC (R-Val-uc)
Bznc Na: e
T`eri,al Resistance (R -Value)
B -a -a Na:-.
T'.i2 .:a': Resis'.amen (R-Valuc)
I hcrr'cy ccrir,, that tt-- 3bavc Ir-sulv:Cn. Ln in W:'.4 L5C CLT.
Enera; E jlcier.c� S;�rJ, d for resid:ntial buildings (Till= 2;, ?a- 5, Ca•.i:cnia Comic o; Rcgala,`;cns) as indical�d on the
Cc:'iI -1 3I c: CrCo^rat^C , u aaPl:ca5le.
S,igr r_r_, De:: lr.s:aain. SL�:Cn'Za.:or (Co. Name) OR
J
Ce ;c:al Cor -.:actor (Co. Vane) OR O•x'r.r.
dna: rc, Da:c
Sid , D�,.:_.
lcs:allir.� Sc`:.ona-actor (Co. Nam_) OR
C, -:,-al Ccrtrac:or (Co.; amc) OR 0,.'r,cr
Ic :alli SC,LC:; wor (Co. Nan") OR
Cc-, r21 Ccr.;:a:tor (Co. N.3ne) 0R Ow-rcr
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 79-825 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: have
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: $
.-
• • u • • •w • •n this nronerty in arccirdanceCan •I :•. • •n
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,California 95825-3280.
AT20:3220030313
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: 79-825 DESERT WILLOW STREET U-78
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-306
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
Building Official
Address
City
By
Date
POST IN A CONSPICUOUS PLACE
74-760 HIGHWAY 111 #200
INDIAN WELLS, CA 92210
STEVE TRAXEL
05-01-2003