0203-334 (SATT)w r4
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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
'168595 B a TI1� � W30/03
Date °,+"� Signature of Contractor �- J_ /10 �.
I' Y
OWNER -BUILDER DECLAMATION
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.
'V I have and will maintain workers' compensation insurance, as required by
Sec fon 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 STATE FU14D Policy No. J602616-02
(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 provisions.
Date: 5_ =,� —_**,Applicant _•t - ! �° °` ��
Warning: Failure to secure Work p' 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 pursua9t to
any permit issued as a result of this applicaton agrees to, & shall, indem I�
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and vol
work is not commenced within 180 days from date of issuance of h
permit, or cessation of work for 180 days will subject permit to cancella i .
I certify that I have read this application and state that the above informatic n is
correct. I agree to comply with all City, and State laws relating to the buil ing
construction, and hereby authorize representatives of this City to enter
the above-mentioned property f`or.inspection purposes.
Signature (Owner/Agent) '11! .'• Date �v
BUILDING PERMIT PERMIT# .10
DATE VALUATION LOT S 1/ 1320"-334 TRACT
5 . /" . c 19,010.11W 1,x13 t}1
JOB SITE
APN
ADDRESS 79,-828 g)k,i9= Wn LOW r�. "Wr
M49^m4,asJ
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WIRAMORMS, LP
W DFV., INC abs DESERT (11n,23 DEN.
74.760 Htxl:]:W;i Y 111 #200
70.600IMIG1;1WAY I I I
i2vT1AN WFU: S CA 912210
T.,,aQ s X=A CA 92-m
ti�iE577?-334A� CI:12.� 21F417
USE OF PERMIT
I%4GLE T°AiMT AlTAC
VA. • 812JU -�3., UHIT Fits, PIAN 113. PE.0,AXT nOUS'ROT F'NCLUDI?
POOf,4 SPAS, 81,C3C K WAL .O., OR 'DiiN AY APPROACH. S% REDUCTION.
1.N MAN CHUCK 110FE VOP, PAULTIP1:,1;' 1SS13"C E OF U&NAL MAN TYPE,
TRAICT Cf>'A3M2iJD'Ff.ON 700,00 w'Ii
'�TitF^' COST t? d;i1��1►"i''1C".%1S�,tV
,tiY�y,i3i3
1' aVii'I.' E SITA " IEW
C'URSTRVCTION FU 101-000-418-000 5343,00
PIAN CI•IM119 FEE 101-000-439-318 a':�.31
MECHANIC.A1, FE R 101.0300.421-000 S39.50
9LZCTR)C.A'L FIFE 101-000-420-000 $55.00
PLUMBING.11KE 101.-010.419.000 Mso
s'1'Iiovo m0mN FEE, Rw- iD 101-000-241-000 $3.80
Da"ELOPIZIRMPACT FEE
_SUB-IT(Y..G C!0M*TJCr°Yf0N AND PZM �CCHECK
$2,1801.31
IYO'T'AL1' !RA .1':11MESDUk.N0W
MAY U 6 2002
CITYOFLAQUINTA
FINANCEDEPT.
RECEIPT
DATE "
J • t.� G'-�
By
i
DATE FINALED
INSPECTOR
I/
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
O , -.01— 5 7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-O ST
Drywall - Int. Lath
„az
Final
Final sT
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 Lines
l'- =,7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
! • o s7
En:apsulation
Gas Piping
Gas Test
lI l •o ?j
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
Utility Notice (Perm) ,
COMMENTS:
C
INSULATION CERTIFICATE IC -1
;zitc Addr_ss
Description of Installation
1. ROOF
' �Jrr
Pernl: Nunber
Th:,- i?. RcsIs:ance (R Va!u�) 3 r�
CEILING
Bat'. o: Eianzet Type Py"16—:5 E. Namc �• � t✓
Thickness (inc`;-s`
Loose Fill TypErs:td
Contractor's r; -;i installed^weight/L- k—lb : fini _ n t.4ickness ?Zinches
N lanufacturc?s installed weight per square foot to achitvc Thc.,nal Rcsist`nce (R-Veluc)
3. EXTERIOR WALL
A.
Material 12YL Brzrd Na -c 'afz,, Un KI [) c 0. _
Thickress (inches) Thermal Resistance (R -Value) 2 -�q _
B . Exterior WCL rr
Material ,?Ylt-S _ Brand Name crl(x l [ T
Thickness (inches) TT -,-:7-,a: Resstanc'_ (R -Value) - l�
RAISED FLOOR
N :�teriel
Thick.ncss (inc`--s)
SLAB; FLOOR/PcRI`IETcR
Mat�risl
Thic:mess (inches)
Perimeter Insulaticn Dcpth (inches)
FOUND. -.TION NVALL
M atcrial
Thic' ncss (irchcs)
Declaration
B, Na, -i •:
T i.......ai Resistance (R -Value)
Brand Name
T,:crmnal Resistance (R -Value) _
Ti.c.T.._! Res:s:anc: (R-Valu'c)
1 h:reby eer,ify that t.`.e abovc irs Stier. irs:all_d in t e 'a�:':_:r.s a: ._ abo.c !oc3:ien in eor.fc-ta ;c: wit" t.5c e rr�r
Er,er E�-fcief:S;nrdfar r:sidential buildings (Till= 2-, 5, Ca•,i.`cnia Code of Reg_1a;:ens) ss indica"-•d on the
Cc iti_at of Co .; !ia ac , u-_.: a piic3b1e.
1-2
InSt3!lir S;.`_•ccntr3,:tor(Co. Nanc) OR
i Ge :_:al Cor.:�crar (Co. Vane) OR Owns.
l:cI -,
Date
Sia .a. Dat'
]--.ailing Seb:onu-3ctor (Co. Nanc) OR
C::lc:al Ccr.?rcc:or (Co. N3mc) OR Ow•r,:r
1-. s:aIIi-Sc`c0r•.c3ctor (Co. l\amc) OR
Cc.,.. a! Ccr.::-:tor (Co. N.„�c) OR Owner
C-- .- :a :70gym, 2 ----Il A-36
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
PROPERTYDesert Willow La Quinta CA 92253 09/11/2002
INSPECTED: 79-828 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: $
Inspection fee : $
Others : $
Total: $
Estimated Cost: $
ppmilp FM
Signature
7(1.00
0.00
0.00
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.
AT20:3420030313
, 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: 79-828 DESERT WILLOW STREET U-106
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-334
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