0203-307 (SATT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
bhapter 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
Date Signature of Contractor
r
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 STATEMUNO Policy No. I6036I6-02
(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: Applicant , �`�) fA1 /;.� A:
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimindpenalties and civil fines up to $10.0,000, 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 tn'e building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyifbr, inspection purposes.
Signature (Owner/Agent)Date � ••--l,.63�%J�•
' BUILDING PERMIT PERMIT#
,
W.0134-307
DATE VALUATION LOT TRACT
} ' 6r - Gtr m9m 114OI 79 28601
JOB SITE t�tr
ADDRESS 79.031 UPP— 1' *�to.NeLOW 911 M. r9.030-045
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
m.A��'l'. t.'?ns., I -P
DCD DEV., WC dba IA36BL--P:T CT100. DEV.
74.76014141WATJ I 1 #200
78.6001311. JW'1AX 111
WMAkYVIMLS CA 92210
T.AQIJIA7?.°A ('A 92253
(760),171.3341 Milfl 2180
USE OF PERMIT
►�T�iI.J� r4�1v.1.I11'�' d�1"i�'�.GI :�:t?
SES. N I3I:Lit3.4f3, F?P31T 79, ?L.Ati1d 2A . 'AI+. RMIT DOZS MOT MCLUDZ
P004 wPA4 BLOCK i?WALIA OR DRIV ?vlAY APPROACH. M REDUCTION
ISI PLAN CHECK ME FOR MUL TIPIX, ISSLf,PNCX OF SANIZ PI.,A24 TYPE.
TRACT C0143i9i.UCTIC44 DO OF
Oeq,IdACIr~!(;f�IiPOIt3' 540.00 Sig
S1.nLFy14&� +NKE 9UMA IflRl. Y
C0140Z'ISifC3'!'10N ",E 101-000-41#400 00 $4 %50
PLIV14 CHECK FI:t1 407-L3�i0.�4'S4f-:41fi $Ic:J,32
'M FCFkANIMlkL FEL 101-000.421.000 X39,50
I LFCTRIMII..FEE 101-000-420-01M, 575.53
Ir+1,t11`!>fi3I O PIT 101-000-419.000 U19.50
STRON0, MOTION FER • RESID 1131-DOO-W-000 $5.90
DEV'EWPYR ilJiPACT :FER
,=--1Vl`AZ: (C�k1� i:IC F1;C3S�1 A= E� .1�3' C WK
$2,:340.24
w 1.,3f�:3 ;f�.Tt:L:�'f�At1T.j 1•lsi":S
W�
$O.t�t3
n 45
°'342! 0
CITYOFLAQUI11TA�a ;
FINANCEDEIPT
RECEIPT
D1) -E;1
BY
DATE FINALED
INSPECTOR
.41
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings —
Ducts
_
Slab Grade — p
Return Air
Steel — —
Combustion Air
Rolf -Deck D • -oi 57
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing g
Compressor
Insulation -aZ $
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate L1nes
Party Wall Firewall
Exterior Lath 1„ 2 • D z
Drywall - Int. Lath i •O Z -
Final
Final
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 I •d 3
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fndures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. ,Use of Power
Final
Utility Notice (Perm) �j
ENStiLA. T IO -N CERTIFICATE IC -1
czite Address
Description of Installation
1. ROOt
"C-/ 5
Thick^ess (ir.ctcs} 13 r r
Perml: Nu: -ober
-G
L
T;:,: 1 Rcsis:ance Va!uc) 3
2. CEILING -
Bat: or E!an!cet Type r"y.,� Ei.=� Name
Thic'kncss (inc*--s` VZ -��%j
Loose Fill Typ:! Er-nd /1 00,'l k.p r
Contractor's r -i- installed weight/ft_Ib Mi.^.ir^-r-t tickn_ss lb" �inches
Manufacture's it -stalled weight per square foot to achieve Ti:c=al R--sistaznce (R -Valve) -
3. EXTERIOR WALL
A. L,,>eLUs c--> dX(o—P1c' 3
-
MaterialS Erz^-d \z ^c
Thickress (inches) — T; crtnal Resistance (R-Valuc)
13 . Exterior LA-)Cluo
Material Brzr.d \a^:.e It -c
Ti ic'utess (irc'r.es) 3� Ti ermai Resistance (R -Value) - (2-,
RAISED FLOOR
M 3terial
Thic'.<ncss (inch. -s)
SLAB FLOOIL'PERI`SETER
Mat --nal
Thickncss (inches)
Perirnvct Insulation Dept;: (inches)
FOUND, -.TION ViALL
Ni.atc:ial
Thickness (ir.zh--s)
Tii..=-1 Rcsistar.c (R-Valuc)
B: -and- Name
T<ermal Resistance (R -Value)
Ti-e.T..a! Res:s:ance (R -Value)
Declaration
I hereby ecr.ify that t`. abo,'c irsulatien was ins! 311ed in -hf 'C - 3. _._ ado•._ !ova:ion ccr.re.^ia;,:c with t.`Ie C' rrc-1
Ener; Ej-tcienc", Sr�r �:rd for residential buildings (Till= 24, F_- 5, Cali `omis Code o`Rc¢ la,;ens) as indiea�u--d on the
Cc::itr.3tc of CoT :ia- a; piica5le.
Ds: 1-�:a!lir �c`:cn�aacr (Co. Namc) OR
i Ge -.:-dl Cor.;mc or (Co. Name) OR Owr c -
:CTI D3iC
1-st21fing SubconLrnctor (Co. Name) OR
Cc: -,c. -al Ccr.trac:or (Co. ; amc) OR Own:r
S:,^.::' Z, Date 17s:alli--, S_`<or. wor (Co. Name) OR
0c-cr2! Ccr.t::.:or (Co. Name) OR Oµ•n:r
Cz. L J i 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
PROPERTY 79-831 Desert Willow St La Quinta CA 92253
INSPECTED: CO. CODE 33 09/11/2002
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 hat are considered secondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
Cost: $ 70-00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70-00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A coil pre-treatment was erformed on this property in accordance with Structural Pest Control Board regulations.
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.
AT20:3420030313
, 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: 79-831 DESERT WILLOW STREET U-79
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-307
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
Building Official
Address:
74-760 HIGHWAY 111 #200
City:
INDIAN WELLS, CA 92210
By:
STEVE TRAXEL
Date:
05-01-2003
POST IN A CONSPICUOUS PLACE