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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 I'M T 9/�C13tt3
Date -fes.^,0 i^ � � Signature of Contractor �= �% f _1A t;�^
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 91'ATP:pU'ND Policy No. 14D3fi1tS•f)
(This section need not be completed if the permit valuation is for $100.00 or less).
( )6 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: --f- "YJ Applicant—
Warning:
pplicant Warning: Failure to secure Work ers�Compensation coverage is unlawful and
shall subject an employer to criminal enalties 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. f�
i'
Signature (Owner/Agent)Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 021r"08TRACT
1 U80 243601
JOB SITE
APN
ADDRESS 7%&3'1 D&SMIT MIMLOW 5.M
m9103(W1+45
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MfRARXMES2 LP
MIDI DEV, INC, diva D,IMMI' MEM DMI.
74-760 TUGri-SWAY• ) 11 02040
'18.600.EMIGHWAY I I I
IVDU Y b1JZ:. S CA 92210
LA, WWTA. CA 9225:
2180
USE OF PERMIT
M NG1.,E.r,'AW -Y A.M�'_�i
STIR . T31,DC.1.40,. UNIT 80, PLAN' RA . P.E113AI'T DOES NOT 1Ni;1..dlDE
P001i MIA. .JO%,OCK.WrSt,L% OItDRtVWAY APPROACH. '75% REDUCTION
IN PL<A14 CHECK IrEeZ R MULTIPLE'ISSU.ANCZ 0-.1? SAME PI.&N 7 PP
TRACT COVOYRUC;T1ON $91.00 OF
f.3A,.RA.C1 CARPORT W.00 SF
I.AT.�C D CJovir 011 CONSTRUCTION
�9,17Yf�.tS.SA
�yt� a�,��+y�9 q�ry� �qy7 hgy�,y 11E.TrIlk
CONS'TRUCTIaN YZE 01-000-4-18-000
PLAN CHia"K lrblel 101-000-439-3123
MECHAI•, ICAL FEE 101-000.4121-000 $39.50
l�,.1x-'�TRICAs ME, 101 -000 -420 -OCA $75,310
I''LE1Mf INQ YFA 101.000.419.000 U3.5t1
S'i"RONO MOTION F9L - Glx' 101 ^000-241 -000 $5,00
DEVEL F� , R .IMP.AC T FEE $1,569.50
SUE-T&A';1...'C;i:9WnRT C°i'IEE�9 AND .RIJill 11F.: V
$2,,`4014
Ln� U
0TAL P "ili ?� +' ��w' 1'i11 1�1E3
2; dfi.Erv�
06, 2€'12
CITYOFLAQUINTA
FINANCEDEPT. y�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
Y,
' DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
$ —02
Underground Ducts
Forms & Footings
G' _ Z
Ducts
Slab Grade
Return Air
Steel
e_ -
Combustion Air
Roof Deck
W,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
ICompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Limes
Party Wall Firewall
Exterior Lath
T `.D 2 37
Drywall - Int. Lath
/ • •O 7
Final
Final
.d ` -��
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
-i/// D
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) — -�
INSL`L-A�TION CERTIFICATE IC -1
S i c c Ad,11r_ss
Perm 1:.Numbzr
r. U.:
Dcscriptiott Of Installation
1. ROOF
Thickness (ir.ci:cs) \3/( Ti'.ri;?. RCsIs:ance (R-Va!uc) 3g
CEILING t
Bat: o: E:anR:et Type ? ,lk�`-D E:a : Na -,c )d
Thickness (inch; -s' ry(�" Thp -r:a. s;star.:fie (Rr1"�lluuc/)
Loose Fill Type \ ) \ F -rand ��.!/�1..0C
Contractor's rni.. installed welghth: _1b t..;c&n::ss ILwinches
Manufacturces irwalled weight per square foot to achieve The.;nal Resista.Ice (R-Vel::e)
3. EXTERIOR WALL
A.
Material VS6—t�,:-s Brand N=c
Thickr:ess (inches)— Thermal Resistance (R-Valuc)
B . Exterior i.t:.G-moo
Material PylS Brzr.d Na7Me l't_-u
Thickness (inches) ;a> � T e.mna: Resstanc= (R -Value) - 1�
RAISED FLOOR
Materia;
Thiczncss (inch --s)
SLAB FLOORL'PERI`SE T ER
Iv'atc-iel
Thickn-,ss (inches)
Perimeter Insulation Dcp,, : (inches)
F0UN DA' T10N NVALL
/ ivla:c:ia1
Thi, Ar.css (ir.chcs)
Declaration
B, r N _..__
T.. ....si R csiscanc- (R-Valuc)
B and Name
T<ermal Resistance (R -Value)
B. -and N _...,,
Ti-e.Taal Ras:S.ane: CR-VMu'c)
I hcre:,y c2r':r•' th3! t.:. 3J3VC InSu!131I0n `.vas iris '.311:d in :i4- 3: .Gc3::cn in w;,h CSc Cl T....
Er,erZ,• E i_ie!: S1Qr 1 f -r residcn63! buil6inss (Till: 24, =a- 5, Cali "-M:3 CO-'.- c; Rcg' a,,cns) ss indiea�t-d ca the
Cc:tl:ial;. CrC0r^.r!:a u appl:c35le.
(Co. Nan -c) G.� -
Ccc_. ul Cor.: -,c or (Co. Nave) OR O•A,r,:
Date
Sid ...-. , D-,�_
1Sul-:onr3cior (Co. Nan-.) OR
Cc ,:ral CCi.!i1C Or (CO. N31nC) OR O'Xr;:r
St:tco=3Ctor (Co. Nam,) OR
Cc.,_. _. Ccr.,..ctor (Co. tia ,c) OR Our,:r
A 30
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 79-837 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: 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: $
.-
• • n • •w • •n this nronerty in accordance•n• Boar•regidations.
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.
AT20:3420030313
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: 79-837 DESERT WILLOW STREET U-80
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
Building Official
vni
Bldg. Permit No.: 0203-308
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