0203-309 (SATT)F w LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
icel W Professionals Code, and my License is in full force and effect.
C =) M License # Lic. Class Exp. Date
r" w 7 $ s9 B Ca F1i' � �ti 9/30/0;3
6 Z r --Date � '� Signature of Contractor
pOH -
J U OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
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. 704_4, Business & Professionals
Code).
C'') () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
--O-�—
2 Q WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of -perjury one of the following declarations:
LO p () 1 have and will maintain a certificate of consent to self insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
IlLO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier ,ATF k?17N17 Policy No. � Q9si2 ►-U2
opo O
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,
14§.61 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' compensatioh;provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thk se prgvisions. !'
Date: Applicant i
Warning: Failure to secure WorkersCompensation 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'for inspection purposes.
` rt%� d �AA .rYi? Date__5
Signature (Owner/Agent) !( _
, t
i
BUILDING PERMIT PERMIT#
0203-309
DATE VALUATION LOT TRACT
*591019M B4)/U81 3 601
'T, 4- - ." 1
JOB SITE li
APN
ADDRESS 79-"3 D'Esm 11 AMLOW SMU
OWNyER��pp��gqy�,ffpa
CONTRACTOR/DESIGNER/ENGINEER
yy.���1•��
.YVR1.Rt1CJsorwss. Ix.
DCD .E,9I.M.,. WC tU DESURT CIT= DEV.
74.760'1.3i'UIM.AY.111 102,00
78.600.1.11GIMAY 3 13
YATL"at'31`l WEE -US CJS► 92210
LAQUIDITA CA 97-252
160)771-3345 M-4 21€0
USE OF PERMIT
SFA - lSSLIX41, IM IT 31, PLM 2A . PIl RNI:,T DOES 140T INCLUDE,
P001, SPA, 4Si 'K WAt,1x!, O11. 3 RIff"VAY A,P 1'RtaACH
TRACT COAI ITRUC'! ION 402,00 1WX
a:QA12af GV4[;AIlP0.FYT 540,00 SP
E'SMUTRU COST OF +i(I)NN" [TRU1•MON
s-9,01sw
P�i�i�Ur M MINMARY
CL NSTRUC'1'IC3'Al lam'`.' 101.000418000 M"M
PLAN CHECK: FRE 101.000-439-318 $101$77
Mi?L=1''NNICAL FEE 101-00.0-4,21.=000 09.511
X; , C PJGALF8E 101-000420-000 $175.52
PLU VIDI O Ful 101-000- 419-000 tft s 1
m01• a moTian FF.E - usio 101-000-241-000 fi5.90
DRkfRWP&R IMPACT FEE, $4569.00
SUk3-`IX)TAOCC7WTI2,1:JC"� ON AND PLAN CHUCK/x4;,
IXW:i? �"-F.etAi�.Z�.�'�'•"`e.�f
rp�/�� n p�g�p�p y� p(ep7���, 91'g;g Now
roT,.%AG S�.l'`rJ.W.AY.[.d.S 1 Ss. S lw�ifST C'7o��'YrsAY
U 6 2CITYOFLA®UIFIN
JjT7
CE®EP?Y
.
RECEIPT
DATE r
BY
DATE FIN A ED ;S
INSPECTOR
It. •E ';
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
r 29 .
Underground Ducts
Forms & Footings
— —
Ducts
Slab Grade
— d
Return Air
Steel
e _ p-
Combustion Air
Roof Deck
B - O •d2
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
S •Oz-- 2Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
o z
Drywall - Int. Lath
L -y -o Zr-
Final
Final
.� —1-� S7
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
ri- r9z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
!9
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) p Tj
INSULA T ION CERTIFICATE IC -1
�zitc Address
Perm l: N'umb2r
Description of Installation
1. ROOF
Nlatcra!VS
Thic:cn:ss (ir.c=cs) . `j' `
CEILING
Th:cri_: Rcsis:ziice (R-Va!uc) 3
Bat: or B:an`.et Type y,�`J E --d Ncmc — -k "C, Xl (�L�
Thickness (irc`.:s' �3" Th, -=z. ^sis:ar.cc (: '.slue)
Look Fill Typc kEL 3,A Brand Q Qo,.n %fit
Contractor's r i- installed wci3hJf3C_lb N4:nir^c th`icknas?Zinches n
M3nufacturces in -stalled weight per square foot to achieve Trc.;,tal Resisia:ce (R-Veh:c) A-6
3. EXTERIOR WALL
A. &' eft Ly L,,--4-US 0'X(O -9�Cwlo 'p A 3
Material Brand Na=`� y�l l� �.,lQ X1
Thickness (inches) _ Thermal Resistance (R -Value)
B . Exterior L c )Cj' 0
N:aterisl �G.��S Br2r.d Name (t
Ti ickness (inchn) 17 T e=.,aI Resistance (R -Value) - (�
XRAISED FLOOR
M-tert_I
Thic:krtcss (inch—ts
SLAC FLOO1?,r'?ER1METER
N: at^tial
Thic:mess (inches)
Perirmeter Insulaticn Dcpth (inches).
FOU\D.;,TION NVALL
(vi.atc:ial
Thi, Apess (in.chcs)
Declaration
B-r.3Nare
Titc..,.A Rcsistar.c (R-Valuc)
Br2nd N--sne
T" crsr,al Resistance (R -Value)
Bnr.d Na...
T*.e:r:a': Resistance (R -Value)
1 h:rcby cert:f'y th3t t"-. _ 3bovc ir4L,lat:en `Nas In5'.31!ed in ' 3: loea::c❑ w; 1h L5: eL•
ir,er�; E j�cier,c�-S .-� for ruidenti.a! builc•i-,Ss (Title 2-., -a- 5, Cali`crnia Code :Reg adcns) as indieat-'d ca the
Cc:1i.5c3(e efCo;^;�! sr u-_, a; piit351e.
L m �s S,izn '.re, Ds:, Nine) 0A
Ge;,_ral Cor.:-2ctor (Co. Dame) OR Ownc:
Datc
S!, n.u_. , Da._
l stalling Su'�con,=2:tor (Co. Name) OR
C:neral Ccr.!,2c:or (Co. ; i3mc) OR Own:r
1-s:alli;.� Su`rr:-3c:or (Co. Name) OR
Cc-..,. _.tor (Co. Name) OR Owner
C:: i S Au L_J i A ?o
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 79-843 Desert Willow La Quinta CA 92253
INSPECTED: CO.CODE 33 09/12/2002
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:
I
Recommendations not completed by this firm
i
Cost: $
Inspection fee I $
Others : $
Total: $
I
Estimated Cost: $
70-00
0.00
0.00
Remarks
• • u • •rtned on this. •• • ..� •� • S•. . •�
Signature
I
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.
AT20:3520030313
, 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: 79-843 DESERT WILLOW STREET U-81
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-309
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
A