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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
1_1 CS 1;H6 4 9/30/03
r
Date —-"'�>"t. Signature of Contractor � � A �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. '
S cI have and will maintain workers' compensation insurance, as required by
tion 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 STAT)? FUND Policy No. 1603616.,D2
(This section need not be completed if the permit valuation is for $100.00 or less).
O. 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 `--T-��+�'• f�`
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.
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.
Si nature (Owner/Agent)�' rt?t �a�•�1i . Date
�~ BUILDING PERMIT PERMIT#
DATE VALUATION $45.320 5'0 80 LOT I&V 02 329 TRACT y ! 7
JOB SITE
ADDRESS 79fi44 DUM WM.LGW SURFIET
APN
64--030-045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
br,IIR.AFufmz, LP
DCD r�:cti,�., IMC dna DEWZT c 119N Dr."Nr.
74.7601110,HWAY.111 4200
7TSA6001UGE?114+'AY ) I 1
I1DZfl1~1 VMLLS CA 921210
):A Q•i.7'.NTA CA 92M
(760)7'771-3345 031ki 2190
USE OF PERMIT
WN LE.'PAMMY
SFA - 111,00.51., UNIT 101, PLAN IA. PERMIT DOES, 140T INCLUDE
POOL. 3PA, fsLOC.'K WALLS, OR DRIVEWAY APPAO:Ac: H, 15% REDUCTION
AN CHECK WE FOR MULTIPLE IISSUAWC E OV SAME PIAN TYPE,
I24 PL
TRACT CONSTRUCTION 70010 EF
GISI;:P" GPOCAitPC. RT 374.00 5r
f:0A1:3T1 UCTION "a 101-000.4113-000 $328.517
PLAN C';?%I;= PI -2 101-000-439-318 $37.85
MZCHIANIC Af.IIXF 101-l9M421.000 $30,50
ELECTRICAL PEA 101-000-420-000 0-000 165.46
k'IrtJM NO FER 1101.000.419-000 $88,50
�..
STRONO MOTION YBE • ,RYSSiD 101 -WO -241-000 $4.33
DF:Si'Lz.[kPXR I:Iu1FW T HE 5.1,559.00
u'+lTA-rfAL C`ONB').RITC�1ION TILAN AN r'52W
_ LESS .i�. _P.�,1D REXIS
—o-
$0.00
a p &A
f1r &'°:1{SAW YM
$2,243,34
DUE NOW
MAY U " 2002
CITYOFLAQUINTA
FINA CEPEPT
RECEIPT A
`� t-`.; • ''`'
BY
X1141 .
DATE FINALED
- 3
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
-
Combustion Air
Roof Deck
74 -! `v Z_ s'
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
- 2 • v Z..,
Drywall - Int. Lath
a t •oZ, 3
o?.T
•�- �O i ?
Final
Final -;:s j S7
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
- y'--
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
_
0-7j
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fudures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) •p Tj
COMMENTS:
INSULA T ION CER-nFICATE IC -1
�zitc Address
Perml: Number
Description of Installation
1. ROOF
;\'g lee:-! 6-Jb
Thickness (inchcs) 3'r
CEILING
T;;,r,a: A,csis:ance (:�-Va!ue) l 34�
Bat* o.- E!an::et Tyre s JJ� E. -a -e N2:7.c Qk X\--, U6 'n ( )L ( 0
Thickncss (irc`.-s' The=a' ^sistacce (R '-alLc)
Loo.c Fill Typ'c Brand A oo n
Contractor's rni installed weighYP' )(- lb I4:r.i ^gym taickncss 10_ ;Sinches
ManufacturcPs installed weight per square foot to achieve Thc.—mal Resist --ice (R-Val::c)
3. EXTERIOR WALL
A.
Material c. 5 Bre^d Na -c a"fs U10 Y1 c O _ _
Thickness (inches) CC 31q— Thermal Resistance (R -Value)
19. Exterior LL)C,&o
Material Bracd Namc (cam
Thickness (irc'r.es) 3'h T e. --;a; Resist -^c_ (R -Value) - l2,
RAISED FLOOR
eft°i
Thickness (inches)_
SLAT; FLOORlPFRI`IETER
Material
Thic:;ness (inches)
Perir..e:er Insulaticn Depth (inches)
FOUNDATION NVALL
Nt.atc:ial
Thickness (irchcs)
Declaration
Ti:c:-rai Resistance (R-Valuc)
Bernd Name
Thermal Resistance (R -Value)
Erna \'a-
T"—z.=.-! Res;s:anc:-(R-V31Lc)
1 hereby eer.;C, that [L- 3:;0% irsulatien «as ins:all:d in :h. c_.' a: ._ ado._ ioc3::en in ccr.Ccrrtaa:e wish t5e e rr.r..
Er,erZ; Ejrif:$1 for residential buildi-.yes (T ill_ 2-, F 5, Cavi.`orni3 Coe: oCReg_la ens) as indieatzd on the
Cc iti-ate eCCon;!:3r.c , w-_._ ap p!icable.
I:?f i �,12n cc^1I e, Da:, j^St1:li^ SLS I-Cn�- ]:'Or (CO. Mn,-) OA
v Cenral Ccn:mctor (Co. name) OR Ownc:
3na:urc, D a t c
S:, n -'t_re, Det_
C
1^,:ailing SCi-On]'3:tor (Co. Nam-) OR
Ca.I_ra! Cer:rac:or (CO. ti3MC) OR Owner
Ir.,:aliir.; Sc`:c=3uor (Co. Name) OR
Cc.,..2! Ccr. ,::.:or (Co. Name) OR Ow•n:r
A -3d
Standard Notice of Work Completed and Not Completed
NOTICE - All reccommedations may not have been completed. See below- Recommemedations not completed.This form is prescribled by the Structural Pest
Control Board, with whom a copy must be filed by license within 5 days after completion of work under contract.
THIS IS A NOTICE OF COMPLETION ONLY, NOT AN INSPECTION REPORT
ADDRESS OF BLDG STREET CITY: DATE OF COMPLETION
PROPERTY 79-844 Desert Willow La Quinta CA 92253
INSPECTED: CO.CODE 33 09/24/2002
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
FIRM LICENS$ NUMBER PR1401 COMPLETION STAMP NUMBER
Notice of completion
Sent To and date : 03/13/2003
Owners 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
Remarks :
Signature
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Estimated Cost: $
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.
AT20:3620030313
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: 79-844 DESERT WILLOW STREET U-101
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-329
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
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