0203-332 (SATT)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
Date' i�N'GZ.- Signature of Contractor �� �� L162
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.
,041 1 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:
Canter STA,TF. FCJ D Policy No. 160364&02
(This section need not be completed if the permit valuation is for $100.00 or less).
1 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 ) I11�1 (� ='
Warning: Failure to secure Work/s' 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.
Signature (Owner/Agent)
Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 5,o? /0Y TRACT
6- ( - • f- s;;) A9.IP.Ud1 28601
JOB SITE
APN
ADDRESS 79-M DF&, 1 f' 1V d 0W STMT
649-030-045
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WZA,FWM, LP
DDM DEV., INC dba X%EMU Cl'1 DEV,
74.76014--IGITWAY I I I tl200
78.600 YUGHWAi i? I
NMI" LLS CA 92210
LA, ()C:W A CA, 92253
(760Y771.3345 4.° Tfi 2180
USE OF PP77ERMIIT��yy
f�IJ.l11 GLI? .Lsd'LLF:i64r i .L'iJ. ,E ..d.3CaLJ
SFA a BIX0. $2, UNIT IK PLAN lit . P1.FPN1l'T VOILS NOT fMCLUDE
P0014 2;PA, OR DRIVFWAY APPROACH. 7% FEDUC:'I'TON
IN PLAN C.fll..s:K FEZ FOP, MULTIP V1 ISSU.ANCZ OF SAI<RE PLAN T Y'PF.
'PRAM CONSTRUCTION 100,00 sly
.�ayKypi7..11•i7.irAd Se,YJ' ki-4oS OF 8.r Oei�!J12JL+S3100•
.7Patf�,7J 0.i
-�[7� y� a �Y rp �+
AT.l�S WTMW f.93 MMAR'S
C014,TFR CTION M 103-000-418-000 CUCKOO
PLAN G►f<I7CK PLW, 101-000-A,39-318 _01.51
MXi1AN1CALBE 101.40( 1.4 i-000 $39,60
E'=TRIC.t' L PEE 101-000-420-000 W.C10
PI'll MI Dia ITE 101,000-419.000 U&Sd
STP -ONO MOTION nF, • MSID 101--000-a�°•41-000 13.810
DKI'VEL0111-91k IMPACT FF S1,Jb�.OD
.ryw,
'l tt�. �.* pT-�yff�.:i p;M�Tr�i�P CHF
.sSi./+1�Y'.i� TAT �•:t�it'tt�d;�.F�i..7.dL✓.c`� mwm.iN.t IPON CFzc.iti,K
$'21180.31
'�'�:N.�-T'1?".IE, a D NOW
�'�JOUX
t o U 6 Z QT
CITYOFIAQUINTA►
FINANCEDEPT.
'RECEIPT
DATE f
BYr
Dg FINALED
INSPECTOR
Alk
ft
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — p Z
Underground Ducts
Forms & Footings / — z
Ducts
Slab Grade —lam t7�
Return Air
Steel //— DL
Combustion Air
Roof Deck o — . o rTZ
Exhaust Fans
0. K. to Wrap / a
F.A.U.
Framing Elf "
Compressor
Insulation / ' 2 Z -0 Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath Z -m Z
Drywall - Int. Lath t l yS -�Z Srt
Final
Final (- �j S_7
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 9�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection �/��.�3 g,
Encapsulation
Gas Piping
Gas Test `I—
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �O
COMMENTS:
INS t`LA T IO -N CERTIFICATE IC -1
czitc Acdress
Description of Installation
1. ROOF
T hickr.css (inches) � J
CEILING
Nrml. \umbzr
Cr.9r...
�-
1%crma? Rcsls:3nce(R-Va!u:) 3
Ba'.: o- Blanket Type �y.l� P.a-d Name
ThlciU:css (1nc'-5' 13// Th si5t3r.C.- (1 al L' ) -1/%
Loose Fill Type �`a,J�\ B"-:td/I DO:t'l
Contractor's r i- installed weigh /fr �_lb �f:.^.: ^� -t t'4ickness ib- � inches n
Manufacturer's installed weight per square foot to zchievc Thc,—mal R.sista-nce (R -Valu)
3. EXTERIOR WALL
A.
Material 16(L.� Brz^.d \amc
Thickr:ess (inches)— Thermal Resistance (R -Value)
B. Exterior LL)CLUO
Material BrardNam, e (-A�
Thickness (ircnes) -5'/—:2 Tr_er:;a: Resistance (R -Value)
R.-?ISFD FLOOR
Thlckncs3 (inch.. -s)
SLAB FLOODUHRIMETER
N.at�risl
Thickncss (inches)
Perirnc!cr Insulation Dcpth (inches)
FOU\ D,%TION Vi a. LL
Ivf.atc:iai
Thickness (ir.chcs)
rl, N�:a:�
t.,c....csistar.cc (R-Valuc) —
Brand- Name
T<er:;,2l Resistance (R -Value)
P, -an: Na~
T%eTa! Res:s:anc: (R-V3!uc)
Declaration
1 hereby ecrtiry that t.`.e irsulatier...as installed Ln :`_ c_.!=.-- 3'. ._ 3`J'._ !oca:ien in, f.r-lance wish Chc e-:rr.n
Erera: Eficienc/ Sf- residential buildings (Titl_ 2-, '3' S, C31i.2nia Codd- 3s indieat—d on the
Cc:'i:l-at;, c:rComr•,i3-- , u. _... a�piic3Sle.
1!ern -s S,far _._, Ds:. Ins:a!li (CJ. Nanc) OR
Ger.:.-id Cont-.3:'or (Cc. Mime) OR Own:.
TTl =
S:, n..._._, Dr-
Ins:3!ling Seb:onsactor (Co. Name) OR
Cc: oral Ccr.tr3c:or (Co. i 3nc) OR Own:r
Ir:s:3ilin Sc`co=3c'or (Co. Mmno) OR
Ccnc 3! Cc,-.;;i:tor (Co. OR Owner
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 Desert Willow La Quinta CA 92253 09/25/2002
INSPECTED: %9 852 CO. CODE 33
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY -ONLY
BELLFLOWER CA 90706
(888) 340 -HUGS (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: $
70.00
0.00
0.00
Total : $ 70.00
Estimated Cost: $
Remarks• . u • •m • •i . •• • ..� •� • :•. . •�
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.
AT20:3620030313
, have
Certificate of Occupancy
City of La Quinta -
Building and Safety Department ``^AFM`°'
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: 79-852 DESERT WILLOW STREET U-104
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-332
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR ..
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
Building Official
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE