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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
76$595 13 C€ $.C3° ,% /9/30/03
Date Signature of Contractor
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
Sjgc%n 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 STAT1apWD Policy No. 1003616.02
(Anisection 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,
III 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,j
Date: 1- Applicants-" /)+ A`. ex T4
.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crib final 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, indemnity
& 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 fo f inspection purpo/s�es.
Signature (Owner/Agent) �._ /a /dll cid Date -A
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 5;Z 103 0203-331. TRACT
JOB SITE
APN
ADDRESS 9 LZIS DEWW MILOW 11MEE :
C4.9-0.40-045
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DCD Y7'W., INC dba DEMIer 0f M D1�"'43'.
74• /603MIGHWA'Y'.} 110200
7f3-600MOi WAY. D l k
WDIAN YVBU,S. CA, 92210
LA Q111WA CA. 92253
(760)771-3345 CBT tf' 2190
USE OF PERMIT
MIGLC F 51d MY MACEED
SF'A • 13L;.00 Sd., UNIT IDA PLA14 13. i:'t'3 U"r DOES 1-40T IT4CLUDE
P0014; SPA, BLOCK WALTA OR DRKVE111;sa. APPRO A.C4, `.n% REDUCT1011
114 I'LL KNI CHECK FFi, FOR MULTI1PIX ISSUANCE OF E M"l MOP—
TRACT C0M71,1'1.UC'TION 700,00 3F
•t COST OF CE3.�'L�".1"idUL''�`� ON
N9101.1 .00
dry, �jn, �My7�j�'j.�� �T�IYy'jS"TIMA1`
MWI, d��AT M �/.IMAJ},%�Kl�.^��J�.
CONSTRUCTION FER 101,- 2004.918.000 $:193,00
PLAN C;Hiw IX r, 101-000-439-318 $•10.51
MECHANICAL FEE 101-000.421.000
3aUC` RICAL FrRIE 101-000-420-000
PLUIeiBINO Flay 101-t3i.30a419*000 $98,50
S—IR NO MOTIONFEF - RES1I1p 101-000-2,41-000 $9.00
DEVELC?1T_►:501ACT WN ti,%9.00
SUB-MT.&L ICIONSMUC7100 AND PLAN (;SEM
$2,160.31
IM09 P"1:1 PAID FRES,
$0.00
FEES DUE'NOW
$2,180.31
MAY 6 2992
CITYOFLAQUINTA
x
.RECEIPT
DAT FINALED
INSPECTOR
a w -
INSPECTION RECORD
OPERATION-
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
I BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
-]/ . oy
Ducts
Slab Grade
oZ
Return Air
Steel—
/—G'�
Combustion Air
Roof Deck
a , (d'- e— T1
Exhaust Fans
O.K. to Wrap
Framing
7
F.A.U.
Compressor
Insulation
yl. &J
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Final _/.4)S IPOOLS
BLOCKWALL APPROVALS
- 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
OZ
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
l y, c 5 5 7
Encapsulation
Gas Piping
Gas Test
/-(' J 3
Appliances
Final
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) 17 - p
COMMENTS:
=C-
�--
INSULATION CERTIFICATE IC -1
Si,. Addr•:ss
DcsCriptioll of Installation
1. ROOT=
Thickness (incl.; s) \3f(
CEILING
Nrr..l: N'umbtr
�
Ti:cr <a: Resis:aace (R -Value) 3
Bat: o: E!ankv Type y, E."an� N2mc ---ZVA --, "r( n ( )
Thicicr:css (inc: s` 13" Th, -=a' ^sistar.c (R- 'aluc) -�jqj
Loosc Fill Typc�' ja,C \ E -and
Ccr.tractor's rni installed weight/::' k- lb 4fini^.n t�ckncss l�- inches
Manufacturc: s installed weieht per square foot to achieve T;.c.-rnal Resist:.nce (R-Val_c)
3. EXTERIOR WALL
Material L6,cj,1 Brand N c Un mi C 0- _
Thicknicss (inches) Thermal Resistance (R -Value)
B . Exterior lvC UO
Material G. S Btzr.d Na.^:.e (c L
Tcickcness (inches) The=,,a: Resistance (R -Value) - 1�
R-MSED FLOOR
Thic'.cncss (inc`.-s)
SLAY; FLOOPUPFRNETER
N.at:;ris(
Thic!,ncss (inches)
Perlmc:er Insulaticn Depth (inches)
FOUND. -.TION N ALL
Ivl.atc,-ial
Thickness (ir.chcs)
B,zn3 Mme
Resistance (R•Valuc)
B; -and, Nzme
T<crmnal Resistance (R. Nalue)
P,. -an -4 Nz:n,,
TI.e.=a; Res;s.ance CR -Value)
Declaration
I ..trey CCrt;r" I113! l.'_ 3bJvC IrS1:I31lCn .N1i Ins:all.d Lel tl:_ ]'. _._ a�O'.0 !oca;:C❑ in cor..rc--la ,CC W1!4 Li,- CCrrtn.
Ererg:: Ej,c;e^Sfor rtstdcntial buildi-.gs (T itl_ 24, -a- 5, Ca!i:onia Code of Regula; cns) as indicitCd on the
Cc-i:�_al crCo,:.;!ia�c
Cenral Cor.; : Jr (Co. N3. -71C) OR O--nec
1-::alling Sub:oncattor (Co. Namc) 6T—
C-,-.:.'al
RC:,:ral CCGtr2C:4C (Co. ; 3mc) OR 0Wr--r
Ir.s:alli;.� S;:`rnL-.wOr (Co. Namo) OR
C--:ra! Ccr.t;.:!or (Co. Name) OR 0,xrrr
C - -..F 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 79-856 Desert Willow La Quinta CA 92253
INSPECTED: CO. CODE 33 09/25/2002
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 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:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70-00
Recommendations not completed by this firm
Estimated Cost: $
• • u • •w • •� • •• • •.� i •� • C•. • •�
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.
AT20:3620030313
Certificate of Occupancy
City of La Quinta
Building and Safety Department
n
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: 79-856 DESERT WILLOW STREET U-103
Use Classification:
SINGLE FAMILY ATTACHED
Bldg. Permit No.: 0203-331
Occupancy Group:
R-3 Type of Construction:
VN
Land Use2one: CR
Owner of Building:
MIRAFLORES, LP
Address:
74-760 HIGHWAY 111 #200
City:
INDIAN WELLS, CA 92210
By:
STEVE TRAXEL
b'
Date:
05-01-2003
Building Official
POST IN A CONSPICUOUS PLACE