0203-326 (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
768It9. 13 C3 31C /p 9/30/03
Date "12-02 Signature of Contractor}h
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
S6cti-d'h 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 3>l't'1 E1''C11'1D Policy No. 10€3616-A2
(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,
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: a`"to Ud Applicant-
Warning:
pplicant Warning: Failure to secure Workerss' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit -subject to the conditions and restrictions set forth on his,=
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon -
the above-mentioned property,fbr inspection purposes.
/ �
Signature (Owner/Agent) r:L�'• 0 ' l Date
BUILDING PERMIT PERMIT# .
DATE VALUATION LOT -&2S W •326 TRACT
28601
JOB SITE
APN
ADDRESS 7g iT )O DXMI.a WIM' OW S• SrFn,
649-W0-045
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Mffwa , L P
DCD DEV., INC dba .1D1:.& -RT Ci' IES DEV.
74.7601 ICsUWAY 1110200
11
lb=w iFdK111 CA. 92"Z10
LA C,11'aa�A.TA. C,',A 92253
0760)771-3345 011W 2180
USE OF PERMIT
BWOLE F'.AWIX t`MACHM
SFA , SLJ* 49, U-N]IT 9S, PIA -44 113. PERMIT DOSS nar INCI.i11:iE
P001-, SPA, BLOCK WAXAA OR DRIVEWAY APPR-0,AC C, ?$% R.EDIXTg P'N
IN I'1 Am m1rcK vra YoR 1V%i11mna 1.s,SI1AAce or, SAmt PI.,i`►t3 Typv,
TRACT CONSTRUCTION 100.vi16;�
X.17WACUM OF
3.010"00
CONSTRU0710N 1OEE, I OJ -000-418-000 VM11.00
PL,A. N CHFXX 1W 101-000-439-:318 M51
MCM)OCAL FEE 101.00(} 421.000 $30.50
3ILEC:'rRIC11.L PLO, 101X000-420-000 $59.0a
PLUMB040 M, - 101.000-419.0W- SW50
WRONG hi OT' ,914 FEE - R °HSID 101 -000 -PAI -000 $3.30
Dl ELOPER IMPACT RE �1,5iS9.i10
r
d
l XEN-`7`C!(IIA . CQ IiCnox A9D P.1-W-WICI ,
�J 1,:7011 P1?X-?AM IMS
$0.00
CITY OF LAQUINTA
FINANCEDEPT
RECEIPT
DATE
•BY
DATE FINALED
INSPECTOR
$a-
4'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
-gyp-
Return Air
Steel
-
Combustion Air
Roof Deckm
- �- •� Z $ 7
Exhaust Fans
O.K. to Wrap
q=E
F.A.U.
Framing
Compressor
Insulation
. Z .Oi 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/a2. • �' d =- 37
Drywall - Int. Lath
/, Z • <<j -L S
Final
Final �',� �, p ?) ��
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines r -S
�.% �-p
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
= .0 3 �i
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) Q
COMMENTS:
INSULATION CERTIFICATE IC -1
Vit.: A--ar-S5
Description of Installation
1. ROOF
3' --
Thickness (ir.c=cs) l
Perml: Numbu
T':.i,�,a: Rcsis:a�ice (R -Value) 3
CEILING
Ba;: or E!an!:et Typc b , E, -and Name
Thickncss (inc.`,,s` (3" The:.^.:a:^sislar:ce (R :aluc)
Loose Fill Type Br -rd j OQ n bot
Contractor's r::i- installed wcight/fc' k- lb Mit'�ckncss 10-_7 incl es n
;`4anufacturoes installed weight per square foot to achieve Thc.-mal Resist`nce (R -Valu) k- -
3. EXTERIOR \VALE
A. &>e� tLv u,�C,-US C -D X(o—PIC'�►'�o -P'3
Material �L, (-A� Brand Nam ���� �.,([ 'Tic r 0- _
Thickness (inches) �0 3�— Trurnal Resistance (R -Value)
B . Exterior l,iiGAo —
Material Brar.d'N-me
Ti:Ickness (inches) 3' T-e.^ai Res:stanc_ (R -Value)
RAISED FLOOR
�': lterial
Thic'.cncss (inc`.-s)
SLAD FLOOIL'PERI\IETER
Nat�risl
Thickness (inches)
Perir.eter Insulaticn Depth (inches)
FOUND.=. T ION \VALL
Nla:c-ial .
Th;.Ancss (ir.chcs)
Ti:C...,3! Rcsistar.cc (R-Valuc)
B, -and, Name
T, ermnal Resistance (R -Value)
B-rra Na-:,,
T%eT:a! ices:s'anc: (R-Vsluc)
Declaration
I that t'_ above irsulancn %vas Ir:5:3liCd Ln -ht -- 3: _._ z�3-._ !oca:icn in code ma cc w;14 LSC cL-,—.Ln.
Enerd: Ej-icie!7Sfor res1denti3! buildi-.Ss (Title 2-, °a- 5, Ca!i.' ri] Code of Regula,:cni) as indieat--d ca the
CCM:1:3t� Of COi*:r!11-
73
1-sa:1:. ; S4:cntr3C'or (Co. Namc) OR
Contin:tor (CO. Name) OR O'.wr,e:
1: un
Datc
S:, .a , Dat_
1-s:3111ng Sub:ont actor (Co. 'Name) OR
Ccr.trzc:or (Co. ; �3rnc) OR O,x'ncr
ir.s:]ilir.� Subcor. awor (Co. Nama) OR
Cc-~'! Cor.t:l:tor (C0. Name) OR Oµ•rrr
C f u 2 A•3o
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 79-860 Desert Willow La Quinta CA 92253 09/25/2002
INSPECTED: CO.CODE 33
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
Owner's Name and Address:
Copies sent to :
03/13/2003
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:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A coil pre-treatment was performed on this ordance with the Structural Pest Cantml Rc)ard regtilations_
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.
AT20:3820030313
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: 79-86Q DESERT WILLOW STREET U-98
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
—dam
Building Official
VN
Bldg. Permit No.: 0203-326
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