0203-311 (SATT)��``,���LICENSED CONTRACTOR DECLARATION
C/4 - 1 hereby affirm under penalty of perjury that I am licensed under provisions of
�f H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
to L 766595 F3 C81 �'/:�0/03
oZ r- Date Signature of Contractor
O `
J U CD OWNER -BUILDER DECLARATION
WWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to License Law for the following reason:
Z_ ( ) 1, 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).
( ) 1, as owner 'of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C") () I am exempt under Section , B&P.C. for this reason
to
N Date Signature of Owner
ON
Q)
a Q WORKER'S COMPENSATION DECLARATION
p 1 hereby affirm under penalty of perjury one of the following declarations:
to FQ- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
CD Q U ( ) 1 have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
4 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier gT.�iF1: -N1)Policy No. 16A3 1�i D2
OD D
t` a
Q (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
1 subject to the workers' compensation provisions of Section 3700 of the Labor
•`••77 Code, I shall forthwith comply with those provisions.
Date: Applicant-
Warning:
pplicant 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. l�
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 ,tK8i building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) �� rs fr �t•�A Date
BUILDING PERMIT PERMIT#
M3-311DATE
VALUATION LOT TRACT
JOB SITE
APN
ADDRESS tW-KI DE.I.I.Mir'r 11M:.Low e's"M MIT
OWNER
CONTRACTOR /DESIGNER / ENGINEER
m OR.M, U
LCD DE ., INC c1ba DE, S.MT ice° W8 DEV.
74.760I.3(1GHW.AY.I 111 $200
78.600 HIGHWAY). I I
1WDM_)q WK ..S CA 9221 Q
1,A QMNMA. CA 92253
"160)77) - '12 345 C VI 71 so
USE OF PERMIT
SFA.. H1,00-42, UVIT H, PLAN 1A. PUYi+ IT DOES NOT 1'NCX.t3DE
P0014 )MI BLOCK WALLS, OR 1'1PiNE W.4ky APPROACH, '7514 I3Riu►tIC• TION
R4 PLAN CHNICK FEEFOR MU1,;itIPLE ISSUANCE OF V -XV, PLAN TYPE.
TRACT CONSTRUCTION 99:2100 VR
(IAR.P.IiLICAii,PORT 540.00 Sr
EXMIAMI COMM 4'ODIGIRUM70-13
W',019.
CONSTRUCTION 10F11 101-000-418.000 $4"49
PLAN CHECK .FEE 101-000-439-318 $102.12
MECHANICAL T+ E 101.000.421.000 $:19,50
Zi.W,11?ICA. L $''EE 101-000-420-000 V5.5
PLUMk3INO 9'RI; 101-000441.9-OCK) gn'".
`;TR.ONCI MOTION F10 - RZ510 101-000-2A.1 -000 $5.90
I31•i»i1 lkFell1MPACT PS
SMk—CYpA ,C�Vi=:trC170N,v.DTOr CHX.
$2,340,24 2,340,AA
6
IMS R -P1143) <V
$0.00
yyv�. /� � •��,'y�a•�r�a FEAKS tt�
IMAL S S.1'S.[.vhS�." .f.�.a' AKS .N' YE NOW
,y .t.tt� �t-q
N'.O, MYV,24
$2,M6,24
�� ,/
��ly'1/! U 6 6102
CITYORAQUIRTA
0WAN EM "
RECEIPT
DATE "c; :`
BY
DATE FIN)
INSPECTOR
[`�01
I"
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— - Z
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ pZ
Return Air
Steel
// --!>L
Combustion Air
Roof Deck
Q .36, _-, 'C
Exhaust Fans
0. K. to Wrap
00
F.A.U.
Framing
Compressor
Insulation
f L $ 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�
a s
Final
Final
.�— ��
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 i
Gas Test
Electric Final
Waste Lines �'
�J_� > 2
Heater Final
Water Piping
Plumbing Final
.Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
tel(_ p
Encapsulation
Gas Test
- .0-5 S7
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)
t, - L, _:
INSULATION CERTIFICATE IC -1
Vit.; A?dr_ss
Description of Installation
1. ROOF
Thickncss(irchcs)
Perm.1: Numbtr
T;:.r n-,: Rcsis:ince (R-Va!uc) 3
CEILING
Ba'.: o: B:an:•het Type Namc L
Thickncss (inc`.•s' (�" Ther^:-. sist_r.ce (R aluc)
Loosc Fill Type, la 3 N Brad , /1 00, l-���
Contractor's rni installed weight/P- A _lb I\fini _n t�ickncss ?inches
Manufacturees installed weight per square foot to zchi--vc T;.c. nal Resistance (R -Vel:,-) - A-6
3. EXTERIOR WALL
A. btl e It L✓
Material PYLI(A S Bre— d Na -c
Thielcr.css (inchcs) — Thermal Resistance (R-Valuc)
B . Exterior tvCJLO r
Material i Cv S Brz.r.d' a-ne
Thickness (inches) T e.rma: Resistance (R -Value) - 1�
RAISED FLOOR
Thidcricss (inc`ts)
SLAB FLOOR TERI`IETER
N.at�riel
Thickncss (inches)
Perir c!cr Insulaticn Dcpth (inches)
FOUNDATION `'%ALL
M atc.ial
Thick.ncss (irchcs)
Declaration
Lei \:-i:?
T it ....sl Kesistar.c_ (R -Valle)
Brand \a:ne
Resistance (R -Value)
8.-a--+ \'a...,.
T'.err:a. Resis.ance (R -Value)
1 acre'y coif,- that t aba�c irsulaticr...as Ins:alkd in th= c_.•._.-- . _._ a` = !o ., .1 th
o-. ca:;cn . cc....�a.;c. w: Lhc c-ncr'
Er,2ra; £%i_ie�c� �ror. .'� far residential buildi-.gs (Till_ 2-., =a- 5, Ca!i:a-nil Cocc of r2cuut_ ens) ss indiea�t'd on the
Cc:'i:i--alc e.rCor*:;a pl:cable.
-s S;t¢r _._, Dg: I s:ailir S_`:cnrac:cr(Co. Namc) OR
' a Ge :oral Cor.:�::or (Co. 1: arae) OR O'x're.
�--a:--:re, D a:c
1-s:ailing Sub:ono actor (Co. Nara.-) OR
C::,cral Ccrtrac:or (Co. N3mc) OR Owr--r
1-s:ailir.� S�:`_C7.=3ca .or (Co. Nano) OR
Cc,.,:a::ar (Co. Namcl 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 79-861 Desert Willow La Quinta CA 92253 09/11/2002
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 : 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: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70-00
Estimated Cost: $
.-
• • u • r•w • •n this nronerty in gerordancewith •n • .•. • •n
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.
AT20:3920030313
, 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`s
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: 79-861 DESERT WILLOW STREET U-83
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: MIRAFLORES, LP
Building Official
9
Bldg. Permit No.: 0203-311
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