0203-314 (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
7+68-595 11 C8 f'Ic 9/30103
Date 07 Signature of Contractorl'-`-
4
OWNER -BUILDER DECLIARATION
V
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
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:
Carrier STAUMND Policy No. 16036161,02
(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,
Fall 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 pprovisions4
Date: Applicants
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 pursuanlis any permit issued as a result of this applicaton agrees to, & shall, indem
& hold harmless the City of La Quinta, its officers, agents and"employe
2. Any permit issued as a result of this application becomes null and vo
work is not commenced within 180 days from date of issuance of s
permit, or cessation of work for 180 days will subject permit to cancellat
I certify that I have read this application and state that the above informatiocorrect. I agree to comply with all City, and State laws relating to the buildconstruction, and hereby authorize representatives of this City to enter; u
the above-mentioned property for,inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 02M-314 TRACT
5- M101960 B43M
JOB SITE APN
ADDRESS 7 V DERERT WlLLOW NTMEr 649-W40-045
OWNER I CONTRACTOR / DESIGNER / ENGINEER
I& R.AXIOMFX, LPI
74-760 ILY(MVIN1.111 0200
19DIM WKILS C. 92210
USE OF PERMIT
78.60011TCrHWAY. 111 /A. ('��y y��+.1
.)._&QTIIN k (,r1J'L .7 Br�{..7r
('760)771-3345 cno 21 So
SriA. m I11,F3(143, LYNI 4' 86, PLAN 2A . PERPAI F DO'S NOT 1-.NC;l..0 Vf
M04 SPA, k1IWK WA.1::M OR DR1VLVAY APPROAC II IS%REDUCTION
1N Pl,.at CMECK FEE M1 11 !atULTIpI,E ISSUAMCF, OF `IAfiA", PLAN 'i YPEt.. '
PACT COWAUCTION 892,00 SN
G%:RAXSFA AMPORT 540.00 SI'
10'13'.0 &I COV OF CSJNSTRI7CIMOK
�s5a plP.W
CWTMUCr1'ION PIKE
; O1 �17JG3•�i'18r�7C»
604.50
PLAN Cd3WK IrReE
$10X.33
MECHANICAL FEF:
101 -000-4 21 -000
59,50
91,11MRIVAL nt%
M-000-420-400 00.420.400.
$75.52
1'LUMIAINCI FF -19
1011.000-419.0001
2s8,$0
STRCrNCl MOTION PHE • MISM
101-000-241-000
$5,90
DW91,0139R IMPACT MKK
61,469h10
"llGJ1MU110H) N CR'K
$2,340.9,4
iai I ISLB
r,
-�
y�_`?£Wt
$0,00
Ni Y U n I,,TOTAL � � FUS PTT «W SI.M0,24
C1rY0FLAQU1WrA i
FINANCEDEPT .V
RECEIPT DATE BY DATE FINALED INSPECTOR
.f—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— ---a
Underground Ducts
Forms & Footings
G' , kZ
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
o - /-p Z. j
Exhaust Fans
O.K. to Wrap
Framing
I I
F.A.U.
Compressor
Insulation
�p
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i 0 37
,ram T ��
4• S- S T
Final
Final .S - -0 3
BLOCKWALL APPROVAL
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ 0 3_ _
Encapsulation
Gas Piping
Gas Test
. O
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 of
Utility Notice (Perm) p
COMMENTS:
M4
:- _C —- --- -- C, - ._: � .
�-. U-1
INSULATION CERTIFICATE IC -I
`i;r Address
Description, of Installation
Perrnl: Numbtr
1. ROO;
Thickress (inch"s) \3t( Tr:. r,�,a: Rcsis:aace (R-Va!ue) 35
CEILING
Bat: or E!an:•:et Type E:an a \a^c �!
Thic;cncss (inc'-s' l3" The r? =: sistance
Loose Fill Type � ,a \ Brand SlA 00-
Contractor's rni- installed weight/f: �_lb Nf ri _rt t kness 7 inches
Manufacturces in -stalled weight per square foot to achievc T1=7nal Resistance (R -Valu) - A-6
3. EXTERIOR WALL
A�e (Ly LJzd�S
Material PY--� Bra d \a -c
Thickness (inches) Therm2l Resistance (R-Valuc)
13. Exterior WCULO
Material CL. _ Brand `-.—.c c:LL
Ti ickness (inches) aj o Ter; ;a; Resistanc_ (R -Value)
RAISED FLOOR
Material
Thic:mess (inc`--s)
SLAT; FLOOPUPERIMETER
Iv!at�risl
Thickncss (inches)
Perimeter Insulaticn Depth (inches)
FOUNDATION WALL
ivl.atc:ia!
Thickness (ir.chcs)
B:a.., N ;- e
B aid
Name
T<er.mal Resistant: (R -Value)
B -a -a Na:::..
Ti.e=a! Res.s:anu (.Z-V3!uc)
Declaration
I h:rC-,y c�r:Ify that L... 31bovc insulaticn `.tics instal!=d Ln :he -.!= -.c ' -._ a�o'.= !oca:;on Wit,h Ch: curren!
Erera; E iorer.Cf Srard:r� for r--sid:ntia! buil?•inyrs (Title 2-, Fa -6, Ca!':"2M;a Cod: of R guta lens) ss indicat--d ca the
Cc:'i5-atC o`C01..i a -c , u a pii=sale.
It: n =s Sign ..^_re, De:_ ]-sta!Itn SL`a.cn� a.tcr (Co. Namc) GR
1 `
Ge :=Fal Cor.t:,c or (Co. Name) OR Ownt.
snatcrc, Date
Sim^.I•-'-e, D2, -
Au n. 2-31
1 -stalling Sub-onw=or (Co. lame) OR
C:-:ral Ccr.trac:or (Co. Name) OR Own:r
Su`_con�.wor (Co. Narno) OR
Cc-cr21 Ccr.;tic:or (Co. Name) OR Own --- r
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 79-867 Desert Willow. La Quinta CA 92253
INSPECTED: CO_CODE 33 09/11/2002
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:
Recommendations not completed by this firm
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Estimated Cost: $
Remarks
• • u •'r•ru • •n this pronerty inarcordance' •n • :•. • Regilliti•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.
AT20:4120030313
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: 79-867 DESERT WILLOW STREET U-86
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-314
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
Building Official
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-01-2003
POST IN A CONSPICUOUS PLACE