0203-328 (SATT)N_ U)
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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
168593 B C8 wc '419
9!, Voi
Date 5— r -4)?-Signature of Contractor—
OWNER-BUILDER
ontractor "!
I.
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.
A( I have and will maintain workers' compensation insurance, as required by
S ctl 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:
Cartier STA.TF !MINI' Policy No. 1603616-02
(This section need not be completed if the permit valuation is for $100.00 or less).
fI certify that in the performance of the work for which this permit is issued,
I s all 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 S ction 3700 of the Labor
el
Code, I shall forthwith comply with those provisions.
Date: Applicant -
Warning:
�..
Warning: Failure to secure Worke 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 f®rjinspection purposes.
Signature (Owner/Agent)' 6 f's �- Date
BUILDING PERMIT PERMIT#
DATE VALUATION I LOT 30 /QC' 0"3-328 TRACT
57- .& - c3 'R S45„420SO It -V 28601
JOB SITE
APN
ADDRESS 79472 D1_t'.��.ii W1LL0;V RU "I'
6490AN- 5
OWNER
CONTRACTOR / DESIGNER / EN (NEER
IAUA1"aLORFS) LP
DCD DEM, :t WC dba Y?I•:SM- T CTMIS EV.
74.760 HIGHWAY l 11 #200
76.6001MUTHWV I I I
11`t1;IANIVE.; S CA. 97210
L.&Qt alv% CA 3e^.253
('760)T71.33 X15 (Xvt 2180
USE O�FPERMIT
�f�
jt�p}����r "TACT
fiili'lCL 1+S1,GY.C1i✓1` �.lw"►'4'2ED
SM - UL.W A Y: XT 113, I%iK.6 4 1A..PUIu I 1 O)?,5' NOT .INC.LX0E
P004 �'P+�, TIL C'f,' V11 lbo. QR I�Iii�T�'9V.AY 141'Fkl.OAC..H. 75�i�ARDUCTTON
1*0 P1,AN CHECK n,'E FOR MUI..°i'IPLE ISSUA14CE OF SAME PLAN TYP9.
TRACT CONSTRUCTION MIN 3F
CfARAL�"ri..d�tiRPORT 373.00 SSK
P.II:A4.IVJ ]� � IR'E A151.DX.�AYJ.trYR
C.'ONSTRUC..TION IFFIE 101.000.4113.000 s ask"
PLAN N CHLwK iy 11B 101-000-439-318 #.IV.155
MEC1. MIC AL MZ 101-000-421-000 $30,50
HLIXTR.>'.0 AL VEY 101-000-420-000 US x&
P Lt MMINO FEE 101.000.419-000 38830
STRO140 MOT1014 FEE. - RMSM 101-000-241.000 $4.52
T3T~s!8VDPEI1 IMPACT PALE $06910
SUB=Tc;n:AY, CONITMUCTION & D IT" P- RECK
$2,243.34.
PPS r_ =6 JAI I•r NOW
$212434M.
CITYCIFLAQUINTA '
FINANCE DEPT._..
RECEIPT
DATE.
BY
DATE FI ALED
5- 6 3
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
9—// —OZ
Underground Ducts
Forms & Footings
_ Z
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
�-
Compressor
Insulation
T
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z- ! L 57
CAIS
Final
Final ra, 4
BLOCKWALL A PROVALS
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
—77 —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—! Q. o ST
Encapsulation
Gas Piping
Gas Test
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) ,�
COMMENTS:
INSULATION CERTIFICATE IC -1
5ltr Addr:ss
Description of Installation
1. ROOF
T hlc,CnCss (inches) 13 r r
CEILING
Prrml: N'umbu
r;::rT-.?t Rcsls:ance(R-Valu--)
Bat: o: Blanket Tyre UJJ�? E:' Nate �Ln� Ur .n od
Thickncss (inc.`.-s` �3" The=a: ^sistar.ce (R z uc)
Loose Fill Type` la 1J{ \ Fr'-1� /1 00:1 3�
Contractor's rni installed wcight/f:' V- ]b ;Mini ^_n t kness 7 inches n
Manufacture?s installed weight per square foot to achieve The. -nal Resist=ce (R-Val::C) kms -S-6
3. EXTERIOR WALL
A.
Brand Na -c � Un Al [) c � O - _
Thickness (inches) �%�— Thermal Resistance (R -Value)
B . Exterior luG-O
Material 61 Br2r.d Name ('
Thickness (inches) Resistance (R -Value) - (�
RAISED FLOOR
:✓::aerial
Thic'mc:ss (inches)
SLAB FLOOPUHRI`fETER
Iv!atc:isl
Thickness (inches)
Perirzctcr Insulaticn Dcpth (Inches)
Y� FOU` DATION Vi A LL
/` Ivtatc:ial
Thickness (iP..ch��)
Declaration
T i:c.--ai Fccsstar.ce (R-Val��c)
13, -and. Name
T, cr:z,al Resistance (R -Value) _
Res:s.anu (R-V3.i:c)
1 hcrehy eer.ify that t::_ 3Sovc insulation was irstal!ed in the c_.:=:-.< . _._ z`o._ iota:ien ccnff-, tancc with t.5e e::rren.
EnerZ, E j;cienC, Sfor residential buddi-.yrs (Title 24, °a'6, C .3!; mis Code e; R g_;a,`:ens) as indieafa.•d on the
Ce :i:l:il� Cf COmr:17:.L u 10PEC31Jle.
S,t'2- Da: t (Co. Name) DA
Ccr._-al Cor.-3.!or (Co. Vane) OR Owne.
Fl:-17=7-
!cn =
Dale
S:; , D",tc
Sub-onsactor (Co. Name) OR
C.n--ral Ccrtr2c.or (Co. ; 3.,u) OR Owner
L-.s:3ili St:tcor:r-3C:or (Co. Name) OR
C.- i Cc,-.t.,z!or (Co. N -3.,;e) OR Owrcr
CZ 3 Au__,. 2_31 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 79-872 Desert Willow St 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 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:
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
.-
marks
• • u • r•u� • •n this nronexty in accordance•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,Califomia 95825-3280.
AT20:3720030313
, 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: 79-872 DESERT WILLOW STREET U-98
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-328
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
-del
Building Official
Address: 74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 05-06-2003