0203-313 (SATT)_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
7p8a9 i B CS ma', ^l OJt�3
Date �%`�"Q� Signature of Contractor
b%
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
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 :ITATI<. rum) Policy No. IOW616_02
(This section need not be completed if the permit valuation is for $100.00 or less).
�Xj I certify that in the performance of the work for which this permit is issued, P
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 1.• -i� Applicant -�- .=t.; L �,' /l c C
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, ind I
& hold harmless the City of La Quinta, its officers, agents and�empl
2. Any permit issued as a result of this application becomes null and
work is not commenced within 180 days from date of issuance of c
permit, or cessation of work for 180 days will subject permit to cancel) I n
I certify that I have read this application and state that the above info im I n i
correct. I agree to comply with all City, and State laws relating to the bu ding I
construction, and hereby authorize representatives of this City to enter pon
the above-mentioned property for inspection purposes. , �1.
Signature (Owner/Agent) t.•' .G%j E._�11-C f� Date"+*'
t'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT { 203-31':i TRACT
$5191019dw .28601
JOB SITE
APN
ADDRESS 79-103 90;rr WMLOW .171 . T
649-0.3t"45
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MRAFL i' ' S, LP
13M DEV, 19C dba r7Fn. TT ' r l MUSK DE .
74.760 MQ1HW,AY 111 ,200
78.600 HIGHWAY I I S
.11 D LAX%J.1+L1,8" CA 92210
LA QI7WA r,".A 92M
(7643)773.3x45 C'1'i#t 21SO
USE OF PERMIT
`TC" MM -Y .PTlAaMD
sm -18txt f.4,'3 UN3T 1955, PLAN 3A , 1'XRi, IT ..009,5 Ni'3a i11CLUDY
P001, 8P4 BLOCK W,A LLN, OR I31;iDyd9falAY APPROACH. 73;6 RE9D>UC' ION
IN PLAN Cid';` X. P'r`>• FOR. MULTIPLY, ISSI)ANCE OF SAM R PI. PN TYPE,
TRACT CONS°i'. UCTION 892.00 SF
0AIZASBd':fe~f1}t.PORT 540.00 SF
COST OF CONS�d`�'.C�C.*� ON
5,9,0�19.60
yy�pp•�yg���-}s�p}� y� ry� � y*��/��yEgSM14A'�'�3
P�b6.tYld.A 1.bLY. CI IJ.[fC6Nlit0.R
GOXOTR.'dJCF30WF29 101.000.4.18.000 $439.50
PLAN CHWK FEE 101-000-4.39-318 $10Z 42
1MiE.CRA43ICALFEE 101.000.421-000 $39,50
CLEC-I`R1C AL ,CSX t 101-000-420.000 $-O_+. n
PLi D1V1kSINO I�`f?I� 101-000-11.9-000 SIN."
STRONG MOTION ME a P VSXD 101-000-241-000 $5,"
Dh'4l•&LOPER 1'1�rPr1C FRE $1,:409,05
• '7
SUB-'1=AL C:O1�Y°R'd.7CT1C313' AUD 1)LAk4 C;;'•'TFs_`Y
$2,340.29
I PRE-17At) FERU
ZOO
'V'1wi 0 6 Luigi
►TYOF LAQt1INTA►
FINANCE13EPT. w
a
RECEIPT
DATE
BY __FDATE
FIN LED
INSPECTOR
� 't
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —pj -
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel j 12
Combustion Air
Roof Deck 0 • 3e a i
Exhaust Fans
O.K. to Wrap 5�
Framing
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 2 -�� •. i �7
Final
Final �j=�•n 3 �—`�
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
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 ��� O _'
Gas Piping _
Gas Test �•a-%
Encapsulation
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) 3 j ZO 3
COMMENTS:
I v
INSULA T IOC` CERTIFICATE IC -1
5itcAdo' rC55
Perml: \umbzr
P. U-'
Description of Installation
1. ROOF
T.Ia:eral t��Ci./�1�
h;c:<nCss (Inc%cs) 1J'r
CEILE G
! is:moi?: RC51S3:1Ce (R-VdIU�) 13,
Bal- o: E;an4et Type � 5 E:' -:a =^c ��(LX\�
Thickncss(inc`. s% �3" The=a. ^sistar.c (1- :aluc)
Loosc Fill Type CL,3,(\ Erind
Cor.tractor's rr:i- irs:ailed wcight/ft- A— lb IMinir cr t thic'.,:n_ss winches
Manufacturces in -stalled weight per square foot to achievc Ti.mmal Resist`nce (R-Veh c)
3. EXTERIOR WAT L
A. bt t,,>c,US �,-) dx(O—P�C--Yl —�? -A 3
Material Py",�ff� Brznd N=c 1j� jQ CLaCIt � t � O -
Thickr.css (inches) 3]�— Ti crmal Resistance (R-Valuc) >2 -se _
13. Exterior Lk -)6A0 r
Material P )Clkk-s Brzr.d `a^e T
Tcickness (inches) 375 Therm.ai Resistance (R -Value)
RAISED FLOOR
:✓:ateri3;
Thic'.cncss
SLAT; FLOOtL'PERI\IETER
Matcrisl
Thickncss (inches)
Pcrir-.c:er Insulaticn Depth (inches)
FOU\D.-,TION WALL
Ka:c: ial
Thickness (Inchcs)
Declaration
B, and N
T it c: -.,,a1 R,:sistar.ce (R-Va1,uc)
Bznd Name
T, ermal Resistance (R -Value)
Ti.z.T..a': Res:s:anc. (.Z-Valuc)
I here -y C.r''�' thM t. 3J0' -'C Irsulaticn «3i Ins:311.d in the C_:._:'.2 3: a�o'.2 loca::on in corrC"11P,:C
Er,era' E icie.,: 1; �:r� for residential buildings (Till-: 2-, Pa- 5, Cali:
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 79-873 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 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: 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: $
Inspection fee : $
Others : $
70.00
0.00
0.00
Total: $ 70-00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment way performed on this erty in accordance with Stnictural Pest Contro Board Regulations.
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.
AT20:4120030313
—I
v.,
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
P
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-873 DESERT WILLOW STREET U-85
t
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-313
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP
rd�l^'l
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