0203-321 (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
768595 .T3 C8 I=
Date C-�=-4-- z. Signature of Contractor
OWNER -BUILDER DECLARATION y
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.
(J_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 ;iSATi•LIAI Policy No. 11srL361Fi-�2
(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,:�j
Date: r .. ,, Z Applicant—"' j F. ��.1h.0 G
Warning: Failure to secure Worker' 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 for inspection purposes.
Signature (Owner/Agent) Date
�..
BUILDING PERMIT PERMIT#
0203-321
DATE VALUATION LOT TRACT
mw 347'1,93 28601
JOB SITE
APN
ADDRESS 19-876 DE1.V131Kr WILLOW UW71T
64"30-"'S
OWNER
CONTRACTOR / DESIGNER / ENGINEER
M11L4X.C.,0, Is
JD03 DEV, DJC alba L9P:,,MT Cl'i ES Z3EX
74-760 a�ICrRWAY,1110200
78.600 1UGHNMAY 114 1
SIA WEtUA CA 92210
LAQtdINTA CA 9rdIS3
(?GO)771 � 3345 CHS 2180
USE OF PERMIT
RINGIZ. RJUVWlY AlTA.CIED
SPA,- 8LDa.4-1, UNIT 9:1, RLAN 3A . PERma DOS. S T40T ENC; IA1111E
P004 SPA 8WCK- WALT Off. DRFV .WAY APPRO-ACH. WMA, biED(Yt"TITIN
Tib PLA14 CHI.9,CK Fri? FOR Tug ULT1K,R ISSl►.A:i CE OLP S,0,I"EP P.I. AN TYPF-
TRACT CONSTRUCTION WolDo SF
Gi1I2AGEICI4RPORT isle
RFMWED COU Ole C0146JM`U(7B0.K
M. NS-TRUC'1014 F.U. 101.000.4.18.000
PL1,04 CI.1111.1.'.K P719 . 101-000-439- 318
WCH&RICA1, FGRE 101.000.421.000 539.0
PA ,C ItFCAI, FEE 10.1 -flit -420-000 $65.46
Pl UIMBYHO FF..i? 107.000.419-000 "84.1111
STRONG MOT1014;f;EE - IL 21,10 101-000-20-000 $4.33
D9VK1,.tWPJR_R IMPACT FOL?$ls�i�3.tTD
l;
OUB- M AF., CO).0 1Tk*(TCn0N.SOD KAN C".FWCK
-- -.XZ501 PRS-PAXD'FHr� 3
D e
a a��
$0,00
S DUC NOW
�it
r{AY U 6 2992
CITYOFLAQUINTA
FINANCEDEPT..
RECEIPT DATE
BY
DATE FINALED
INSPECTOR
x -,- f,.. F-
T
1171 • 45
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
9-,12-02-
Underground Ducts
Forms & Footings
- $o -oma
Ducts
Slab Grade
y ,o L
Return Air
Steel
Combustion Air
Roof Deck
- -o e,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
�Z �,p.Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewafl
Exterior Lath
Drywall - Int. Lath
/
G
Final
Final 3 57
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
— 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
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) 7
COMMENTS:
INSULA T IOC` CERTIFICATE IC -1
Dcscriptiozz of Installation
Perml: Nu;-lb2r
i�
-1�78
1. ROOfalx�,t{s
ThicknesC (inches) 13 Tl.,ra,_ Rcsis:Ence (R-Va!uc) 3
CEILING
Ba'.t o: Blanket Type i 7� Era- Nanc
Thickness (inc.`,-s` (�" The=!- ^sistacce (R- '.aluc)
Loosc Fill Type �a �t� B"-nd 00:('1 %4 t
Contractor's mni installed wcight/i: �_lb fir i _ -1 in'ic!tiness ?Zinches
Manufacturces installed weight per square foot to achieve T c=mal Resistzz�ce (R-Velcc)
3. EXTERIOR WALL
A. &t L,/ L,,)CUS c--) o1X(O—P�CWLo ep'A 3 ..
Material SL SBrzrd Na -c � ��af:�, Un An c) c (c, _
Thick-r:ess (inches) '%�— Therm2l Resistance (R-Value)—
B . Exterior WCjio
Material _ Brar.d Name A -
Thickness (inches) 3' Tte.=a: Resistance (R -Value)
RAISED FLOOR
v:aterial
Thic`.cncss (inch --s)
SLAB FLOORlPERI`tETER
N.atertsl
Thickness (inches)
Pcrir-eter Insulaticn Dc?th (inches)
Y FOUND.=,TION %VALL
Njatc.ial
Thi.''K css (inchcs)
Declaration
T i:c.- siP, csstar.ce (R-Vallc)
B;zrtd Name
Tlhcr.mal F.esistar,ce (R -Value)
Tr.e r -a? Res.s:ante (R-V3luc)
I hcr."y c2r'tr; that tte 3bovc Irsulatlon vas In5:311Cd Ln th. a: _._ 2b0'._ !OC3::Cn In CCCrC,'"aaC�CC WttS Cie CL'�T....
Er,erA: Ej ciene/ S;���.r� for residential buildi .gs (Till= 2<, Fa -6, Ca'i.`cria Cod: of Regula,:ens) as indiea�td ca the
Cc:'itr_3t:, c' Co ..."!ia c
Ile -1 -s S,i2r :sr_, Ds: Insca!li SLb.cnzractor (Co. Nanc) OR
C"._. al Co-:73cror (Co. Nine) OR Own:.
Fc-- I.-
dna:ere, Date
1: 1r:21l ;:, Subcontractor (Co. Name) OR
Cc,,!r2e:or (Co. i 13MC) OR Owner
(-.s:a1!i- Sc`cor.�wor (Co. Namc) OR
Cc-.sa! Cc; -.::actor (Co. Nacre) OR Oµ'n_r
-. v
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 79-876 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 : 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:
0
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pr -treatment was performed on this property in a .cordance with Structural Pest Control Roard 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.
AT20:4220030313
, 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
ol%wing.
BUILDING ADDRESS: 79-876 DESERT WILLOW STREET U-93
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-321
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
19