0203-322 (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
76095 ra, cc IHC �' RC)M
.WI
Date `/�� Signature of Contractor "� t:�f U�P�Z
/
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
pert rmance of the work for which this permit is issued.
Ki 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:
Cartier STA A'CII+t£7 Policy No. I603t+ttl O:d
(This section need not be completed if the permit valuation is for $100.00 or less).
(itr I certify that in the performance of the work for which this permit is issued,
1 S�a11 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: Applicant
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 pursuar� to
any permit issued as a result of this applicaton agrees to, & shall, indemh
& hold harmless the City of La Quinta, its officers, agents and employer
2. Any permit issued as a result of this application becomes null and vol
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 cancellati n.
I certify that I have read this application and state that above information is
correct. I agree to comply with all City, and State laws relating to the buildi g
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo'r inspection purposes.
I
r ,� ?, t,d:G -
Signature (Owner/Agent) ��- •� Date -'2
BUILDING PERMIT PERMIT# V
DATE VALUATION LOT 00"2-2 TRACT
U5,320M 247U94
JOB SITE APN
ADDRESS 79 -MO MPSIUM WMLOW 9MEET (WAV -045.
OWNER CONTRACTOR / DESIGNER / ENGINEER
Mk6awns, Is D-1:) DEV., INC dba 1).E� Y-221 CTMS �.'� EV,
74-760111GHWAY 1116200 200 78.600 HIGHWAY 11 I
ZMAN . ` 8' CA 92210 LA t IM T A CA -9''225:1
(760)771,W45 =6 2180
USE OF PERMIT
W NG -1.F 1``.1WT. Y AWACIRD
SIKA • FLIM. 4% €TWIT 94, PIAN IA. PERMIT TOMS NOT INCLo DF,
POOL, 0PA,'8iOCh.WA"1- OR I1WKWAYAFPI2.C1ACH, 75% REDUCTION
IN PI,P.N CfiMPEP FOR hq't%TIPLE ISSUP.NCL OF `JiiME PJ_A..N i'`l1rIK '
TRACT C0140'i RUC" x 1t}N `Ti' X100 ?
Q1A RACEICARPORT 373.00 .",t?
1~'.MATKO, COST OF I<. ONSURIT(MO 45;%29.80
CONSTRUCTION PEP, 101.000-4113.000 $333.10
PLAIN CH.VilIw � $87.91
MECHANIM FRF 101=1100-421.000 $39.50
PA,,V `.TFUC:AL T2*,11 101 -00"20-000 $65.46
P,LIMLST,tW r1"F 101.000.419-000 $0150
STRIONO 140TION Ift • ARSID 1011.-000-249-000, 24.x7
r _
a �`1(m 11 11 CON'STR-f yeTION AND Tit AIT C ;CK V,W.34
I&M krMPAW FRES $0,00
tANY 6 2002 10TAL -F.MynT, s DTA NOW 42,24334
CITY Of LpQUINTA
FINANCEDEPT,---
RECEIPT DAJE BY DATE FINALED INSPECTOR
�Cw7
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
OZ
Underground Ducts
Forms 8 Footings
— z6q—
Ducts
Slab Grade
%Z .o G_ 5
Return Air
Steel
Combustion Air
Roof Deck
/ — — p 2— rj
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Z . . p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final .�+'�/'o uj
BLOCKWALL APPROVALS
POOLS - SPAS
§teel
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 ��
�' — 2 —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
oZ—lCj. v �7
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) . , �j
COMMENTS:
� . til -=
INSULATION CERTIFICATE IC -1
5:tr Address
Description of Installation
Nrml: Nu;imbzr
L z
1. ROOT=
Thickness (incb.cs) j" T ::rr_: Resis:ance (R-Va!ue) 3
CEILING
�5 'd
Batt o: E'ket .arTyrc ?,Ers. �'
d �^c .�: �
Thickr.css('Inc'-s' 13" Tre^a:^s;star,ce(R-'.clue)
Loosc Fill Type Erne' �QQ:I'l b- -t
Contractor's rni installed weight/1!= A—_Ib Mini ^_m tflckn_ss (()--2; inches n
Manufacturces installed weight per square foot to achieve T;.e.,�,al Rcsistarce (R-Val_c)
3. EXTERIOR WALL
A. �,><�tLl X(0—PiC'w� 4p'A 3
Material B!2 -,:d Na -c aA -�-, UO A-1
Thickr:css (inchcs) _ Ti crmal Resistance (R-Valuc)
B . Exterior U-)GUo
Material Cv _ BR::d'• ` n
-,:e �t
Ti.ickness (inches) Sj' 2 The.,.,_. Resistance (=-Value) 1�
P,MSED FLOOR
�.iterial
Thic'.cncss (inc`.-s)
SLAB FL001UHRIMETER
I✓ate:isl
Thickn'_'5s (inches)
Perlrnc:cr Insulaticn DcptL (inchcs)
FOU\DATION \%ALL
h1alc:ial
Thickr:css (inchcs)
Declaration
Bars \--:e
-._sis!anc (R-Val'uc)
Brand N_,.me
T, cr.mal Resistance (R -Value) —
B-sr.a \'3:-c
r.e:r..a: ReS:S:a^c: (:1-V3!uc)
I hcr:ay ccr.;.`y th3t i::_ 31-lovc IrSuIatic P. .v351r5!311Cd Ln !l:_ -_.lc:z 2 _._ loca::cn CCnfe"lance w:!"i Chc cL•Ren!
Er,erg:: Ejiciene", Sror•a�r. for residential buil^i-,gs (Title 2:, Fa- 5, C-,:i.`cni3 Code as indie3�rd on the
Cc::i:I_aI;:0`CO3*:r':3-c a piic]Sle.
S,i2- -_. _, Ds-.,
Ger,:-u1 Contm.ror (Co. N1 3ne) OR Owr.c.
ET
D3:c
S:. , D_;_
1-s:�iling Sub:onuactor (Co. \arc) OR
CCa_:al CCr,ir3CAr (Co. 13MC) OR Oxr,.-r
t'. i:liliC� SCt-,:t(Co. Narno) OR
Cc-._. a! Ccr. t..::or (Co. Na:,ie) OR Own::r
_Ez �U-_o. 2_J1 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 79-880 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: 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: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Recommendations not completed by this firm
Estimated Cost; $
Remarks
A soil ;?re -treatment was performed on this property in accordance with Structural Pest Control 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.
AT20:4220030313
Certificate of Occupancy,
City of La Quintal
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: 79-880 DESERT WILLOW STREET U-94
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
vni
Bldg. Permit No.: 0203-322
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
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