0203-324 (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
C14 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
LO
,� wCi 1- 768395 B CS ,T1:CC 9WID14
.
r- Z 'i Date {� "'U 3Signature of Contractor ~ ! �''¢ ��?�j#�
o0r`
U CD OWNER -BUILDER DECLARATION
HW r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
fn License Law for the following reason:
Z_ ( ) 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).
LO () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
Oa)
Q WORKER'S COMPENSATION DECLARATION
C:, 2 Z I hereby affirm under penalty of perjury one of the following declarations:
LO - O () 1 have and will maintain a certificate of consent to self insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q pert rmance of the work for which this permit is issued.
ED Q U ('Q I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
IlLOI permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier 0'a"AT9 BUND Policy No. l�tl3fr16•Q3
cb
I� p
J (This section need not be completed if the permit valuation is for $100.00 or less).
l certify that in the performance of the work for which this permit is issued,
I sAII 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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with.those provisions.
Date: '25 - 4i! --127 Applicant�� =+ �' : `'V� �1
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, 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 forinspection purpose .
Signature (Owner/Agent) 1-ayf//' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$38,010.001 1345015 79601
c� 4/. i;4
JOB SITE
ADDRESS .79-w mmau ms ow nRw, r
APN
649-03ID-4D45
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LP
DM IJ:E'V.,12;)'C &a D31 '17 CTM, Y: -EV.
74^760 FUGHWP+Y 1.114200
78.600 Ti G-11WAY 111
CA. 92210
:1.1'x, QCMTTA CA 9W "t
(760)771. 345 (mik Z so
USE OF PERMIT
Gue mmu,•Y 11;.x'! Amm
SFA . BLDG. 4k UNIT 9G, P1..�N F.B. PERhO T DOES 1J0T 1PdCL.U'0.q'
K30L 9PA,11LOCK WL1% OR DFltVtt"V AY APPROACH., 75 1'aEl:aUC to d
!13 PT KW CHICK FEE, FOR M.ULT'iPL.9 I STANCE tilt' :S,AIME PL.4N T'VIPF.
TRACT CON TE.L1C TIO1d 700.00 AQ1F
E.MhWrLD COST OF f.citmSMU(7flOH
319,010.9011
PKRMtT YEE SUMMARY
CO)3TRUCTd00 FEE 3 01.000n418-400 8�13.Ot1
PLAN CHWIC ME 101-.000-439-318
MECHANIC, CAL. FEE 1014*0-12.1-UOn
EZ,Et: rPITCA 1.. FEC 101-000-420-000 $59.00
PL1:1MBIING FKK 101.000.419.000 "8130
iTRO!`iO MOVt3N F95 • 1t_E,SID 101••000.24.1. -CM $3.80
DEVELOPER MPACT ME 51. 59.00
lr-►'8 17RULMOX AND
D LEM PRE -:r TD PEE J1
Z00
MAI U 6 2002
_9 VEIZMff YKES DUR N W
C ry OF LAQUIRTA
NAN EOEPT
RECEIPT
DATE
BY ;"/ dd
DATE FINALED
INSPECTOR
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— 3 — C9 2
Underground Ducts
Forms & Footings
p — O
Ducts
Slab Grade
.f yp L
Return Air
Steel
Combustion Air
Root Deck
•02— S
Exhaust Fans —
O.K.to Wrap
F.A.U.
Framing
Compressor
Insulation
, v Z 59
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z —,//-d i SJ
Drywall - Int. Lath
Final
Final s7- �0'S sl
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— 3.
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�� 9.0 ?j 4!r7
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 (Penn) ?
COMMENTS:
INSULATION CERTIFICATE IC -1
Ar_drCss
Description of Installation
1. ROOF
N a!'- r a'. lc. .5
Thickness (in..-cs) j'r
CEILING
Perml- Nunbtr
L /
I--......
l�t,rt ( Lam.
T =: Rc51s:ance (R-Va!uc)-_-
Bat: o: E!arikv T,;pr V l'.L1kt-5 E.a:-.- N -;7-,c Ur .Y) Odes
Thic'u css (irc.`.:s`_ �3" Ti- ^ Z. sistar,c: (R 'aluc)
Loose Fill Type &a St\ Fra-nd /1 00
Contractor's r -i installed weigh Jit' ,V- _lb \.I;'I; :.,_mr4i c kncss ?Zinches
Manufacturces installed weight per square foot to achicve Thermal Resist-nce (R-Vcl_e)
3. EXTERIOR WALL
A. X(o—(�C'�-rte
Material j Bra-nd Na't
Thick.ncss (inches) (�— Thermal Resistance (R -Value)
13. Exterior U-)CLkLo
Material Br-r.r.d `a e t _l1
Thickness (inches) 172-5 Ter; ;s: Resistance (R -Value) V
RAISED FLOOR
�/ aterial
Thic'.cncss (inch Cs)
SLAB FL00}L'?t.RlMETER
iv`aterisl
Thickr,c5s (inches)
Perir..eter Insulation Depth (inches)
FOU\DAMON WALL
Thicliuncss (inch --s)
1 :. ....;; csistancc (R -Val c)
B znd Name
T,`.cr:;al Resistance (R -Value)
B:a:.a \'a-„
Tr.e.mai RestStance (R-V3luc)
Declaration
I hcrcy ccr.;F,, that t:._ 3bovc- irsulaCCn ins'.al!Cd Ln -�f loca::cn W;,h the cL'r ..'..
Er,erg,- E�-tcie!: Srs '= f -r r:sicicnti31 buil^'i-.gs (Till_ 2-., "-a- 5, Ca'i:crnis Cod: _: iZcg`aa;.cns) as induatzd cn the
Cc'i:i_at,e`Co-;�.,' u a F1ica`✓le.
Le n �, S;izn c_r_, Dsx 1nS:3!lin:Z Sub-cn-3C.Or (Co. Nano) 0
Genual Cor.: -.az: -or (Co. Marne) OR Ownc:
3: re, Date
Installing Sub_onu-actor (Co. lane) OR
C.n--ral Ccr.:rzctcr (Co. ; 3nc) OR 0•x'n:r
Ir.s-.alhng Su`co=..wor (Co. Nano) OR
G ..-.,l Cc,.,. -: tor (Co. Kane) OR Own:.
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 Desert Willow La Quinta CA 92253 09/25/2002
INSPECTED: 79 884 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:
Recommendations not completed by this firm
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total : $ 70.00
Estimated Cost: $
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
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: 79-884 DESERT WILLOW STREET U-96
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-324
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