0203-316 (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
7t4S 5 5 B CSM.d N1 / 9130/03
Date Signature of Contractor �! fA� (11A
if v
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 '1`1"AI,E Policy No. k6D,m}$ Q2
(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.
Date: --� Applicantahs'
b
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 t
whose request and for whose benefit work is performed under or pursuan
any permit issued as a result of this applicaton agrees to, & shall, indem i
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and: v_oi i
work is not commenced within 180 days from date of issuance of_s c
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 the above informatio 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
1I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT '� TRACT
it-�,Ui9tT t34:T1fi8 .21301
JOB SITE
ADDRESS *79 -MS DEN NT WUJ,0W S `Tn.-T
APN
649-0 045
OWNER
CONTRACTOR / DESIGNER / EN (NEER
ZAFLO..TZ0, 3,1'
1X1.a IYW , .INC dbn 1 iMP T MES; DEV.
74-76013108WAY 111 #200
7SRr6001-HOMMAY 111
MA -)LAN WRILZ CA 92210
LA QWNTA CA 92253
(760)771-3345 t'B 4t. 21Stl
USE OF PERMIT
M1401L F vMY AITA.CEPED
a17A. • B1,15CIA4, a)ik IT 9; ?LAW 2A.. I?tXMIT DOES N0T INCLUDE
P004 SPA, 13VQ('K Ik1At..IA OR I'.1tIV KWAY APPROACH. 73% MUC;1 iON
I14 k'W4 CHZCY FEE FOR M-11IffIP L9 IvSUANCB? 0 Ir f3A, M.L PL,A14 `KYPK
TRACT C<7dJO1`RUCTiON 902,06 SF
Ci:R.litli?/ �ilZ'PURT' 3EC.U0 ,SF
CO'S'T OF COJ'+1S:6R11€:'f .011 r
59,019.60 '.
IFji'ihh1�py1��y .''r,I MA£ Y
/fg313".tj
V-116 $103.3E
PLAN CHECK FCi; 101-CM.4'.V-116
M1?CILWCAL, MP 101.000.421-000
ELECTRICAL Cl3 L FEE 101-000.9 20-000
FL17MBIM RE 101-000.419.1000 $also
aTRON0 MOTION F99 n PASM :101-+aW-241-000 2(•�' o
1XNK.7,OPER. WA.CT Ffi?I!:' 1,3fxa,QCt
8T-M-rt.:i'?rd:�k' UC'il ON .i� ND 'f?'.i.,.��!3 r.1WK
!`2, 340.24
u U U US. a'RR-L'AW F983
$0.00
i,AY 0 8 2G9c �� .. ;� '�%: �v'���
$2,340,24
CITYOFIAQUI�ITA
FINANCEDEPT.
RECEIPT
DA
C r.p
BY ,
DATE FIN9`O
INSPECTOR
1 14. N_,_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ 3 - Z__
Underground Ducts
Forms & Footings
10- / 7. o —=o'
Ducts
Slab Grade
Jzz -
Return Air
Steel
Combustion Air
Roof Deck
(• rJ j
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
. /�•O 2 -
Drywall - Int. Lath
a
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
V 3 —
Heater Final
Water Piping
-10. 0 z oS
Plumbing Fina:
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
• a 3 S
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
GY.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)6 S%
COMMENTS:
INSULATION CERTIFICATE IC -I
5itr Adan'ss
Description of Installation
1. ROO;
Th;cknes5 (ircit- .cs) \31(
Pernl: Number
Qrt n I Lam.
Rcsis:ince (R-Va!ue) 3�
CEILING
Bat: o: Eian:.et Typ e E;a-d Na : --,c
t✓
Thic',crxss (irc`..s' 13"
Loose Fill Type ` Erand A 00,tl �4 t
Contractor's rni- installed weighJfr �_lb �4ini ^'c n t�kress _ 7 inches n
1\13nufacturces installed weight per square foot to zchievc The=, ,al Resisl-- ce (R -Vel, -.c) k- -S-6
3. EXTERIOR WAT L
((O_TMaterial PY'Litj Brznd Na -c 4..,1(; n () (((o -
Thickness
hickness (inches) 1G3�— Thermal Resistance (R -Value)
B . Exterior liiC'. O
:aterial �C"�4S _ Brzr.d `a :c lL
Thickness (inches) 37o— T::e=,ai Resistance (R -Value)
RAISED FLOOR
M. A! e " i a I
Thictricss (inc`:s)•
SLAB FLOORRERIMETER
i�atcrisl
Thic:<ress (inches)
Perirnctc: Insulaticn Dcpth (inches)
FOUNDATION NVALL
Ivlatc: ial
Thickness (ir.c'r.cs)
B j Na -e
Ti: ....moi Rcsistanc (R-Valuc)
B:2nd Naze
T, ermal Resistance (R -Value)
Tr.e..- .ai Rests:arc: (R-Valuc)
Declaration
I here -,y eCr;;w th3! t:.. 31-ovc irsulalicn `%-ai Ln 3i a�o-._ !oca::c❑ wilh Ch: cuiin.
Energy E jtcie^4 —' for residcntia! buil,i-.gs (Till_ 2,, Pa- 5, California CoL': as indiea�t.d en the
Cc::i:icat;; of Co;-:�!ilnc , u-_.,, a piic161e.
/J
SLI:cnz:wor (Co. Nan:) O
Gca_ral Cor.ta:ror (Co. Name) OR 0•.•r.t-
1!c.n =,
:gnat rc, Date
Si
Installing Sub=ono-actor (Co. \amc) 02
Cerr_ral Ccr.!rzc:or (Co. ; iamc) OR Own:r
Ins:111in� SCbCZr:-actor (Co. Names) OR
Cc..., a! Ccc,:.::or (Co. tia,;,e) OR Ow•ncr
C 2 0; 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 Desert Willow La Quinta CA 92253 10/11/2002
INSPECTED: 79-885 CO. CODE 33
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -HUGS (562) 920-7571
FIRM LICENSE NUMBER PR1401 I COMPLETION STAMP NUMBER
Notice of completion
Sent To and date
Owner's Name and Address:
Copies sent to :
03/13/2003
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:
Recommendations not completed by this firm
Remarks :
Signature
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Estimated Cost: $
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.
AT20:4320030313
, 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: 79-885 DESERT WILLOW STREET U-88
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-316
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