0203-323 (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 B C8 o1 W30103
Date t;–L— –1Signature of Contractor—
OWNER-BUILDER
ontractor 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
(A 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 STATLFUND Policy No. 160.26116-02
(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 hall 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.] a`
Date: _n� ,11„Applicant `^i_/v-�
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. I
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 r
application. l
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 purposes.
Signature (Owner/Agent) • / 4����'.� Date 1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0203-3113 TRACT
.848YFf95
JOB SITE
APN
ADDRESS 79-M DEMW WM,OW iIRFEr
OWNER
CONTRACTOR / DESIGNER / ENGINEER
wwwR ES, IP
DCIS Dh-V'., .INC dbu D IG ClIT10,11 DIEW.
74-760 Fi1GHWAY.111 #200
78.600HIGHWAY 1 I I
DMIAN WFUS CA 92210
1A Q[9KT.X CA 9225:7
(76QY171=3345 Ck'sT . 2180
USE OF PERMIT
MNOU FA ..TAA*V=*1M
'
SFA • 13FZO. 4k UNIT 95, PLAN IH . PFRMIT 00M NOT INCLUDE
P004 SPA, ,RLdOCK WALU% OR ISltitr :EWWAY APPROACH. 7S .RELWCTION
IN FW4 CH fiX k 1110R. MULTIP1.Z 1S sOASdi;;E OF SAME :PL&1d T`s'Pi_
TRACT CONSTRUCTION 700.00 SF
EYMA':I` COW, OF COXY73-.I1MC .10AN
30.010.00
CONSTRUCAC IN M 10140%'*418,00 i 3341.00
P.LA.111 CHECK 14ft '101,,000-439-318 V78.51
M��TT.��CHA14r1Cl`.l4�L iEE 101-000-42y 11 ")Oy00 $39.50
LLdi: , F RIC A1, J' ['% 101-000-420-000 cp5i.00
?Lt11ABiN'1 FFIR 101.000.419.000 UA so
STRCr83O MOTION FEE - MIXT 101 ••000-2.41 L7t}t? $:5.80
DFVFJ,,0PFR I-MRACT PEt $1,569,810
n
ST. PI.- '1',AY,_ ON t1CTC'' ION 113+ D P AX CgI~�f.`K
51<, 9 0.3'1
s A _ _ :I �2 s3 PIRM PAW P'B9a
$0.00
u 6 �UUL
CITY pF 1p►QUINTA
FINANCEDEPT, ----
RECEIPT
DATE /
BY. = n[ "
DATA FINALED T
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —13 —,0
Underground Ducts
Forms & Footings q — oz
Ducts
Slab Grade - O.M_ 7
Return Air
Steel `�— �_
Combustion Air
Roof Deck ((— - o 5 y
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation y' 3 • d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath 2, `l
Drywall - Int. Lath u_ ,,o
Final
Final S—(- D S
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection o2, �8 O �j%.
Gas Piping
Encapsulation
Gas Test ! • o ?� ^'
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) Q
COMMENTS:
- =C —- --- -- C, - •-
:
IN HULA T ION CERTIFICATE IC -1
Site A d rens
Description of Installation
Permlr Numbzr
1. ROOF
T hickncss (1nci:C) �13'r T i:: ?i RcsIs3ace (R Valu) J�
CEILING
Bat: o: B1.an!:et Typc L5 E.a-d Nac;c cl 'n L
Thickncss (inc'-s'
^sistar.ce (1- 'aloe)
Loosc Fill Type KIN Er'-�
Contractor's rni- installed wcight/f:- lb liini^_ t �'.qickncss lb�inches
Manufacturces i%talled weight per square foot to achieve T e.��,al Resist`nce (R -Value)
3. EXTERIOR WALL
A. �x�( t,,,cL(S C---) o)x(O—PIC'w�o 0� 3
Materal 76( j Brzid Namc aAk ---, UJD Aq t t � -
Thickness (inches) 61q Thermal Resistance (R -Value)
B . Exterior LL)C• E0 r
Material Br2::d Name tnn J -L T
Thickness (incites) S'/--2 T a: Resistance (R -Value) - 1�
RAISED FLOOR
Thic!cncss (inc`,cs)
BLAH FLOOR'?cR1`1ETER
Mat^:isl
Thickness (inches)
Pcrirnvice Insclaticn Dcpth (inches)
FOUND. -.TION %V. -%LL
�` Iv1alctial
Thickness (ir.chcs)
Ti._....3i Rcsistar.ce (R -Value)
Brand Name
T`cr.r,al Resistance (R- Nalue) _
E. -a -.a Na
TCe.T..ai Resis'ance (R-V3luc'-
Declaration
I h1 rCCy ccrt�; that IrSUIat:cn was Ins:allcd in th_ C_:IG.-.z 3:..._ 3�0t: loe3:iCn in W;"h Chc cL'rreG.
Enerd; Fj-icier:cf Srac .-� far r:sidenti3l buildings (Till= 2,, Pa' 5, Ca'.i:ania Code of Regu!a; ens) as indiealtxd on the
a; piic3ble.
1-2
l:•:-� =s S;i2n _._, Dsx Ira:3:li^: S��ccn�ac:or (Co. N3mc) OR
Gcr.ral Cors 3c or (Co. Nacre) OR Ownc:
�na:--;rc, Date
C^ F 0 rrs
F+".- .,1 2 -Ji
l::s:allir.g Sub-ontmctor (Co. Name) OR
Cc-rral Ccr:r3c:or (Co. ;.amc) OR Ow'n:r
Ir.s:311ir.� Suico=wor (Co. Name) OR
C--=2! Ccr.,.,:,or (Co. Mme) OR Oµ•ncr
A•3d
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 79-888 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:
Recommendations not completed by this firm
Cost: $ 70.00
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70-00
Estimated Cost: $
.-
• • u • r•w • •� • •• • •.� ' •� • :•. • •�
Signature
r/
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: 79-888 DESERT WILLOW STREET U-95
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: 134 Type of Construction:
Owner of Building: MIRAFLORES, LP
Building Official
Bldg. Permit No.: 0203-323
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