0203-318 (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 ce VIQ - +� j W30103
DateSignature of Contractor
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 �gT;k7lE,��I1�1C Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
,(A, 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: 4:!ff e3 1- Applicant (' A
Warning: Failure to secure Worker1is' 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 0
& 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 i
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above4information
correct. I agree to comply with all City, and State laws relating o the buildi
construction,. and hereby authorize representatives of this City to enter up n':
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ``-✓ �� '� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT O20 -31'a TRACT
4, r B45UM 28601
JOB SITE
ADDRESS 79402 DESMa WZLOW SMET
APN
CA9-030-•0425
OWNER
CONTRACTOR / DESIGNER / EN (NEER
.SFJ.€ JOLO1M, I P
D(M I)LEV., 19C c€ba DENXT (-TI SIN-E,V.
744601*tiIGAITWAY 111 4200
78-6(9)TMAIW AY I I I
WDW4 WEIS CA 92210
LA QJINTA CA 9225
(�60)7771-3345 CK ." 180
USE O,pyFF P��E�RJMIT�j
jf ,� j
l,/.L� • �u 12, F. it1-Y .i et��EAC
SFA- IILDKIA_: , UNIT 9C� PLAN I Ii . PXR.ItfliT DOES NOT INCLUDE
P0014 SPA, RLOC;f tnLIAOR DRItEWAYb1K1tA0,14,:5%17DICTIO3
N PLAN CiLr,*,YIpY, 1ORMOLTIPIX NUANCZ O edME PLAN TV112,
EeSI THW;l3+WD COST T OIC CC3Nfis',(UiTMIOH
PROW WE OMMARY
CONSTRUCTION PIKE 101.-{OQ--418.000 $3400
PLAN CB3irK FEE 101.000-490-318 $78.SI
,
M C HANIM ME 339130
FJ= 32lC1A1., V1i•.'.Lr: $59.I10
!AI,UjM9RW('417I E 101.000-419-000 5981.0
STI2O O MOTION F .Z - RE -SID 101-.000=241, -000
DKV'F-V)Pr1?k I1< PAPIT FEIN $1,m9.00
4
St.,TI:I.TCYrAL CORA- RUC 7109.AND PI:AAY3' G' -rECK.
$2,1.80./31�
G-
L30 PRg- A'Yt l.� .�17.T.S S
$0.00
B �+
Ml�ti� 0j E ru E
QTYOFLA liI
FINANCED f �-
RECEIPT
��BY
fi:L�j =;
P"
DATE FINALED
INSPECTOR
' Iv.' M
r
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
i.
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms &Footings Ducts
Slab Grade si S7 Return Air
Steel —.g,.j5 —p Combustion Air
Roof Deck •o z Exhaust Fans
0. 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
Drywall -Int. Lath •o Z
1
Final
Finals7
POOLS-SPAS
BLOCKAPPROVALS - steel
t
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover -
Equipment Location
Underground Electric
Underground Plbg. Test
Final Gas Piping
PLUMBING APPROVALS Gas Test
Electric Final
_
Waste Lines —CT-797Z Heater Final
Water Piping Piumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral Pool Cover
Sewer Connection Encapsulation
Gas Piping
ptacles
G.F.I.
Smoke Detectors
Temp•. Use of Power
Final
Utility Notice (Perm) p
Gas Test
Appliances
Final
i
COMMENTS: \
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit •
Rough Wiring
Low Nottage Wiring
Fixtures
Main Service
Sub Panels
e
Exterior Recoe
�^.
t
ptacles
G.F.I.
Smoke Detectors
Temp•. Use of Power
Final
Utility Notice (Perm) p
IN'SULATION CERTIFICATE IC -1
Sitc Ad--jr-ms
Perrnl: Numbtr
r' _ L' __
Description of Installation
1. ROOF
M2., -ria! � 5 Era �_..._ `� Un n i U
Thickness (inches) \3 Resis.a, (�-Va!u_) V,3S�
CEILING i ,
Batt o: E!an:•:et Type s' )1_ k `J E:' =- c ``X\� "JA ,n
Thic ncss (inc';-s' IZ)" Tier* =: ^sistar.ce
Loosc Fill Type Brand /1 00:►'1 %4-1
Contractor's rni- installed wcig`rt/f —' �-_lb inches
Manufacturces ir,_stalled weight per square foot to zchievc T c.rma! R:sista_nce (R -Val, --c)
3. EXTERIOR WALL
A.
Materia] Brzrd Na -c Al c � t � � O
Thicicr.ess (inches) CG _ Thermal Resistance (R-Valuc)
B . Exterior LA -)GU -,-o
� r
Material L&A5 Br?-nd Name (a_u, T
Thickness (inches) 3' Te.^s: Resstanc_ (?-Value)
RAISED FLOOR
Mmeri!!
Thic`.cncss (inches)
SLAB FLOOIL'?F-RI`IETER
Mat::rial
Tbicknc5s (inches)
Perimeter Insulaticn Dcpth (inches).
FOUNDATION WALL
NTalc:ial
Thickness (ir.ch_-s)
Rcsisrancc (R-Valuc)
E-anc Narne
T`cr7t-1 Resistance (R -Value)
B: -a -a N
T•-.,
�_.ra: Res:s:anc: (R-V31L'C)
Declaration
1 icrecy that t�C 3bJ�'t lrSJl3!:Cn .gas ir,s:ill_d in :he c_:':c.-._ _. _._ a`_o•,_ !0Ca:;cn ,,, ecnle-naa:: wi!h t.5e c--rrcn'.
eer.ir
Ererti.: Ej_tcienc� S:�rd.rd for residcntial buildings (Till_ 24, °a- 5, Ca'.i'Jni3 COL'_ c.`:2c¢uL ens) as inrica�,•d ca the
Cc�:!:i.itc c:`Co...:�!:a c , u a. P�:c3bh:.
� " � %' ,3 //. y z G•�X � )���y✓l 0.�%2� r /cam/ /�yc., l - /.%
1!.:-t -s S,i2n _._, Ds:_ l::sla!liS;.b:cntric:or(CJ. Name) G
31 Cor.tm: or (Co. Name) 0R O•+ nc.
Da:c
Si, r_. , D_':_
l:'S:alltng Su` _ontractor (Co. ti3(;C) OR
C:nc:al Ccr.!rac:or (Co. N1 3mc) OR 0•x•r:cr
Ir.s:alli-� Sc`-con=wor (Co. Nam,) OR
C _nc-�2! Ccr.t: a:!or (Co. tiamc) OR 0,.vner
C_. - ^.-CZ) - %u �-�t 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 79-892 Desert Willow La Quinta CA 92253 09/24/2002
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 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: $
Inspection fee : $ 0.00
Others : $ 0.00
Total: $ 70.00
Recommendations not completed by this firm
Estimated Cost: $
Remarks
A soil pre-treatment was performed on this property in accordance with Structural Pest Contra Board regiilations_
Signature
If you have questions regarding the work as outlined above,you should fust 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
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: 79-892 DESERT WILLOW STREET U-90
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-318
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