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0203-320 (SATT)N 11J O M Q W o Z r �0 HC) W w H d W Z M LO N ON U °) `"QLO W X W — mVU O 0- rn H v Z_ ob Z) Q J 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 ljfd `�/�j 9a3N. ria Date':7-4--® Z, Signature of Contractor `''. ✓�" +;:�146A 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. j(cI have and will maintain workers' compensation insurance, as required by S tion 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 5.TATE F1y1,1D Policy No. 1402416.02 (This section need not be completed if the permit valuation is for $100.00 or less). ` 1 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 proyi" ions.gg. Date: ^^f. �O�Y Applicant `.1.. Ar /,IAA. Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. r� IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application -is made & each person.at whose request and for whose benefit work is performed under or pursuant';to any permit issued as a result of this applicaton agrees to, & shall, indemnify . & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for;inspection purposes. Signature (Owner/Agent) ° �''✓` ��t?• Date 4 BUILDING PERMIT PERMIT# DATE VALUATION LOT 0203-310 TRACT B461M 28601 JOB SITE ADDRESS 79-%M DESE r MUM S".I'gi.UT APN (549 -IM -045 OWNER CONTRACTOR / DESIGNER / ENGINEER MMMI"M, LP DCD DEV, 19C db -9 DESWr CITIE14 DE V. 74.760 HIGHWAY 111 -#200 78.600 MORWA.Y 171 IM tNnlz CA 92210 LA QTTJNTA CA 922,5'a (760)771.3:.5 Cwfil. # 2180 USE OF PERMIT SFA, f LD0. 46, UM1.' 92', PLAN IA. PERMIT DOES NOT IPtMUD P001, SPA, BLOCK W,AI. LS, OR EIRNEWA.Y APPROACH, 75% � L�iIC91ON IN P KH CHECK ��.�..4' FOR MULITIPLF, I.SSUANICZ OF S,Ai It PLM41 '$'41 IE. TRAff"f 1�CY�11'"STRUCTION 700.00 SF 0114 .ACRYC.yARPOIIZ"C r3.00 .S*Y FISIMI9l;, 10 C' ogr OF C,"O.I IRM"l:ION CON211RUCT1014 ME 101-000-4184= $388.50 PLA14 MCK IE,tt $97.93 MECHANICA-L FEE 101.000421.000 $30.50 MECTRIC M,111F2 101-000-420-000 $65.46 NIUM. INO ME 101-1000-419-000 SSA.50 a"+'ty',z.Z01453��Ytvp9�f�.1*TQ'l�fg�p' PEP,- 101-000-2411-Mq $4 3 {�RptESID MT PEXIS DIM, NOW PP ;243,3 i AY u 6 Z@Y 2 I FINANCEDEPT _ x RECEIPT DATE /� - BY DATE INA ED I INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — j� — p Underground Ducts Forms & Footings Z Ducts Slab Grade . p Z Return Air Steel —e? --Combustion Air Roof Deck S'7 Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Fireplace P.L. / ±¢ . p Z s% Vents Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath _ Drywall - Int. Lath /y0 Z ST Final Final 6 0ISEPOOLS-SPAS BLOCKWALL APPROVALS steel 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 — Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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 s Final Utility Notice (Perm) 7 Q 3 INSULATION CERTIFICATE IC -1 Site A dress Nrml- N•umbzr Dcscriptioll of Installation 1, RM Resis:?ace (R -Value) CEILING Bat: o: E!anket Type Ui E.an' N -me Thic ncss (inc`,-s\ a)" The ^ a: ^sistar.ce (R 'aloe) �`%j Loo_c Fill Type Brand�Q QQ.1'1 � %4-1 Contractor's rni- installed weighY :- J_lb Nfini a_ n t:fickr,ess ? inches Manufactumes installed weight per square foot to ach:evc Thc,;aal Resist`-ce (R-Vel_c) Al 3. EXTERIOR WAT L A. �)4�(i,✓ Lo,-Lat, X'(o— C'�-� 7 'A 3 Material �IYJJI-SBrand Na -c '' )�k ---, Un yl [) (( (0, _ Thickzcss (inches) 3�- Thermal Resista:;ce (R-Valuc) B . Extericr t,(.:.CAo Material P-)Lt�� Brand Name t�L Thickness (inches) The.,,,-, Resistance (R -Value) - 1� R -WISED FLOOR V:at erial Thic:cncss SLAB FLOO.RiPERI\PETER iv'ate:isl Thickmcss (inches) Perirne:er Insu':aticn Depth (inches) FOU\DA.TION WALL Iv(.ztc:ia! This' ncss -ir.c'r:cs) B.-ar:i N T i. ....3! P csisrar.ce (R-Valuc) B, -and Name T<,cr:,,al Resistance (R- Nalue) B -an. \a...,, T%e T." -i Rz!s:s.anc.' .Z-V3!uc) Declaration I hcrr'oy eer.:r' that l::_ 35o"'c insulation %vas installer: in 3: ._ ado-,_ .oca::cn in eonfcen3 ;ce With the eurrcr.. Er,erZ, Ej-icier.. for residential buildings (Titl. 2-', Pa- 5, Ca•.ifomi3 Cocc c.`Rcgula,^;ens) ss indieatzd on the Cc-iti�at• c.rCon;.::3r.c , u-_,.. aaF!ica5le Ise n -s Si2r ,_,_, De:� Ir.sta:lir cL�.C.1 ac'or (Co. Name) GR Cor,:�ttor (Co. Name) OR Ownc. I:c:n =. 3r:a:'_1 rc, Da t Sid . t::c, Da:_ 1-s:allicg Su'--con-�-actor (Co.,Namc) OR C, -:1:r31 CC,.tr3C:or (Co. ; iamc) OR Owr,:r 1-s:a11i-- Sc`_c:;r.-actor (Co. Namo) OR Cc -r.2! Cc,-.t:n.to.-(Co. Name) OR Own :r 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 79-904 Desert Willow La Quinta CA 92253 INSPECTED: CO.CODE 33 09/24/2002 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 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: 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: $ Inspection fee : $ Others : $ Total: $ Estimated Cost: $ 70.00 0.00 0.00 RA soil nre-treatment was nerformed on this nronerty in ac�nrdance. with Structural Pest Control Board reprulations. emarks : 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. AT21:1620030313 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: 79-904 DESERT WILLOW STREET U-92 Use Classification: SINGLE FAMILY ATTACHED Occupancy Group: R-3 Type of Construction: Owner of Building: MIRAFLORES, LP Building Official vni Bldg. Permit No.: 0203-320 Land Use Zone: CR Address: 74-760 HIGHWAY 111 #200 City: INDIAN WELLS, CA 92210 By: STEVE TRAXEL Date: 05-06-2003 41