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0403-364 (SFD)LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code; and my License is in full force and effect. p M License # Lic. Class Exp. Date QLLJ tr� a/ �i e ZO F -_Date � Signature of Contractor -- CIO _ 1 J U CID OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ 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, BUsiriM & Professionals Code). ( ) I, as owneef thcr pFo erty, am exclusively contracting with licensed contractors to c%o,. triict't e project (Sec. 7044, Business & Professionals Code). ot,, () I am exempt under, ct�dfn B&P.C. for this reason. N Date Signature of Owner rn d< WORKER'S COMPENSATION DECLARATION QI hereby affirm under 'piopalty of perjury one �f the following declarations: F_ p () 1 have and will-maimtain,.a certificate of consent to self -insure for workers' K W C� compensation, as providedsfor by Section 3700 of the Labor Code, for the D J Q performance of the work for which this permit is issued. n Q 0 t?4r) I have and will maintain workers' compensation insurance, as required by J V Q Section 3700 of the Labor Code, for the performance of the work for which this L. � Z permit i . smelt. Cyt urkers' compensation insurance % & policy no. are: Carrier Policy No ob C3 V.. g (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 1 orkers' compensation proyisionsf`of �ection 3700 of the Labor 3 Code, 'S 'all f • rt� h comply with those rov sioii r �[ te:' FJ �� AppliNht—Vt .%' 1,. ti...,_.r.. 11111 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 appiicaton 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 informairon 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. r ,Signature (Owner/A�e Q., x? _ ! ' '°��'- �' `` ` -'""" Date �i -3" BUILDING PERMIT PERMITA t>41Q:4••sk�� DATE VALUATION Sj �6 59 7 A0 LOT 2 TRACT JOB SITE V1 -9i7 APN ADDRESS OWNER CONTRACTOR / DESIGNER'/ ENGINEER TA RIA, :1•{viul,M 111, UP rYR10' FA:.`RACA E. CT!: 112 AVI_I IT111I; 705 5 F. C".1't't+; A9.VIFE, Z 205 -Tr.1-DIA/NY CA 92373 ("'11NO 49t1 USE tl ", Y , - '1 -1w1'.FV. ZI '1' Y - ? 7'1 'yr,V yr - P001, PA OLLj F, f�t+.l�rt�k�!AY A.PPROA-05L c>ORCHIPATIO .550.00 SF t1ARA0FJ(AR.P0RT BAi!,tlEt 8F .Wnfl i1WDED CONT OF r_0!VMRTTC'I 0.K 236!597.46 COMM RUCTION i TZE 101.000.41 S-000 SIM9.00 pi f`ILN CHL;r4cIK FEE i K $333.09 NEC1dA1tfIM,FELE 1011.000.421.000 3tr;:t,l)0 r TrUCA1, 1,117,11' 1014"U"11-0, 20-0Lill $192,'31, PiAlIMP11-PI(;1FEE 111.000-419-(1f;3tt $t .11121 - ISTRO1,1x3 MOT1014 FEE - 1'R'14D 10 1 -OW -241-000 V-166 C1!tMA11.40 HI I C11 -()Q0,4.73-000 $15,00 D.it'>�Ef t)PFR IMPACT I?FSE 17,405.00 ATS"1. M MUL.1C PL MS - REM 270 030-443-000 991.40 SYB-1C TAL!_'%:1tii".-17M1Jr~r10'ff PXD PT AN C,19_C`K $4,416.21 L&349 RREIPAID .E vEj P1::XII> T I�KV,,S S3[]I& !%?0V1 APR 0 5 _!z $011)(1 't4,416,217 RECEIPT DATE__ BY DAT N ED ,/ INSPE R OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 1 7 Ducts Slab Grade / D Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing .m S.'e Compressor Insulation -/ r o Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath // o Drywall - Int. Lath / Final Final POOLS _ 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 Z d Encapsulation Gas Piping Gas Test _ / ,gam 67;1- Appliances Final f 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 Utllity Notice (Perm) TANDY'S Vow' INSPECTION INC. V""-, SPECIAL INSPECTION DAILY REPORT PO BOX 13766 PALM DESERT. CA 92255 OFFICE/FAX 909.769.9717 PAGER 760.776.3339 I HEREBY CERTIFY TMAT I.HWE WSPECMD ALL OF YHE ABOVE REPORTED WORK, UNLESS OTF■RWISE NOTM AND TO TEE BEST OF MY ABRITY I HAVE FOUND TM WORK TO COMPLY WRM THE APPROVED PLANS,.SPECFICATMM & APPUCABIE SURD fi LAWS. SIGNATURE V4SMCTMCERTWATftAdWWAMHUQSM DESCRIPTION OF O' 1 SUPPLIER TYPE OF INSPECTION PE::Z2.Qjq DATE � PHYSICAL A12258,�.. (1 604? C' `I �, , 1TYPE PERIAfT NUMBER - - .--'es (o Ll JOB N Lo f a 1� OF STRr ARCHITECT ENGINEER GENERAL -'9 _ �A 1` � � SUBCONTRACTOR I HEREBY CERTIFY TMAT I.HWE WSPECMD ALL OF YHE ABOVE REPORTED WORK, UNLESS OTF■RWISE NOTM AND TO TEE BEST OF MY ABRITY I HAVE FOUND TM WORK TO COMPLY WRM THE APPROVED PLANS,.SPECFICATMM & APPUCABIE SURD fi LAWS. SIGNATURE V4SMCTMCERTWATftAdWWAMHUQSM DESCRIPTION OF O' 1 SUPPLIER TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP TEMP SLUMP TIME IN MOVER. + ' �` rt 9 \. V .� � :1. +.�'Oo.�� X5:1\ ' � , � r . �r�t1i1• LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER �Mft EMS Nlar, W% I HEREBY CERTIFY TMAT I.HWE WSPECMD ALL OF YHE ABOVE REPORTED WORK, UNLESS OTF■RWISE NOTM AND TO TEE BEST OF MY ABRITY I HAVE FOUND TM WORK TO COMPLY WRM THE APPROVED PLANS,.SPECFICATMM & APPUCABIE SURD fi LAWS. SIGNATURE V4SMCTMCERTWATftAdWWAMHUQSM SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP TEMP SLUMP TIME IN MOVER. LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY TMAT I.HWE WSPECMD ALL OF YHE ABOVE REPORTED WORK, UNLESS OTF■RWISE NOTM AND TO TEE BEST OF MY ABRITY I HAVE FOUND TM WORK TO COMPLY WRM THE APPROVED PLANS,.SPECFICATMM & APPUCABIE SURD fi LAWS. SIGNATURE V4SMCTMCERTWATftAdWWAMHUQSM JON TANDY 78-194 Elenbrook Ct. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED O REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT �THER O REINFORCED MASONRY D FIRE PROOFING ��^+ JOB LO W Gso 0r.. t.6% TN REPORT SEOVENCE NO. Tv q iBUCTUEE 0�.•. d� � � PERMIT NO. 1JUAre 4- DA Odot DAV OF WEEK MATERIAL DESCRIPTION -� ARCHITECT 1 VV a MRS. CHARGED E-*7 tT- 9 FC -*w- ENGINEER ASSISTANTS MRS. CHARGED TION PATE DATE CA m oDNTRActaR w! cma SaVG7K L ��K 7° '&S6-uonk t�+�.s .yes stems • Q4JeLA6 VjP_ ; Ca V 2 0 K X14 N� C.• A - C cry (..4,c- .,cCOPY COPYSENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF Md KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE AVOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. SI URE OF REGISTERED INS TOR S13® TE fF RE RT REGI STER:NUMBER 0 Q. Aff LOJ�� C Certificateof Ocupancy �a� I G OF� Building -& Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance,. this structure was in compliance with the provisions of the Building Code and the various ordinances of the :City regulating building construction and"/or use, BUILDING ADDRESS: 81-977 COUPLES COURT Use classification: SINGLE_ FAMILY DWELLING Building Permit, No.: 0403,364 Occupancy. Groups R3 Type of Construction: VN Land Use Zone: RL Owner of Building: BIRDIE HOMES 111. LLC Address: 5 E. CITRUS AVE. SM 105 City, ST, ZIP: REDLANDS, CA 92373 By:. GARY HARTMAN Dater JUNE 14, 2005 Building Oficial min POST IN A CONSPICUOUS PLACE