0311-224 (SFD)LICENSED CONTRACTOR DECLARATION
I 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
CV W Professionals Code, and my License is in full force and effect.
License # Lic. Class, Exp. Date
LU 3131/03
cZ r Date -'f 3 Signature of Contractor-
CO 0- �' !
J U 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
c") O I am exempt. under Section , B&P.C. for this reason
U)
O R1 Date Signature of Owner
rn
U Q 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.
(`t) 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 3TAaTE FUND Policy No.
(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 agr.'ee that if I should become
subject to the workers' comper�saiion provisions of; Section 3700 of'the Labor
Code, I shall forthwith comply with rthose,provisions__
Date:1 ;7 i! f L Applicant -
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
r 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
a & 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. �I
Signature (Owner/Agent)"'1'•'!,-'' u�� `..mss m--�--"Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 031121Nt TRACT
4q ,yy p 77((
77
JOB SITE
APN
ADDRESS M-•9511 0013 Lys COURT
764 -W -Oft
OWNER
CONTRACTOR / DESIGNER / ENGINEER
rinwip,1.1s_)1vi s a 11, LLC
1111WR PMMgc_A. DI,Vs4'.I.OPME1411' CORP.
5.100T C-IMIT0NMT(W, MI,, Z05
5 K i IDMS AVF, YM, 20:5
REDL.A1vD34 CA 92373
1Z1?DLANL14a (2A 92373
(909)7n.-3658 CY.SLO 4911
USE OF PERMIT
37NOLR F�AvaAaY DIAIRLUNO
S7D -LOT 71, PIAN ILA. PERMIT DGEN NIOT 11 f L.UI)f_ BLOCK WALLS,
f'004 .:IPA OR L IUVF ;°SAY APPROACH,
CUSTOM C04STRUCT1014 2,160,0(1; OF
POMC HIPA'TIO 483.00 SF
GAJ &OWC°AR..PORT 664.00 +F
BM A..[1V.4AJ+-.[L.4/ COSI• 011 C N411J 3.fL5 a.' L,RO
2.7 0,ozax)
CONSTRUCTION FEZ 101-000 =i'l 18.000 $056100
PL -.AN CHECK FEE 101-•000.439-314'3 W. 17
MEC'xAMIO,rul IM) 101.000.421.000 5163.00
VLEC TR1CAL FF?W 101-000-420-000 $185.03
f l"UMS1 40I?EE 101 4100-419,K0 %iftso
STRO140 MOTION PLIZ • RU311D 101-000-241-000 $21.81
C'FRAI311•i0 ME 101 �( 00-423.000 $0,00
D),''✓ P r i11'l;-R IMPACT FZZ $2,405.00
ART114 PUBLIC PL1#CV13.• MAY 270-0001445-000 $4;i,x>
STIB-TarAL COM '1*KU(:'i %T.AN.0 l'LAX C I*H CHC
TA,9S8.7.k
D e L1513 ;PR a1'AU) T-EL75
!OTA?:, Fly:[ f- YEMNUWp NOW
$$lot?
DEC 15 2003
CITY OF LAQUINTA '1'.
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FINA1
INSP?;X
OPERATION
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
BUILDING .APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings A
Ducts
Slab Grade j
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing S"
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath 7 d
Final
Final
POOLS - SPAS
RLOCKWALL AP ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines rc
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 L Z
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
Final
Utility Notice (Perm)
Certificate of Occupancy
Tar
ot
G f
OF,v 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: 81-954 COUPLES COURT
Use classification: SINGLE FAMILY DWELLING Building .Permit No.: 0311-224
Occupancy Group: R3 Type of, Construction:. VN Land Use Zone: RL
Owner of Building: BIRDIE HOMES 111, LLC Address: SE -CITRUS AVE. STE.105
City, ST, ZIP: REDLANDS, CA 92373
r� By: GARY HARTMAN
l Date: March 21, 2005
Building Official
POST IN A CONSPICUOUS PLACE
-