0403-366 (SFD)LICENSED CONTRACTOR DECLARATION
co I hereby affirm under penalty of perjury that I am licensed under provisions of
I- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
D M License # Lic. Class/ Exp. Date i
tr)
W
7617U9�1 D ( ✓ 161;',IA) 3
f: F,
r-- Date Date ' r %Signature of Contractor
CIZ 0D ' r _
J U OWNER -BUILDER DECLARATION
WaW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
Cl) () I am exempt under Section , B&RC. for this reason
IO
N Date Signature of Owner
OC -4
a< WORKER'S COMPENSATION DECLARATION
p cc I hereby affirm under penalty of perjury one of the following declarations:
Lo
0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
0 J _Jperformanceof the work for which this permit is issued.
Q (� I have and will maintain workers' compensation insurance, as required by
Q 0Q Section 3700 of the Labor Code, for the performance of the work for which this
d H permit is i sued. ly rkers' compensation insurance qg pglicy no. are:
It Z Carver Policy No.
CIS5
ti (�
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
3 subject to the workers' compensation Provisions of,! Section 3700 of the Labor
Code; 1 II fofthvuith comply with{hose { rovi i n's. t
sh Jr n
,-Date: L! //- With
Applicant �•• it t_j t, N4 �
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 persofsY�[ whose request and for whose benefit work is performed under or pursuanany permit issued as a result of this applicaton agrees to, & shall, indem& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and vol if
work is not commenced within 180 days from date of issuance of s ch
permit, or cessation of work for 180 days will subject permit to cancellat on.
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 prop erty4dr inspection purposes. P J�o _�Sidnature (OwriedAgent)Y' --} _. > .1 �ti-- t:. Date '/ %
BUILDING PERMIT FERMIti40i 166
DATE VALUATION t21I9,08 i S0 LOT L/ TRACT
JOB SITE 1COT 'TI'L01'! C'E,iUdYO=,T
APN 164-P,60-- _
ADDRESS
OWNER CONTRACTOR / DESIGNER / ENGINEER
P_rRob ,RuNC} 3 111. I""w l+SLST"A M-13 A IM -'d1 -i -O +YME1~)T C "iaRT.
5 L. CTITIT 7111"V Fri. 205 5 T, ['17 rUS AVE, 5TE, 2"05
rif-I9Lc"KD C.A. 4` 73' 1rF713C h'rJD`a `.A 992101,t
(909)798.36 8 CDur 491
USE OF PEti�R IT
POP L, 5111 OR 1)11ML"l AY APPHQA !_'14. `?"K, 9ED UC.`TIO14 T 0 P6414 CiIE0K.
FF, M—R. MULTIPLE IMUP:GdCE OF g-tMIE rx1AN TYPIMP
C;MTO 21550.00 3
PORC HiP.A.1'10 4>? a.00 SF
OAP.Ac'TC.ARPORT 0AIDD O.-
}Q`aSMMM ' 0.7 OF Tr(a NGTRUl�!` ON
StiMMAK
CONOTRUC ION AMR 10] -000-4) 8.000 S9,P� i,ti0
AIJI.N CHl t`it FEE 1 U 1-G 1%i -a139-3 1 t; $iGill.7y
NI C11.P.'@a1C'.ALFIE 501.000-.4:x;1-000 $10.00
vrm 01 -GQ -4 20-000 $15.03
PAIM1311110 ely 01 --000-419-000 $N,40.io
STRONG l: UTIC'YN Flit;' - I2.MID 141-0100-7.41-000 $31.:1
f RAMNO FI?F i 01 000-41.•„a,-000 $14,!10
DEiTE41OPMR INIPA.C:r FER V,405A,u'
Atte' IN PU131:. PLAC&S - P IL 270.000.4,45-000 14-5s d1
Xuet�t-1�!f`£MZI(.`.'',D.W?1, AND PI -.A1<1 Z,' !!Cr,
rJ
,`�A,293._s4
i1 1X3,9 1ITF-PAID.F.U15
Wo,ocl
,r
APR 0 5 fl TtT.rAL Runvirl' rxvs, :01.w .mow
RECEIPTDATE
BY
DATE FI LED
INS EC OR
OPERATION
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 4al 7
Ducts
Slab Grade 6
Return Air
Steel
Combustion Air
Roof Deck Q'
Exhaust Fans
O.K to Wrap
F.A.U.
Framing / _7
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
Final
Final
BLOCKINALL APPROVALS
POOLS - SPAS
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 44 4ZHeater
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 i p
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)
COMMENTS:
a arm
0 0Certiricate of Occupancy
too
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: 81-937 COUPLES COURT
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-366
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BIRDIE HOMES, LLC Address: 5 E. CITRUS
City, ST, ZIP: REDLANDS, CA 92373
By: GARY HARTMAN
Date- JULY 7, 2005 T,
Building Official
POST IN A CONSPICUOUS PLACE