0403-367 (SFD)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
N W Professionals Code, and my License is in full force -and effect.
G M License # Lic. Class Exp. Date
U) Y 60044 60 �1311055
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Z ti Date Signature of Contractof//'� r - �`, +
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U OWNER -BUILDER DECLARATION
Hd 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 const*t the project (Sec. 7044, Business & Professionals
Code).
Cf) () I am exempt under Section B&RC. for this reason
U')
N Date. Signature of Owner
ON
d d WORKER'S COMPENSATION DECLARATION
o Cc I hereby affirm under penalty of perjury one of the following declarations:
r H O () 1 have and will mailitain a certificate of consent to self -insure for workers'
X UJ compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit'is issued.
r>7 Q (� (I���j I have and will maintain workers' compensation insurance, as.required by
D U Q Sebtion 3700 of the Labor Code, for the performance of the work for which this
Il H permit is,i� u t.l�lyE r rkers' compensation insurance iTjfgylicy no. are:
Z Carrier Policy No.
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g(This section need not be completed if the permitvaluation is for $1.00.00 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 workers' compensation provisions; of Section 3700 of the Labor
Code, I s all foohwith comply with{those gravis vns.
Date: / ' .n Applicant Eli 10 l i 1
Warriing: Failure to secure Workers' Compensation coverage is unlawful and
sl al(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
& 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 fai,inspection purposes. /
ignature-(0.wnerk4gent-'��-_-�-== -Dates-a�`
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BUILDING PERMIT PERMI�Ttn}ti4�'f
DATE VALUATIONLOT TRACT }
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ADDRESS'
OWNER "'
CONTRACTOR/ DESIGNER / ENGINEER
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RECEIPT
DATE
BY
DATE FI ALED
IN,SPEPTOR
_/ '-'«
f
off.
(o/
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Lc! Q
Exhaust Fans
O.K. to Wrap
V114 491
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
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment_ Location
Underground Electric
Underground PI . 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 Voftage•Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final�L .
Utllfty Notice (Perm)
Certir'Icate of Occupancy
G 0F9 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: 81-917 COUPLES. COURT
=
Use classification: SINGLE FAMILY DWELLING Building Permit No,: 0403-367
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BIRDIE HOMES 111, LLC Address?'6 E CITRUS, STE. 205
City, ST,. ZIP: REDLANDS, CA 92373
_ By GARY HARTMAN
Date: JULY_ 26, 20.05
Building Official
POST IN A CONSPICUOUS PLACE