0311-226 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
O n cn License # Lic. Class Exp. Date
LU 70044 ' I, I `t' 3131103
n lX 1 rt ti 1,
i�
cZ r --Date 12-21-�1 J Signature of Contractor ' A
000n
�
U C> OWNER -BUILDER DECLARATION
W Wan I hereby affirm under penalty of perjury that I am exempt from the Contractor's
co 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
Cf) () I am exempt under Section , B&RC. for this reason
LO
01 Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
r
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.
(�,) 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 STAT>L1! FU14D Policy No. 46-0 053
(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 workers' compensation provisidnslof Section 3700 of the Labor
Code, I shall forthwith comply with those provisions... _ -•r
Date: -� ", APPllcant • -'` i'' . j„'
--
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided rfor in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter, upon
the above-mentioned property for inspection purposes.
Signature (OwnedAgent)'�- _ '% I5� �^^ ' Date
BUILDING PERMIT PERMIT#
D11 t Z'
DATE VALUATION LOT TRACT
'9 Y.40 74 Ttl�?H
JOB SITE
APN
ADDRESS 81-9.14 C' OTIFUl S L'.C,YT_ rcr
764•060411t$
OWNER
CONTRACTOR / DESIGNER / EN (NEER `
RitU.mM %il;:u.711.tlC
15IArVi�A._i'7j.k:vl1'►�9k1\l��c.�ii�.
i;lEtr,
rl^eA(TER M6idn7,, -
c111aL�MS
205
rin-WfSA
y`]pi9 13
( 09)793-3668 1'r.E114 4911.
USE OF PERMIT
5F]D - LOT 79, PLAN 2'3. I'Ff7.iY IT OCIFS NOT INCLUDI? BLOCK WALLS,
POOL, SPA. OR ItiMVE, .AY APPR.CIACII. '?'SV* f:Yi'1?1.f['tnow 'i C1 PLAN ofw! 1;'
FES; DUE 767 >1 UL TiPLE JSSrlA'KCF OF 3AVIV, P! A14 TYPYK
t1JR:`f'�P.9:'.Orl�xl�tlGTi+„�l1 �,i$i3.11� �F
I'C+Itt;HNIAT10 ;50.00 114 If
0,B;R,4CTYCAR.Pt R -T 644,00 SP
P'.5r�7LM.15TI?.�1.)
P'It',RMI1' 1irfi2 RUMMARY
CO}ISPRCJCTIMIFtS, 10 -000.418-000 31,115)) �i
PLAN CHFP_K Kq? 3 UZ ttt30-d3S�:a l t4 $33`i.(f{
MFi)N-. NICA.L TeEF 101.000.42..1.000 $16.i,M
e LLC:TCZICAL VF?F 101-0 'u i-420-000 $192,78
PI'Ll MB]'N0 FF, 101-000.4.1;7.000 5127, t�
N71RO1 0 MOTION FEE - F&Sm 10 1 -wo-- 241 -ow
DEV ELOPER 1MPAXT .FEE V�i;ns.Do
ART IN PUBLIC hllACES- U1 SIC 270 -000,445 -WO $41•,49
DEC 15 2003 TOTALlr���t� :����� r�Ip�� NOW
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FI LE
INSPECTOR
ar
61-4-
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
Exhaust Fans
O.K to Wrap
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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 ConnectionEncapsulation
Gas Piping
Gas Test
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:
Certificate of Occupancy
tM
oF 9 Budding & Safety Department
F .
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: 81-914 COUPLES COURT
Use classification:. SINGLE .FAMILY -DWELLING . Building Permit No.: 0.311-226
Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RL.
Owner of Building: BIRDIE HOMES, LLC Address.5 E. CITRUS AVE. STE. 205
City, ST, ZIP: REDLANDS, CA 92373
By: GARY HARTMAN
b
Date: APRIL 8, 2005
Building Offichff
POST IN A CONSPICUOUS PLACE
-.