0403-373 (SFD)LICENSED CONTRACTOR DECLARATION
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
N W Professionals Code, and my License is in full force and effect.
E; =) M License # Lic. Class Exp. Date
QLLJ r I Al
ti X �? ' 041 I ri f ; (t ( '� � 13 I lvd
II; Z r Date �+ Signature ofCoritract.jr .r .t /^�f ti
o I, q
J U coo r OWNER -BUILDER DECLARATION
WWW I hereby affirm under penalty of perjury that I am exempt from the Contractors
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 oroffered 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'') () I am exempt under Section , B&P.C. for this reason
In
N
Date Signature of Owner
OC4
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.
I(/ ) 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 Policy No.
r, 'r1s FtalD 16•05-
(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 workgrs' compensation provisions Of Section 3700 of the. Labor
Code, I a( f0�th comply wit those provision.j% j
Date:: ? Applicant's
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 attomey'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 applicator 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 r
permit, or cessation of work for 180 days will subject permit to cancellation. I
I certify that [,have read this application and state that the above information is 11
• 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 iris) ection purposes. ;
n�..-c_� Date
Signature (O.wne �%Agerit) !:fig ar ' I • %� -�-� J j �r� i
�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ' T TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/ DESIGNER / EN (NEER
BIRDIE 1101% '9 t 1 1, LL r:'
5 E, CITTRIJ0 AVE ME 205
g L. M-RUD AVE, :'fig., '05
C.A. 923 i`:3DJ,.r
I!IGD +:;.,k 1237:1
USE OF PERMIT
01
FFDLOT 15P.I—.,14IIN...PERMIT DOES NOT INCLUDE iLOVIC's:_tti
POOL. SP -A OF DRIVAmE0e rPnT10A(Ifi, chl% cVDVr':'IQ,W.) PIAN r1FOK
TE C+R-MULITPLE ISSUANCE (%FSIUWK PLAN TYPE.
t'UOT(l'6 COMit:TRUCTM4 zssf . o S,r
f'UFt.CrilliiA�'IICi alz+.0f SIF
t�t�f<.r�t1I1(`AI'�F��1I:T 1464,€10 SI.
F5'ETIe'1AT.'I.} ("OST C'iF
91
C:OWY1•tkDCTJOP PT,% 10 j -000,4115-000 ROMA)
PLAN CHItCK i;wz 101.1000.439-318 1 dk7i,W
M EC°R,i' 14TOAL H E 1071-(.100.4121.000 $io.P
k:Lit ' I'VAC'AL I*`ES 101-000-420-000 $ 185,
P4_,U)MI311401 RE --it )V1-000.4'19.000 R1?1it•5
S-fR.)WO i�iC.:Tlllld f'IWE- Ftf?Slii }U1-ii0Ci-2-17-C1()U 9 Ii.0"I
t}R.A.1DI:AI(j W
VL*1rE1PEA IIylPAC°f FEE 11�,4f1 .(►Et
AKIC 01 PUBLIC PLACES - R r 11270-000-445-000 $45,'00
CIWJTTRUT("TIOM ,AND F'T..N_ CAIFO-!i
'LFESS 1„R,V T'AT_-D I :`J
901.U0
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APR 5 2004
CITY OF LA r,.,uiRTA
Fri'.".,;,a^E: G.DL-P'T.
RECEIPT
DATE
BY
DATE F D
INSPECTTORRy
l/
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade Y7 A
Return Air
Steel
Combustion Air
Roof Deck p v
Exhaust Fans
O. K. to Wrap 410
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 i
Drywall - Int. Lath / Z:
Final
Final
SLOCKWALL 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
PLUM91NG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping Z Yllf Y,
Plumbing Final
Plumbing Top Out
Equipment, Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 2 p
Encapsulation
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
U014 Notice (Perm)
COMMENTS:
�� Certificate ®f Occupancy0
o
OF 9w 9► Y p 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: 81-844 COUPLES COURT
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-373
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
_mob By: GARY HARTMAN
Date: August 4, 20.05
Building Official
POST IN A CONSPICUOUS PLACE