0403-371 (SFD)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
H apter 9 (commencing with Section 7000) of Division 3 of the Business and
C4 W Professionals Code, and my License is in full force and effect.
p ch License # Lic: Class Exp. Date
ti Wr 7
117F�f'ft
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Date Signature of Contractor _ _
L) tp OWNER -BUILDER DECLARATION
~ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
J
~ V) 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&P.C. for this reason.
to
N Date Signature of Owner
0�
a< WORKER'S COMPENSATION DECLARATION
C) Cr I hereby affirm under penalty of perjury one of the following declarations:
Lo
N 0 () 1 have and will maintain a certificate>of consent to self -insure for workers'
X W !�: compensation, as provided for by Section 3700 of the Labor Code, for the
00 J Q pe{formance of the work for which this permit is issued.
Q 0 (11) 1 have and will maintain workers' compensation insurance, as required by
O 0 Q Soction 3700 of the Labor Code, for the performance of the work for which this
d LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cb O KATE FUND 46.0-5,353
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
subject to the workers' compensation provil§ions df',Section 3.700 of the Labor
Code,lI Mil f¢rth ith comply With lthose provipio
�.Date:l ld Applicant_-.�..i�
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 person at
whose request and for whose benefit work is performed under or pursuant to
�1 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 hereby authorize representatives of this City to enter upon
ed property fp�,in
the above -men Iohspection purposes.
�) r
�Signature%,t) Date
`(UwneVAgen'� ` `= "' -^^ ae /
r� a + J
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
7
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Eark.ral.11O1lR s i.1 1,
RE OTPAC'TrICA T)RVF,3.0P;,,il:.'N r COPP.
5 E, Mri'MI: AVr'• F .; 2015
5 x. M7'1r:ITO."•.lVE, 205
RFDI: ANDS ICA 92313
R'[T).i iO.11X's 923173
(909•,)98 688 1
USE OF PERMIT
SIN), LOT 13€II,AN IAR.C1 . P1?J2L!1T DOES tJCi'f IPJC'LLili� Bl�iS�'ii'V+1ALl�
P001-4 ,113_. 013 DRIVEWAY APP O�MIJ.
t:M`{'OM CON:STRUC'tICYN A742,00 SF
F(Vi:3RIPATiCt 637.00 SF
1r�.i'.fNT,�'1'I�`.!� �34>S'1° <T1�' �`�?.�1'+'9'�17'(.'`�'[�:+fd
,yp •�,2.s.5,:faii
P"I, Mill, PER "U:(V mA R'd
CONSTRUCTION F -RE 3 01 _0001.4.18.000 $11192100
PI .A -W CHECK [+•P..kr 1Ji l�i')(DYh3g-31b �t,1d3.g3
MEC.H-011C'AL KE 1i1•f74l1�121 OClOJ $19b.f141
E1XrC TRK1,&L 1:1 -r -E 1 i21-C[3F) 2G-+Ltt>� $32S.�Jl
PIrL1W.%10 V F,1g. 101-000-4 19-000 3216.71
STRONG MIDT ION EE , R.L,UID 101-ODO-241-000 $33.43
tliIAiJ1'1'I0 VET 101.000.423.0041 $.M00
,D V'kbSLOPER 1MRA.CT FEZ $' 443.otr
ARIT tN 110BLIC'' PLACM - .MIL 270-000445-000 S10.0
£31 B-* fX AL,120N0'.t ITf TIS'" N A >3� PLAIT s HE 'K
'call PF.€zrATV FKEN D1` F .ti fCD'I!isO
APP 0 5205
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CI ' Cr 1:1•:
RECEIPT
DATE
x ri ' �
BY/
DATE FI LED
�/ /
INSPE
ip
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANCAL APPROVALS
Set Backs J,
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 2 o
Exhaust Fans
O.K to Wrap Zli
F.A.U.
Framing 11 f
Compressor
Insulation J 05
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 6
Drywall- IM. 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 Pibg. 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 Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
C�O AMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY r
78-194 Elenbrook Ct.
Palm Desert, CA 92211 *�!�
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE CT. STEEL ASSEMBLY 0 5,fo
0 POST'TENSIONED CONCRETE 0 ASPHALT' pTHER
0 REINFORCED (MASONRY O FIRE PROOFING
JOB LO
�-�' 1 ' „�.. t. AU rA
I/VI � t
REPORT SEQUENCE N0.
?Y Q� "TUQE , T 1 � s) � _ 5 PERMIT No.
I`I—/�� (-��
w 6
PJf`
DAY Of WEEK
MATERIAL DESCRIPTION ARCHITECT
1
•
MRS. CHARGED
,� F'c�lkENGINEER
�tT- S �-
ASSISTANTS
MRS. CHARGED
IMSPGENERAL SUB
CONTRACTORor
DATE CONTRACTOR •i�+a C A COIrTM1CTOR A �► it
(9 CAVUS
AeAe
COPY SENT TO CLIENT 0
CONTINUED ON NEXT PAGED PAGE OF
CERTIFICATION OF COMPLIANCE
1 HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
r1
ATURE OF REGISTERED 49PECTOR
ATE OF YEPORT REGISTER NUMBER
Certificate of OccupancyV,
V
OF 9
.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.
LL1
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BUILDINGADDRESS: 81-816 COUPLES COURT
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Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-371
Occupancy Group: R3
Type of Construction: VN Land Use Zone: RL
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Owner of Building: BIRDIE HOMES 111. LLC Address: 5 E. CITRUS, STE. 205
City, ST, ZIP: REDLANDS, CA 92373
By: GARY HARTMAN
i
ha'kt
Date: NOVEMBER 17. 2005
Building Official
POST IN A CONSPICUOUS PLACE