0408-370 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
p 5 Ch License # Lic. Class Exp. Date
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70-01,"41 13 � i, jlr 35 1. 105
Z Date Signature of Coniractor
J U CID 1 OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
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).
C0() I am exempt under Section
LO B&P.C. for this reason
„ C\; Date Signature of Owner
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.
(V) 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:
Cartier Policy No.
9TATE FUND 46-040.03
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply -wit hose provisions. f,
"IDate: K/ Applicarit � r 1 \�a _�1 i t - A
r •
Warning: pailure 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 4the 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
theabove-mentioned,property for inspection purposes.
Signature (Ownsf�Agent);�_A -U. - A; 1,1 Date 94 %`'� 1 r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ;! fJ!1ik�• �� �� TRACT
t'1N"Qi R��J d�.rE.t➢
JOB SITE
APN
ADDRESS
811.4802 COIfi' EPS COITh-''E
OWNER
CONTRACTOR /DESIGNER / EN INEER
MURK HOMES I t 'I , LI -C,
r R f,.1.CRU8 A.1TE• rlis 30 5
3 L. 'r`1•.ITMOV, AVE, des';
bK0,,LA'WDa C1A 92313
PiEL5.L.sVRDS (",A 923'6
(pUcf�7rw,�?fi SLY 4311
USE OF PERMIT
S r, Lt'JTi2 PLNN 5A -C'2 . PEIr.Ir111' DOES NOT INCLUDE 4LGtCK WALL.
POOL% V PA 011, 'QRIVEIVAY APPROAC t1. Ts% IR. FDUCT 10H TO P{.,AN C1 I Et K
FRE; FOP MULTIPLE iSSUAITCE OF P.Mtr PLAIT TN PF
CUSTOM 00NIS'I'IILI; TY)N 1011F
QAt" &OWC'AEt.€'O R T In.fnJ IF
0081,11 0L' `.��A[/7�,Li.YJ�'�itid1R
w:r'V �•P,TtJ�,1�r UY .
CONS TitUC 1`IOW FLEE V) -•a 1€3.000 S!,496,50
FL.&'td CHECK FRY, i+al 30
MEC14-A1,11 AL .FEX SI6110I1
211I ;`i'RIC%4 f.. 1769 90
ILUMP0'R,iI Irt E 10 1 -0001 419.009
STRONIJ MOTION FEE - ItEMD 101-000-241-000
(R1,kDW(J FEE 1014WO-421.0 0 $€4.00
DEVELOPER' !IMPACT FEE $4405.00
ART 114 PUBIAC. PLACES - € ESE 270„000-444-000
(,?'r_.'ITCf'ND PIAMI C11E, i:,,t<.
$5,229.63
n r `(I PaL k'ER11 T1.' ly MS DATVOW
U1 F
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RECEIPT
DATE f
BY
DATE_FJN ED
INSPECTQP_
66
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CJJ
wI
NSPECTMN RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
a
Return Air
Steel
Combustion Air
Roof Deck
p
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
7
Compressor
Insulation
J z a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
6
Drywall - Int. Lath
/
Final
Final
POOLS - SPAS
BLOCALL
APPROVALS
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
Heater Final
Water Piping
Wml
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
O-7 D
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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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).
REGISTERED INSPECTOR'S WEEKLY REPORT
BON TANDY
78-194 Eienbrook CI~
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE ICT. STEEL ASSEMBLY 0 5+jo e
0 POST TENSIONED CONCRETE 0 ASPHALT HER
17 REINFORCED MASONRY 0 FIRE.PROOFWG
� �.r.. t. t T4 '
JOB l 4 p -a,- Co
(O
REPORT SEQUENCE N0.
TY (IUCTU�.! ��
R
PERMIT NO.
OA
DAY OF NfEEK
MATERIAL DESCRIPTION
3
AR ICT
NRS. CHARGED
L-,? IT- VY a �r
a• i'GENERAL
ENGINEER
ASSISTANTS
HRS. CHARGED
DISPEliT10N SUB
DATE CONTRACTOR L CA pi�� -la
WF CAL•s
L•A.G cpo I.ue-
COPY SENT TO CLIENT Q
CONTINUED ON NEXT PAGE '0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALLOF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
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(jV4GA' TORE OF REGISTERED PECTOR
4)4 oq-_ o C.0a47S'o,
DATE dF RE RT REGISTER NUMBER
Certiricate of Occupancy
,� L�carec+hn 4.
OF IBuilding & 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: 81-802 COUPLES COURT
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-370
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: August 4, 2005
Building Official
POST IN A CONSPICUOUS PLACE
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