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LICENSED CONTRACTOR DECLARATION
I Fteo*by 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
",c r4 1sem 3/ /05
Date Signature of Cont(ax ," :? ., - - _ - ; l -,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) I am exempt under Section , B&P.C. for this reason
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.
( ) 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.
(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, 1and agreg,dhat if I should become
subject to the workers' compensatipn provisions of Section 3700 of the Labor
Code, I hall forthwith comply wip those prbvisiorisi f lj
Date: !� 1 //' Applicaht
f 77
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
whose request and for whose benefit work is performed under or pursuant �'�
any permit issued as a result of this applicaton agrees to, & shall, indemn' ' U1
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and Vol
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati n.
I certify that I have read this application and state that the above infor'matio is
correct. I agree to comply with all City, and State laws relating to the',buildmg
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertylfor inspection purposes.
l �
Signature,'(OWk e_r,(,Agent)•th ' r
Date I�
I
BUILDING PERMIT PERMIT#
DATEVALUATION
LOT TRACT
IT
JOB SITE
APN
ADDRESS
14 -tY) i QQ1f .*f., ''.S CCWRT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
iV BT T'ACU -XA
5& C'T i 1fa1 AVE INTI', Z05
,i K EMUS AVE. PTF? 205
REO r414LJS ('A 925M
1i1=:^t LAMMS t,A 9:t37_<
(909)798-; 6999 C-MIr0 4911
USE OF PERMIT
INGI i, TeKiViAly Dw'1. I tdCl
51701, LOT1 Pl.�PV 2CR . 14 11 ' IT f.)0&13 td JT IN " )E EILOC=Y: WALL,
KY01 + .l A Olt DRIVEWAIr APPt1ftM`H.
C{+Tri57`S:.tC'IIQN
CV2'T')9t1JF
13D.:i .:,r
�3T?.C:t3JPt�.1'fU
`''�fl.f�t1 tilt'
L. L"±vTC
,e ' `W t n" IRM -MON
xK59;"!40
C044SVIT1C ONf!FT nt
R..lfjt. �' ptert0
Mb.:I-l:,hIWALf+Y,,, )0'1 •
c CIO "1'"7.00
ELL C"s'Fil. !iL l'rL i kt t -G
44 .�G-00r,
10 FL 101•
� )aUt�++
s` ryN+� T�9G7�tvs`f ft . R.&"fD 101
100 JAC
(1), 40 Mf Its`'
-41�Uo
)FV EL uli. RC v k7,E
ZOS95.Vo
(W F. L Ito, .
'1Vrf $91144
7i 'iiti
INSPECTION RECORD
1 OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 8 d
Ducts
Slab Grade 2 p (p'
Return Air
Steel
Combustion Air
Roof Deck A
Exhaust Fans
O.K. to Wrap c
F.A.U.
Framing
Compressor
Insulation - , p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath p
Final
Final
P®®LS a SPAS
BL®C WALL 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 0
Plumbing Final.
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection L
Encapsulation
Gas Piping
Gas Test
Appliances
Final
C®,WEDITS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures 4-114
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
• s
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
PERFORMED
D REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY OINSPECTION 0 POST TENSIONED �
ASPHALT
RETE 0 FIRE PROOFING 3w
DRE REINFORCED MASONRY
JOB LOC
' T�
COU`
REPORT SEQUENCE NO..
TY EUCTUpE O I '�
PERMIT NO.
D O
DAY OF WEEK
MATERIAL DESCRIPTION
-�
ARCHITECT
1
•
MRS. CHARGED
_— ''07 tT
�;,4)-
ENGINEER
ASSISTANTS
MRS. CHARGED
INSPECTION
DATE
GENERALSUB
CONTRACTORor wtrg•.C.A COF,TR,►CfoR. -•S ASI e b iw
(Ares 3 wadm eS Szu e-& ;.
LAJ
�-d� ��U'L. � ih oN 1•ro
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COPY SENT TO CLIENT O
CONTINU D NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
IHEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
�r
S NA RE l F REGISTERED INSPECTOR 1
O ���d7S
ATE E REP RT REGISTER, NUMBER
100
0 Certificate. of Occupancy
OF Building & Safety Department
er
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: 81-997 COUPLES COURT
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-361
a f
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BIRDIE HOMES 111, LLC Address: 5 E. CITRUS AVE. STE. 105:
w ;
City, ST, ZIP: REDLANDS, CA 92373
By: GARY HARTMAN
&J.
Date: JUNE 14,2006
Building Official
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