0310-094 (SFD)A ham, LICENSED CONTRACTOR DECLARATION
I'herrEby affirm under penalty of perjury that I am licensed under provisions' of
Cridpter 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 i Exp. Date
Date s�"l�i�?/i` � Signature of Co tractor4 44" " t ' � i -=��•r"+
c. V_
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am'exempt from the Contracto'r'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 exclusivel' contracting with °licensed .
contractors to construct the, project (Sec. 7044, •Business & Professionals
Code). :
O I am exempt _under Section " B&P.C. for this -reason
Date r ;Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of ' perjury one of,: the following declarations:.
O 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.
(). 1 -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 is$ued.,M workers' compensation insurance carrier & policy'no. are:
Carrier •t e l ;! T'i'3d'✓ Policy No. KA'e�r s tJa
(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 provisioris yof Section 3700 of the Labor
Code, I sh ll forthwith comply witR those provisions! 1, h
4ate: 1>, , ! " Applicarlt� 1 at r_.' `�S�'•.i '� ',/lt
/ 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
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
the above- mentionedproperty for inspection purposes.• f I
• � i! �
Signature (Owner/Agent). �� _ ' -L.. Date L� N)
WILDING PERMIT ;PERMIT# ��
DATE VALUATION sKfw�. �D �� .LOT . r, TRACT 2�" tS1?1
JOBSITE 1iY�r3 ti asf<'y�Gi�.�l
APN F.SgJ
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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ART rN PURLIC KsF OM ' RESIIC r?G- 003 445.000 Ufa• o.7
,
Moo
OCT 13 2003
CITY O6 '!�' OUINTA
CACI ANIr�G nr-P
RECEI
DATEBY r
DATE FINALED
INSPECTOR.,,
}}^
INSPECTION RECORD
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.
Framingq
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
POOLS - SPAS
BLOCKWALL 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
Plumbing Final
Plumbing Top Out
Equipment Enclosure � �-
Shower Pans
O.K for Finish Plaster ._
Sewer Lateral
Pool Cover.
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: "
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
JON TANDY
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 ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER ep 0 yt
O REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION _ s� � p L A Q O Q n TA
REPORT SEQUENCE N0.
TYPE OF S CTyAy� / �^�O 4 ( k
CRP 6_
PERI�y) EIS IN� ^ /g
Y
DAT �e O
DAv OF WEEK
oS C q
MATERIAL DESCRIPTION ieJ y�
top
ARCHITECT
I T�
J
HRS. CHARGED
u z>
ENGINEER
ASSISTANTS
HRS. CHARGED
:INSPECTION GENERAL C_DATE CONTRACTOR:.J� 1iC l l L' CONTRACTOR
1 I #;�34GJ I Ir
US ( tA- S (w,S
_ .._....._.... _. Ul)l.✓�-
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE ❑ PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF 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.
S)§FNAUR OF REGISTERED kSECTOR
DATE OF RE RT REGISTER NUMBER
u
�-- - Certificate of Occupancy
3
Building & Safety Department
$i
OF 't
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
s
14
provisions of the Building Code and the various ordinances of the City regulating building
f
construction and/or use.
I Ix
out
BUILDING ADDRESS: 56-725 VILLAGE DRIVE
del
4 of I
i
!r
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0310-094:
f
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
1 4
i
Owner of Building: BIRDIE HOMES Address: 300 E. STATE STREET, STE. 100
;
City, ST, ZIP: REDLANDS, CA 92373
By: STEVE TRAXEL
t
! d Date: OCTOBER 26, 2004
F •"7
:
Building Official
POST IN A CONSPICUOUS PLACE