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0311-203 (SFD)I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 1000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 760044 B 3/31/05 Date Signature.of Contractor 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 astheirsole 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 STATE FUND Policy No. 46-034353 (This. section need not be completed if, the permit valuation is for $100.00 or less). O I certify that in the performance of the work for which this permit is issued, 1 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 with.those provisions. Date: Applicant 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-mentioned propeity for inspection purposes. I Signature (Owner/Agent) Date BUILDING PERMIT - DATE VALUATION LOT 0311-203 TRACT $218,083.30 .64 28983 JOB SITE ADDRESS 56-765 VILLAGE DRIVE APN 764050-1M OWNER CONTRACTOR / DESIGNER / EN &NEER BIRDIE HOMES 111, LLC FIRST PACIFICA DEVELOPMENT CORP. 300 EAST STATE STREET, STE 100 5 E. CITRUS AVE, SIE. 205 REDLANDS CA 92373 REDLANDS CA 92373 -(909)798=3688. _ . _. .. CBL# 4911 USE OF PERMIT . SINGLE FAMILY DWELLING SFD - LOT 64, PLAN IA. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION 2,550,00 SF PORCH/PATIO 483.00 SF GARAQEICARPORT 664.00 SF ETED GOSTOF CONSTRUCTION 218,083.30 PERMTr FEE SUAUAARY CONSTRUCTION FEE 101-000-418-000 $1,056,00 PLAN CHECK FEE 101-000-439-318 ,$$87.17 MECHANICAL FEE 101000.4:21-00.0 $163,00 ELECTRICAL FEE 101=000-420=000 $155.03 PLUMBING FEE 101-0.00-419-000 $180,50 .,STRONG MOTION FEE - RES1D 101=000-2417-000 $21.81 GRADI'NG FEE 1 CQ -000-423 -000 DEVELOPER IMPACT FEE $2,405.00 ART IN PUBLIC PLACES - RESIL 270-000-445-000 $45.21 SUB -TOTAL CONSTRUCTIONAND PLAN CHECK $4,958.72 LESS PRE -PAID FEES $0.00 TOTAL P—r-R T FE'S DUE NOW $4,958.72 RECEIPT DATE BY DATE FINALED INSPECTOR >� LICENSED CONTRACTOR DECLARATION '- �I hereby affirm under penalty of perjury that fam 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. µ'License # Lic. Class F i Exp. Date ..w_ `�. i '► 611105 ,;.Date + � � Signature of Contractor 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 CodeyY ( ) I, as owner of the property, am exclusive) contracting, with licensed contractors to construct the project (Sec. 7044,O)Business & Professionals _ Code). fin O I am exempt under Section B&P.0� this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION s /, I hereby affirm under penalty,,of perjury one .ofhe following declarations: () I have and will maintain a certificate of consen to self -insure for workers' compensation, as provided for by Section 3700 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: Carrier9�,.,VZ FUND 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, 'arid agree f that if I should become subject to the workers' compensation provi ions of'Section 3700 of the Labor C den'I'sh f f hwith comply wit those p`dvlsions t ,.Date: ([ !) Applicant f. �• �- "��" ".°'« Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and 'restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit -issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with -all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above -mention ed property for inspection purposes. 1 Si nature OwnedA ent _�=-- DateT� BUILDING PERMIT PERMIY# - LOT TRACT DATE VALUATIONQQ� 9q pp �qq}}�� .'77;� qQ{�•—� yppflp JOB SITE APN ADDRESS KSC�iY� 764 -WO -002 OWNER / CONTRACTOR/DESIGNER/EN (NEER n=ar, 'i omyus.1 i I. LTA' W(r!r STPi7 ET, S I`_F; l OD- 5y�cc���,gq4'��AlE�1R,.pYM ��VR Ste'-: 205 •30•0rr••R���/:�a�.,`51�.��;' �4 q. .�G.LDL1�56V2 S CA 9 373 S5.>�.Llt.nf'fNDS (909)M-3688 C, V?. 4911 � USE OF PERMIT ie SWGIT-F FAMILY X DV L SFIJ - LrJT 64, 1'l,Ald IA. F, 'r'r,)OL?s NOT 114CLUTIE )MACK A- WAWI P004SPA OR D1UVjY`vV1��t �OF°l�l$C)faC"•(s %'' / CUS11*0M CONSTR ION 3,5$4,40 SI? PORC.'WP-A11O.`! .OA sli, CIARAG:'.FW .13:PORT tlf ,atl8? : SIU91A D CO'ST OF C4D.1aLaMUC:€3<27.i`F �'A#Y,t3N� 3Cb B FZ W. lb TF, SLTI"SA.RV C.011l3'1`AVICTION FRS PLAN C;HWK MIF 101-000-4 39-31 `dw&WJ i MECHA141t; AL FEE .101-000.42, -000 $163.00 FLEC TiZIC 1., FM 1.01-000-420-000 $185.113 PL,t7Rff13RIG YME 3011-000-419.030 100.50 STRONC9 ft9CiTION .IMF, > RESID 103 -000-241 -000 $21.81 OlZrADF140 VEE 101-000-425-000' $15.00 Y3:1?V'::id..0 PLR 7,FJfP.ACT IVZF, �s�lOS.i10 ART IN .?1.1iLIC PLACES - RESI 270.000-445.000 50,21 S%dS3-V YIQL OMO ,3�°t'' U'0` fC?l� A�37a ] T. 13 f:Ii(?C:eC14,958.72 p 1'�1' 3S iTCrPAID 1'RIKS D R h.0. i 7 :. � F—?iSi�H Y &S 1ATE laV O L'V t8 gi7W ° 7.G. DEC 0 5 1003 CITY OF LA QUINTA FINANCE DEPT RECEIPT DATE sr• ���`''� �� �.. � BY ''' �' DATE FINALED O�13°iso INSPECTOR • t- r 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. Framing Compressor Insulation JeB 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 BLOCKWALL P ROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I I 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 — D. 4Encapsulation Gas Piping LZi Gas Test 7 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: REGISTERED INSPECTOR'S WEEKLY REPORT JOtV TADY 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 O STRUCT. STEEL ASSEMBLY O 1i ICA. O POST TENSIONED CONCRETE O ASPHALT O OTHERu}� O REINFORCED MASONRY O FIRE PROOFING JOB LOCATION A G�`kTA L REPORT SEQUENCE NO. TYPE,!Fe E �O tt / PERMIT_q�0,� _ P'®rte fS OAT Q DAV OF WEEK MATERIAL DESCRIPTION ��RS a ARCHITECT•4J I P I� HRS. CHARGED /QS ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL S�d LG SUB DATE CONTRACTOR _ CONTRACTOR AU JI - ()&S e -e LA -D8 A C I t olp-e- U-) It 1401 K rks �An, s COPY SENT TO CLIENT O .'CONTINUED NE> T PAGE O 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. ATURE OF REGISTERED INS" CTOR E OF REPOR REGIS NUMBER i art -Cert�fica to of. Occu p y• _anc , Q a r r + � ` •_ 'r ' �� Lco�otws ��` _ •'k � , :►f - �c- .• - ' - • ` .. t - T '. a ._= ,_ ..�.. ..a y 7 �L - „� ^�� . ,.•Err V OF T�' Bu1Id�. ng & SafetyDepartment p _ _ -This Certificate is issued pursuant: to the requirements of Section .109. of the California Building 'q ' Code;,, certifying' that,°ate the time 'issuance, this ''structure' was .in compliance with the .:of provisions of 'the .Building. Code _ anal the '"various' ordinances ;of.,the Cit_ y 4regulating ' building .. construction and/or use. 'BUILDINGADDRESS:56465 VILLAGE DRIVE`,, s -`- Use.cIassification: SINGLE FAMILY DWELLING . '� .`' - : - ,_ Building a'ermit No.: 0311-203; ; -Occupancy Group:=R3, - - 'Type of Construction; V -N :, Land -Use Zone: RL Owner'of Building: BIRDIE HOMES 111, LLC - ' ' ?" ° Address: 300 E: STATE STREET, *100 , City,;ST, ZIP:--REDLANDS, CA'92373 • . - •.� - = _ , By STEVE,TRAXEL _ `' Date:OCTOBER, .14; 2004 ` r, _ Building.Official, .r _ ,_ ....: . . 616 'POST.INA CONSPICUOUS PLACE • "°` . t