0403-369 (SFD)' LICENSED CONTRACTOR DECLARATION
1 hereby 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, j ! Exp. Date
Date °"r Signature of Contitracto,tl-16
[ 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).
( ) .l, 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..
(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:
Carrier Policy -No.
S1'A72 YUN.D 46.03-"33
(This. section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California,' and agree that if I should become
subject to the workers' compensation provisions gfjSlection 3700 of the Labor
Code, I shall, forthwith comply with'those•provlslo. soy. J
,Date: 4 /�J�4. APPhcant-� �' %$*
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2: Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of "issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information J
correct. I agree to comply with all City, and State laws relating to the building
construction, and, hereby authorize representatives of this City to enter upon
the above-mentioned property for -inspection purposes. ' n
Signature,—(a 4)f l- �.' •_ �'- ^"^"" Date `; f l)
BUILDING PERMIT PERMIT"
DATE VALUATION LOT 661 CWC'3-,169 TRACT
JOB SITE
ADDRESS
APN
M-90 N'W:€:,LLGE DRIVE
7254-V50-029
OWNER
CONTRACTOR / DESIGNER / EN (NEER
3yIRur,= -[r3:�a".f s 111, LLC
F1 PZr wcIF,C1, Dr. VM. opa"e2Fjgr CC rw,
-5 F, G11RUIS AVa ',Y_rR 205
.11; C!`9. US AVE STE, 205
REDLAIT.DS" CA, 92473
REDLANDS NDS 0%. 6+237S
(91))793.3688 G'i310 4911
-
USE OF PERMIT
�i�� f31:ds I11' S' Dl1U�.S �i1r.�
ITq'{�C1(i��1ae 1�L"��T :gTgi�+�f,''tL.U.pD�F, BIX)C�Kyr
Y.�•C2T 69p1�1�.)2� N
yS,ry1y?O,, �;;q.��,yY;fPSC;f��+..ry.P{�'vgi'.I.+. •� spy ��q
X�7.P�UL, 1004 SPA OR -MI F.•WKl .!AY-.4tl(',ACR.'?$Vo REDU(, €O R•!� l�/,C7.ft:-9 �
CHECK FEE FOR. MULTIPLE, ISSUANCE. OF SAMZ PLAN TYPE.
CUSTOM CONSTRUCTION 4,020,0€1 SF
PORCHIPATIO 1,044.00 S9'
f
c8 i Ass MAMi `€ X0,00 X71'
EU A LED COST CYF C'O)?T6";5RETC:,1.T:OT4
341,X1.20 .
'rIRTIMIT ]PIM Si:iM'ltls. ZY
CONST RUCTION FEE 101.000-41£-000 $1,48cs0
PLAN C H&C.�K FILn;. 101 _000-09-31 $105.0$
149CHNNICAL FEE 101.000-A21-000 $163,00
: LECTIUC,AL FEF 101-000-42.0-000 .$2311.90
PIA3,410W.4 FEE 101-000.4.19.000 S22V1:5
STRONG MOTION FEE . RMSID 101-1)00-'2.�J I -WO $:34.14
GRADING € EE J.01.000.423.0011 $15.00
a7E:N'L.J,011-E, IMPACT FEE,
,Eal f rN -PUNLIC PLACES - €L 2''10.000-445.000 $353IM
.1U8-T0*KA T,fWW1.T, RT,!'Cf1014 P.M PLAN 0-MCK
$5,228.63
s' .4 Y�-93 T1P T.;k1.d 1D 11,=' 3
�Q, 00
APR 0 5 �Q� 61
CITY OF
r�
FL'a�A_NCE DEPr.
�D'ATE
RECEIPT
BY
DATE F LED'
INSPECTO
111
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs �
Underground Ducts
Forms & Footings �-1
Ducts
Slab Grade 2 a Q
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingZ a
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /D /{ o
Drywall - Int. Lath
d D liS�
Final
Final
BLOCKWALL A PROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _
Heater Final
Water Piping (O
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final /
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) i
COMMENTS:
.JON TAN YI�.
'78-194 Etenbrook Ct. '
Palm Desert, CA 92211;
Office (760) 772-7192
R 11114 11
ER
Fax (760) 772-7193 `
Pager (760) .776-3338 p•
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF0
c
REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY • 0 5+��
THER
INSPECTION
0 POST TENSIONED CONCRETE 0 ASPHALT
"
PERFORMED
0 R INFO CEO MASONRY O FIRE PROOFINGV
V�
JOB IOCUWN_
Sb
pool
/
OJ &A'
REPORT SEQUENCE NO. ,
DA
`
DAY OF WEEK ..
•
PERMIT NO.
TV EU� � A r
CTUL Cr �+�•rYK
AR MITECT - -
MATERIAL DESCRIPTION
INjJ$(1,-�_
MRS. CHARGED
EIi'8 FEW-
ENGINEER
ASSISTANTS
r
HRS. CHARGED
INSPECTtOJ1
GENERALSUB
B/�1TL ICA, CONTRACTOR -S A� ` �7 KCrK ti
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DATE. . �,
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_ ^OONTRACTOR
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COPY SENT TO CLIENT O
COPY
CONTINUED ON NEXT PAGE.0
PAGE OF
4
CERTIFICATION OF COMPLIANCE�.►�—
I HEREBY CERTIFY THAT 1 HAVE INSPECTED'TO THE BEST OF M'1 DS(G'07�TU RF OFREGISTERED: SPECTOR
KNOWLEDGE ALL Of THE ABOVE REPORTED WORK UNLESS OTHERWIS/' O� L
NOTED. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED co L J
x. PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE 6ATE76F RE ORT REGISTER NUMBER
GOVERNING BUILDING LAWS. w ^ _
May 27 05 .10:54a THE PALMS 7607771965 p.2
>� CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT I
�F^f
OF Mt�w . - ,
777-7012
INSPECTION REOUEST LINE
-777-7153
Owner BIRDIE HOMES 111 LLC
Contractor�mer
Permit Number 6
POST ON JOB IN CONSPICUOUS. PLACE
INSPECTOR MUST SIGN ALL APPLICABLE.SPACES
JOB ADDRESS 56-905 VILLAGE DRIVE
SFD, LOT 69 PLAN 93AR-C2. PERMIT DOES NOT !
INCLUDE BLOCK WALL, POOL, SPA OR
DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING I WASTE
U/G ELECTRICAL I GROUNDING.
FOOTINGS / STEEL
CONC E SLAB
/fes'
DO NOT POUR CONCRETE ONTIL'ABOVE SIGNED.
ROOF NAIL/ PRE -ROOF"•
OKAY TO WRAP " .
F FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING l
ROUGH MECHANICAL
INSULATION Za
COVER NO WORK UNTIL ABOVE.SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST _
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS {
FOOTINGS / STEEL
BOND BEAM
POOL/ SPA /WATER FEATURE INSPECTIONS f
PRE-GUNITE / SETBACKS
U/G PLUMBING'.
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
e COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED j.
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
k - Certificate of Occupanc
oY
�.
�,
$ilia
_414
4A
V"5
la
OF Building & Safety Department
V
M4
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
11'4
Code, certifying that, at the time of issuance, this structure wasin compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
;T
BUILDING ADDRESS: 56-905 VILLAGE DRIVE
JC
1
Use classification: SINGLE,FAMILY DWELLING Building Permit No.: 0403-w369
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
City, ST, ZIP: REDLANDS, CA 92373
By: GARY HARTMAN
Date: May 27, 2005
Building Official
V
POST IN A CONSPICUOUS PLACE