0311-222 (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 land effect.
License # Lic. Class , ` j Exp. Date
760 4
Date( f _ Signature of Con'tractor�. _
OWNER -BUILDER DECLARATION
I horoby affirm undor ponalty of perjury that I am exempt from the Contra,:tGP'a
License Law for the following reason:
( ) 1, 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 -6f the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt underSection 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 lftATR.FUND Policy No. X48 -C13 If3�3
(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 with"those.provisions. wN
Date: /.6>"•, /. Applicant._
—t ! z
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.'
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
► & hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
1 n?.dJ
1 certify that I have read this application and state that the above information is:
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon,
the above-mentioned.properiy for inspection purposes.
Signature (Owner/Agenit)L'�+�'�',`;�- • f , a+--- Date��';'?�'�
- i • • ..
BUILDING PERMIT PERMIT
I
DATE .I VALUATION LOT TRACT
42.45" � o- 3 o".11,351.20 71
42,
JOB SITE
APN '
ADDRESS %1 '1 MLaAGE DRrVF.
764-050.WW
OWNER
CONTRACTOR / DESIGNER / ENGINEER
BIRDIE t3:fiAAUS 1 11:, .LLC
MST 11AC1 ICA DE'Il'FLf31>.1� iNt CORP.
5 C1J0 AWITUB, - 205 -
It) BE CHUM A- 205
FLEDLANDS ;i. 9237.3
TaiDLA%T.C3S CA 92:373
(909).798.3688 C'T'; N 4911
USE OF PERMIT
S11?0.1k)T 7I, :PL." 3,ARJ2X!C2. PMMI-; DOES NOT INCLUEYE'BIZIC Y.
WALLS, P004 ;F'A OR J.DRNFEWAY APP110.464,
CUSTOM CONSTRUCTION •?�VXOP 3F
PORCHnIATIO IjVA.00 SP
OARAORICATt,I'Oid.4` 730.00 Sid
EF17W7J'1�D SMS!' fir+' C'.".Ofis.d'.i�fJC°9:.P:ON
34$Xw�..7.{: ,.
,p [[�'y,y`����''�� ` �y . q'�
P�.�E►.�A.f �10t7 YS0.7 WMARY
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CONSTRUCTIO14 FEE 101.000-418-0100 S1,41 816,50
1(J9.-C,CsCi-�39-325 ,120.Z4
PLAN Ci�IL;C't�" FEE $I
MECHANICAL FEE 101.000.421.000
LPLECTRIGAL.FIP $237.80
PLUi44I1 NO :FREE 101-000-419.000 $228.75
S"?'3LO1a:C MOTION FEE- RESID 101 -000 $"�. E�!
ORADING KIM 101-000.423.000 115100
t3I??V• LOPER IMPACT FEE $2,405.00
ART IN PUBIA. PLACES - RF811270.000.445.000 $M3,U'
n
�ti1�1t`F3TTC1 tt� i�7i ;PLANt rL.CII:
$6,14 3.81
DEC 15 2003
CITY OF LA QUINTA fi:-
FINANCE DEPT.
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RECEIPT
DATE '� * -
By °
DAT ALED
INSPECT0
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 42
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath AV7.
Drywall - Int. Lath i
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS I
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL
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 a
Pool Cover
_
Sewer Connection —z/— py a
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final S
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) '
May 27 05 10:54a THE PALMS
DFccI ' QUINTA
ILDING & A DEPARTMENT
I7Y p`- LA QutNT-74
q 12
FIMq
ION REQUEST LINE
ii7 7153
Owner BIRDIE HOMES 111, LLC
Contracto ICA DEVEL. CORP
Permit Number 0311-222
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 56-961 VILLAGE DRIVE
-SFD - LOT 71, PLAN 3ARIEX-C2. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE I INSP.
TEMPORARY POWER
U/G PLUMBING / WASTE ! l,/✓�(/
U/G ELECTRICAL / GROUNDING
FOOTINGS /STEEL i
CONCRETE SLAB
DO NOT POUR CONCRETE NTIL 8AOVE SI
ROOF NAIL / PRE -ROOF
OKAY TO WRAP g' s
FRAMINGCOMBINATION
ROUGH ELECTRIC 141
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION <
COVER NO WORK UNTIL ABQVE SIGNED
INTERIOR GYP. BD, DRYWALL
EXTERIOR LATH
GAS TEST /•
INTER
MASONRY INSPECTIONS
FOOTINGS /STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIObls
TEMP. USE OF PERMANENT POWER
COMMUNITY
DEPARTMENT
E
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
-
ribb
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�a/� Q.c J
f� Certificate of Occupancy
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Tay
RX
G� OF'T9� Building & Safety Department
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This Certificate is issued pursuant to the requirements of Section 109 of the California Building
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9
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
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construction and/or use.
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BUILDING ADDRESS: 56-961 VILLAGE DRIVE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0311-222
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
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Owner of Building: BIRDIE HOMES 111, LLC - Address: 5 E. CITRUS AVE. STE. 105
q MI f
City, ST, ZIP: REDLANDS, CA 92373
3
{7i
By: GARY HARTMAN
& Date: APRIL 22, 2005
'
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Building Official
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`• `
POST IN A'CONSPICUOUS PLACE