0311-223 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
'Cliapter 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 f Exp. Date
0 60044 s /31 /03
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Date j � � �// Signature of Contractorj•� ' 1 +�,j .--��.-(..•r':-i_ ,--
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
() I am exempt under Section B&P.C. for this reason. t
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. 4&03-0353
J (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 agtee that if I should become
subject to the workers' compensation provisions of"`Section 3700 of the Labor
r.I r%{
Code, I shall forthwith comply with those provlslonsr . A
Date: ! %r. -9 Applicant- -i✓� Fi ,i 1:hr �' !1 i
. 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 applicator 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 entertupon
the above-mentioned property for pspection purposes.,
ry yl,_.ii7 t i
Signature (Owner/Agent);, YDate.]
BUILDING PERMIT PERM'T#
011 9,x13
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS M_ 4�UaiTe%�t3E MVE,
764.060-004
OWNER
CONTRACTOR / DESIGNER / EN (NEER
131RDT-i HO1vt 0 I I I, LLC
MRI' MCUIC-A DV sasLOz✓dUMN'r CORP,
5 MAW (U.P J) AVE -MM -14 ME,
5 J1, CKKEUV .AME q
DLA a .01A 92373
S'�r. LMMS C..i < 9237:3
(95 05I)79S«3688 CBL# 41-911
USE OF PERMIT .
a1T,P.J' ly, FJO&L.71',' Dm1a1.1'2 G
SM a !A-,!,; P1,AN 3.AR/EX-C2. PEI' LIMIT DOES NOT DICLUDE'BL€ CK
lydAWS. P00" SPA, OR WitWAY APPROACH. 7514DUC TION; TO PIAA14
CHECK IAF'• DUE ?'L"111111 UHPLZ ISSUAI4M OF SAME PLAN TYPE
.r
r
tt•
CUSTOM, C;ciAt:l RU�t:TIOAM 4.020.01D `3P
.
PORCH/PATIO i,GdGAo Sly'
,
0.1 RAGEIC."tPORT 7X00 SF
11F'&TIMA ED C:OaSf OF CC'.I`IURDIC-1100
1541.35X19
CON TRUC,TIOA MEZ 101-000.418.000 Si,486,50
PLAN CHECK IME 101-000•-439-:318 $309.r.
MP.rGiANICALaFEE 101.000.421-000 MUD
ELECTRICAL x EE ;, 01-000-X120-.000
PLUMBINO FRE 101-i 00.419.000 F�2V,'SS
=:CJ1' O .'v OT1I314 FSE - R.1MID 101-000-2A 1-000 lei
OFIA.DINO FEE 101-000.423-000 $15.00
S, 2iv.V.IN..eOPER IM -PACT "M $-4405.f10
AWr 1'• I't,M) LAC IPI ACI , - RUM 270-000-445-000 63x3.33
SUB - TOTAL COME I'R.LTC.'TMA' A T AM C:3:iECIC
�P.
D /A f� J,e 58 PARE -SASH, F.°rE. S
$0.00
YKIMT FEES DUE.00W
DEC
-2.0
1 5 2003
�..
CITY OF LA QUINTA
FINANCE DEPT,
r
RECEIPT DATE
f r� 1
BY
DATE FI LED
15 ZZ 6
JINSPECTOR
Es/G'�L
INSPECTION RECORD
It 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
- 1 j — D
Exhaust Fans
O.K to Wrap
is -6
F.A.U.
Framing
Compressor
Insulation
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
6
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
A PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
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
Sewer Connection
_ _
1_7 •
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final Q�
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
is
{
g Certificate of Occu ancy
o oP
1W-08?
grim
w�g
G��oF�9Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, * certifying that atthe 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 andlor use.
BUILDING ADDRESS: 56-985 VILLAGE DRIVE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0311-223
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BIRDIE HOMES 111111, LLC Address: 5 E. CITRUS AVE. STE. 105
City, ST, ZIP: REDLANDS, CA 92373
V 4
By: GARY HARTMAN
-7 Date: APRIL 20, 2005
Building Official
of
z
POST IN A CONSPICUOUS PLACE
7607771965 p.3
QUiNTA
BUILDJJ��a,&. TY DEPARTMENT
I DEr 1 �UU##jj�� ;70,2
INSpF�T�N HEC.IUEST LINE
I CIN OF 1. eL'INTA
i qWjjrI- DEPT• '777,7153
Owner U1vIEal 11, LLC
Contractor FIRST PACMCA DEVEL. CORP.
Permit Number 0311-223
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
ILLAGE DRIVE
JOB ADDRESS 56-985 V
SFD - LOT 75, PLAN 3AR/EX-C2. PERKff DOES NO'
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE 1NSR
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL r; �• `
CONCRETE SLAB
DO NOT POUR CONCRETE UN IL ABOVE SIGNED
ROOF NAIL/ PRE -ROOF —B
OKAY TO WRAP
FRAMING COMBINATION /
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION z /'
COVER NO WORK UNTIk ABOVE 6IQNED
INTERIOR GYP. BD. (DRYWALL} T a/
EXTERIOR LATH r m
SEPTIC ABANDONMENT Ij
SEWER CONNECTION 1 3— //..D
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS I
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS /BARRIERS),.
FINAL INSPECTI NS
TEMP. USE OF PERMANENT POWERI -
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT ( /
FINAL/ JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING