0306-289 (SFD)LICENSED CONTRACTOR DECLARATION
I 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 Exp. Date
t50)r' 44 F) 1 ' N14
E I
Dater a Signature of`Cor tractor. --
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 Corlp).
( ) 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 GTATF F0140 Policy No. 40.03.213 ::
(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, l shall foftl with complyrith'those provisions. i
Date:t.� `•',�/%✓'�>-APPlicaht" 'i _�'"�.�t�
Warning' Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety'
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. r
Signature (OwriedAgeot),
d
BUILDING PERMIT PERM'TY#
DATE VALUATION �';!$�`� fu LOT C1 TRACT 213A3
1
JOB SITE a
ADDRESS �r.�V;
APN 70353-i14419
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r<.L1, i3°.'RuC1m.m I 11, IT.1{��C."
It RE3/YCg1y't' " ' i:. 'L`ry.RIV L�@31", INT CORP.
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x1 1J3 I".f•'• 923 73
1RADL€,NI, CA 92373
CbLff 4911
USE OF PERMIT
aUEI • tOT 42 PLAN 2A. P217- _ sMIFF i , e AS t lir.• •. r -moi n�. > ,, e: a_•,,y
POOL, S?A OR Di31'V Ci'VIlA "¢'Al'PitOAV"K 75%REDPC:'TIO14
V'T r,iTJN TO MULTIPLE 1MAVatICA OF IS.l4ME PLAtt TYPE
CUSTOM C:ONSTRtar"i' W ZIA0190 Ulf
1'C1RC); IPA'F10 IN3.00 SF
11AR.A091C'.APPOPT 1+19A OF
MINA170.) C099 OF Zra✓.L�A7 J,.�t. N.� t. `, .1: .'L`S
a'"By, .v+7.' X17
CONSTRUCTION ME I01_000.418.000 V
"
MAX CHF',,X T7'C 101 -OW -439-318 $11,4410;
E 1,'7 1 . 000 ••42 0- OM A) 42.
YCr� 11..99X:l��:tt�i11'��idS77ICl�.�f�..yy1.a.��FtrE
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(MRAD1140 NK 0 t I
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AA l' IN ;PUBLI \c �"�GC`aCES - tawUSIL 2707,000 -445 -WO 1,91,49
,. _ = x _� , >\\ � €�fT1 •Ta 'C C %+ Ii2il r3'Ai tl<tl, ���.Pels C k .,'�
$4,416.27
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[RECEIPT
DATE,
BY
DATE FIS^ D
INSPECT
we
�J /Z D
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
r
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
z
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
p
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 Z
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)
0
INSPECTION GE40M
DATE DONWACTOR
'5'
COPY SENT TO CLIENT O
CERTIFI1CATION OF COMPLIANCE
I HEREBY CERTIFY THMT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
TO COMPLY WITH THE
PLANS. 1 SPECIFIHAVE CAT ONS. AND UND THISWORKAPPLICABLE SECTIONS POFOVED THE
,—couiur. RI III GING LAWS.
CONTRACTORsue
s
ON NEXT PAGE O PAGE OF
GNA �RE—
OF REGISTER C:OR���
1 3 6
NEI O REPORT REGISTER NUMBER
JON TANVY
78494 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
❑ UCT. STEEL ASSEMBLY ❑ s
O REINFORCED CONCRETE +p�HER
TYPE OF
❑ POST TENSIONED CONCRETE ❑ SPHALT
J'-' ��
INSPECTION❑
❑ REINfORCED.MASONRY FIRE PROOFING
PERFORMED
REPORT SEQUENCE NO.
JOB LOCATION 1 , S Ian
a `�j`•
0 DAA OF WEEK
PERMIT NO.
a (�
,TVP F CTURE
y
INS OR NRS. CHARGED
ARCHITECT
MATERIAL DESCRIPTION A./ A Fi 0
4. f"F ,�W
- ��.cTeutc MRS. CHARGED
INSPECTION GE40M
DATE DONWACTOR
'5'
COPY SENT TO CLIENT O
CERTIFI1CATION OF COMPLIANCE
I HEREBY CERTIFY THMT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
TO COMPLY WITH THE
PLANS. 1 SPECIFIHAVE CAT ONS. AND UND THISWORKAPPLICABLE SECTIONS POFOVED THE
,—couiur. RI III GING LAWS.
CONTRACTORsue
s
ON NEXT PAGE O PAGE OF
GNA �RE—
OF REGISTER C:OR���
1 3 6
NEI O REPORT REGISTER NUMBER
•
- ,- Certificate• of Occu ancy,.,
0 0� p
of 9 ..: - 8ui1din4'&'Safbty Department
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
provisions of the Building Code and -the various ordinances of the City regulating, building
construction and/or use.
BUILDING ADDRESS:'96-325 VILLAGE DRIVE
s
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0306-289 `
Occupancy Group: R-3 ,' • Type of Construction: V-N Land Use Zone: R-L
l
Owner of Building: BIRDIE HOMES 111. LLC Address: 300 E. STATE ST #100
1'
-City"-ST, ZIP: REDLANDS, CA 92373
i
By: GARY HARTMAN `
• ,4 Date:8/12/04 ,
Building Official .
POST IN A CONSPICUOUS PLACE '
Ic
•