0304-179 (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 # Lia Classy # ,Exp. Date
`313 '03.,
ate�r' 11 r+''' ? ` Signature of rContractorS-�'�
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'F& Professionals
Code). - +
O I am exempt under Section ; B&P.C. for this reason
Date Signature. of Owner =
WORKER'S COMPENSATION.DECLARATION a
I hereby, affirm under penalty of perjury one of the following, declarations:
() I have and will maintairi a certificate of consent to self -insure for workers'
compensation, as provided foPby 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:
CarrierT.f, ITE 1'vV D Policy No. 46-X03.2=-
(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;Nnd 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-mentioned4P rope rty,foc'insp'ecti6tn purposes.
Signature (Owner/Ag ntA,t `- .-- fySF .....:aW . • Dater_"V1115
4 ,
PERMIT# _
r
PERMIT
BUILDINGVALUATION
Q�yQ�'y.
DATE OT //fjy yy TRACT
"t
'r
ADDRESS F`± 4`F.wL+kqx � �V77!
JOB SITEAJ
APN ° '16-11_04
OWNER
CONTRACTOR /DESIGNER / EN (NEER
UW I
'3sE1:1 ' �iI7'rt7 0 !'J vlJ.f�; ' 1 2'33
S 1-n t T.'ia l Z P11 S 10,10 °, 2VIS
3� Lt NDS , .P. 9231 .5, I
• M)LA D S ce.
USE OF PERMIT +
-
�sd'"i..d. • Lb.a X Ff a Ybr�.JY :4ii« .!' ?.fi1t + 1 i:i'V ' .i 4d:{ iAYq,.:. (93.ie'.. uSs�,.+L.:.�, °ft7.t?+,i.,;..� .. x"
.:
.
.. /`.
�°�'��'i.�;ll'�.+wi.�.�'iP,.'�jP}��•rA31':�;a��`:'+:CS.d�''F�
CUSTOi4+,3 CMVIThtiCT1 :,4 Zw",I),09,Sp
'
t
1D0' S
- .y,:y`y�`►^ :'dl's` ' .}+ ��F c:°,•f,2NS..'�dUt:'.�`%s;�.t�
f �q;r�y�/�yr�(+ y� - _.
.,d:�S:a,.�Y14,6ee7�T. , 1A9►r,,JA. 1 ..9.5,.•�Y ..:.
T�tt�,,eA'.
/yb ,p !y
:� .g3 �.1. Ti' �JY,i }13� :`t. 10.Y -000-41840, Z +.a `sg.00
,
�F�.�."ri S;i.Y,G:fC k�,;�?> - 1%#,..�tad•� 9••a3� , • r���:�i�i
P'44:`• ��,Z?Ifls / ::t. :j;(j, 00304 1=000 vw.tta3:OD
y'.1.'E ;TRICAL.FRA
PLUMBING ,qrx'
•in�l/7}f�•�2�€2-/f��Gyt �c3,{yS3i
ASy�s�K��PML.ry'1�y'IC%���••n.1�`re�` 9F4��,1
'1,0!1 000-423-000' _ � � �.�f�.:f�,. i�!f� <
.;'i«}2"SAd/+..ItJP�f4�V.,'lJt4117B ✓t�p`
,
rrrp
' '1 .'9 LT1rN37Li. W!'!d}9i.1w�i'. FRX
�li�,"1' �d i�it���::!� z';�;.e�C���:„ ItF�6C �'�'Ly�Gt�(�i�2S••00t� ��:1,�<�
•
.. .al.w .^i�1M5, •d
of
- - f
Sum xf T'tai:, r''sYW1q'17P1**Y171 .°� 11N I0.v�.'?�1FC.�f...t�31��G^} WIIIw
yM��2
VMA,
—.,�.11 I• ' �Mar,
G�ppg y ��ry7� ` f+,1�f fla
5 E DxroV?�
q� ♦ CSF
J�' d S� x.V A �SbC1�.&1.,.1 &14 d7
`',' K
milL�l
' bf I.l
RECEIPT
DATE
DATE FI ALED
INSQTpR
V
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
OX to Wrap 7n
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
Drywall - Int. Lath
Final
Final O
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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 i
Encapsulation
Gas Piping
Gas Test
Appliances
Final
•
Final j
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 Z%
Utility Notice (Perm) _
COMMENTS:
��1� o`er J �'S � 3 57
vw.
JON TANDY
78494 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT s
❑REINFORCED CONCRETE ❑ UCT. STEEL ASSEMBLY rp�HER�(
TYPE OF ❑ POST TENSIONED CONCRETE 0 SPHALT Jam'
INSPECTION (3 REINFORCED.MASONRY O FIRE PROOFING
PERFORMED REPORT SEQUENCE NO.
JOB LOCATION ' ^` 11 S��Q AQ �� Q
W�=� Of WEEK
ry`�F�fSTBUCTURE
MATERIAL
DEESCRIMON
E.--) t c
INSPECTION GENERAL
DATE CONTRACTOR
I sr
pAr
HRS CHARGED
sue
CONTRACTOR 3AJ6"O'C�
ttm
COPY SENT TO CLIENT O
CONTI ED ON NEXT PAGE C PAGE OF
A
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV 40A
NAT RAE OF REGISTER
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE V 6
NOTED, I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED 0 PORT REGISTER NUMBER
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
--cokua!] AI III GING LAWS.
Apr 27 04 02:14p ,, p.1
_ CITY OF LA QUINIA
BUILDING & SAFETY DEPARTMENT
777-7012
z�. INSPECTION REQUEST LINE, ,
' 777-7153
, Owner RiRD1F HOMES111. LLC C
;Contractor .I x'ro RT ,R � rr�ir� � i1FVT,`i .flP PORE„ � 4 � 0
1,.,.,...... :cca zds: �------
Permit N> Iffier I 03.(14-179 C'
POST ON JOB IN PUZE
INSPECTOR MUST SIGN ALL APPLICABLE SFACES
JOB ADDRESS 53-305 VILLAGE DRIVE;
SFD -,LOT 41 PLAN 2A- PERMIT DOTES NOT
INCLUDE BLOCK WALLS, POOL, S?A OR
'TYPE OF INSPECTION DATE INSP-
TEMPORARY POWER
SETBACKS L-
' U/G PLUMBING /WASTE t)
U/G ELECTRICAL / GROUNDING I
FOOTINGS / STEEL
CONCRETE SLAB
x 151—
DONOT POUR CONCRETE L A OVE SIGN
ROOF NAIL / PRE -ROOF
ELECTRICAL -b
PLUMBING
OKAY TO WRAP
`�-'" ✓'v /
FRAMING COMBINATION
PUBLIC WORKS DEPARTMENT - Z 1-.0
ROUGH ELECTRIC
ROUGH PLUMBING
COMMUNITY DEVELOPMENT DEPT. 2&1 o :1
ROUGH MECHANICAL
INSULA'nON
n
ViJ
COVER NO WORK UN T LAOOVE S GNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
t -vv I nv%aa 1 o 1 ccs
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U!G dAS "
U/G ELECTRICAL
PRE -PLASTER ALARMS ! BARRIERS
FINAL INSPECTIONS
TEMP. USE OF -PERMANENT POWER
ELECTRICAL -b
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT - Z 1-.0
/ ._--
COMMUNITY DEVELOPMENT DEPT. 2&1 o :1
z ✓
FINAL / JOB COMPLETED 7 Z, 2,ol
ABOVE APPROVALS DO NOT INCLUDE RIGH•f TO
Certificate of OccupancY.1
k M
t
o
,#
p
I
� WB
W I
IN
OF Building Building &Safety Department
g
u�
This Certificate is issued pursuant to the requirements of Section 109 of the California Buildings
6
i
Code, certifying that, at the time of issuance, this structure was in compliance with the
t
provisions of the Building Code and the various ordinances of the City regulating building
a
construction and/or use.
t
w�
BUILDING ADDRESS: 56-305 VILLAGE DRIVE
r y° {
e
X74
r.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-179
I
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
js
i
>
tI
3
Owner of Building: BIRDIE HOMES, 111, LLC Address: 5 E. CITRUS, STE. 205
4
E
City, ST, ZIP: REDLANDS, CA 92373
By: GARY HARTMAN
'j
E
�• Date: APRIL 27. 2004
h
p' ;
p
ui di g Official'
POST IN A CONSPICUOUS PLACE
c
• ., z ..F. .a....; �.E+�.� +e.3i'd4Yk;1�x3�i .:;:4ip. h4 4 14 ,..k„ 42 .1,,d'�-`rAit� A'L, k. .r.b 'h"4>�rt'-ia'i .d �+Ys Sv � d5il .{?ylksi �.!%i M ek...;