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LICENSED CONTRACTOR DECLARATION
khereby 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
700fe'14 B r 1 l } V31103� f
,Date ���� J , ' ; =' Signature of Contractors*
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).
O 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
S ction 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 01T?5,12 k -1114D Policy No. A6-0!�Z* ly3
(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 pro,Vislons.,off Section 3700 of the Labor
Code, l shall forthwith comply -with those provisions.
Date: 1..,4 )P ti , Applicant: l iA C • .a qt1- -:d...
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, indemnity
& 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. inspect4 1 ion purposes. � /f
Signature (Owne%AgenA4V'` �-�' •v• Date
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PERMIT #'
BUILDING PERMIT
DATE
VALUATION a'��rA IfF' LOT aj, '" TRACTJOB
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ADDRESS r,Si�w 02-1Y 4E ,,i "fr
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
Y300TE T10i ? ;Llk,
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t� •i ts. ;k 912: i73
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(fW')7?8-3688 CM14 4911
USE OF PERMIT
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' ..- APR 1 0 2003 m rxxv ryS. ; blA1^i ..iiO Y'C
} CITY OF LA QUINTA r
4INANC'E DEPT.
RECEIPT
DATE
BY r
DATE FINALED
INSPECTOR
.. � r�Y Vit: + � - •�
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 s Q -! a
Exhaust Fans
O.K. to Wrap , o
F.A.U.
Framing 4f ,Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -107AL-iz 6z
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
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
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 -D 3
Appliances
L /
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS,F�LnAt,
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)
COMMENTS:
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erb icate -of.Occu anc_
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• Incoroaeirb "• y :r
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t Building & �Safely.Department ,
OF,
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This- Certificate is 'issued pursuant to -the requirements of Section 109 of the California Buildir`►g .
C" certifying that,: - at- the' tii»e of .issuance, : this; `atrwcture was in 'compliance with the' � ;
s 'of the City 'regulating bu►Iding
' .provisions 'of ,the. Budding' v and ; he'various,ordinanceo
r
_Code
:construction and/or use:
= a ; BUILDING 'ADDRESS. 56-025 VILLAGE DRIVE "� (Temporary :mo del'/ sales office only)
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Use Classification% SINGLE FAMILY DWELLING., , , �. Building Permit No.; 0304=047:
4 , •�± �;
- Occupancy Group. R-3'% U-1 '��.: d } Type of Construction ,VN =`� Land'Use Zone:
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'a; �: Address:`5 E' dTRUS'AVE #205`4
Owner of'Buildini BIRDIE HOMES .� -
City ST ZIP:yREDLANDS, CA 92373
By: !PHIL• CAROTHERS -
_� j' y ;•f
^ 10{2003 �� Date -1
�r .`.. ,.:
� .- _•' � ..
Bullding:Oflclal,
PLACE
.. POST A CONSPICUOUS•L> "
REGISTERED INSP
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF 206
INSPECTION
PERFORMED
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY O FIRE PROOFING
❑ OTHER `
JOB.LOCATION-�"
TYPE OF STR CTE �
\
-te w
%��`i�'�
P RMIT"NO
REPORT SEQUENCE N0.
DAT'�
DAv OF WEEK
M TERIAL DESCRIPTION
ARCHITECT
INSPECIrOR
HRS.CHHARGED
y
l
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR— '-'' -------
. -'
SUB
CONTRACTOR
I)
`
I,JC' WIsA O -P cf
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Md
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SI N RE OF REGISTER D INSPECTOR
���w
ATE F, REPORT REGISTER NUMRFR
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TAN DY
37630 Medjool Ave.
Palm Desert,' CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
6119
❑ REINFORCED CONCRETETRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT.
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
'Soor
THER q - 0%;j
�/Q��
JOB LOC
REPORT SEQUENCE NO.
TVP OF STRUCTURE � � � � ^ - --
PERMIT NO. •`V
D �
DAV OF WEEK
MATERIAL DESCRIPTION
ry
ARCHITECT
I F TORI
.
HRS. CHARGED
J `
E -) j T AL
ENGINEER
A556TANT5
HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR S/, ,. 1'A��._�___..-CONTRACTOq
`'vim "• WeA.01P &AS4e�
(A-TE5
S k h 12AA.S U)CXA N To
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(A.11F5 Cols
GO�s
asp=-.
. Ax -Io
7
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY'
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
WV�
SI ATUI OF REGIS ED INSPECTOR _
DATE OF REPORT REGISTER NUMRFR