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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
agate Signature ofContractor �
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 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. 'aye:
Carrier y9 y1-��tyj yyya�:� yy t�� Policy No. t
+t.DM`- �Rc�.t1!,✓R .d A A'AiJ N A
(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 Se tion 3700 of the Labor
Code, I shall forthwith comply with those-provisi Rqq~
/Date: i-,11 1 /` lr7 Applicant `"•�.. t. /) /�'Y1�1�Ir
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 iinspectio!�purposes. �`,
,,Signature (Owner/Agent) '`� t ���/ i Date id -7 7'
PERMIT# -
BUILDING PERMIT
99OV_241143
i� r
DATE VALUATION � '.b�y�( LOT 7 TRACTJOB
SITE
ADDRESS 79400 C ATR U
APN i69 17434)41
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ASH y"I,�r�'@t�.flp?��..
.
-
CA' 91506
92'A5
01110 51.W6
USE OF PERMIT
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SA,705 S-9
LESS �':1dE-i`S'1.[D FEfI 'S
$0.00
41t,
RECEIPT
DATE
BY ; C1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR,
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-11
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
_
_-2 _CJ- C.V L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath'
j
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
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Lateral
Pool Cover
S Connection
Encapsulation
as Piping
Gas Test
Appliances
Final
-
Final
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.
SmMe Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
s CITY OF LA QUINTA
cFbov BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Contractor
Permit Number 9909-2t3
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-100 CITRUS
SFD-LOT 7, PLAN 1R. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL A -L ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
.c s Z - 9' -q
DON T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
ROOF
,C Uf/ 11KO,
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
- 23- Cv
INSULATION
U
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR 5:70
EXTERIOR LATH —
POOL PRE PLASTER
POOL FENCE & GATE
S ER SEPTIC TANK
FINALS
-' ELECTRICAL --�
PLUMBING
FINAL GAS TEST h
} HEATING - A/C
HOUSE NUMBERS
TEMP POWER V ,
100
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
—'r,n; I'll I I -Tli nP (XY`I IDY P1 III PNNr,
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: CITRUS - TRACT # 24890-7
LOT# 7
SITE ADDRESS: 79-100 CITRUS
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3" R -VALUE: R-38
------------------------------------------------------------------
GENERAL CONTRACTOR: SHEFFIELD HOMES
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY: �l�lN J
TITLE: PR D CTION MA GER
DATE April 13, 2000