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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
Date f �k r/Signature of Contractor VAI r'
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, assowner 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.
(Y9 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 '• Policy No:
SiE\OR' iIOX4A 51'.p YO
i3A
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify thatin 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 -df Section -3700 of the Labor
Code, I shall forthwith comply with those provision�, I
�'Date> /A6 7,/�+ ' Applicant
F-1 / ' ' t ��,r •a
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 insp $cfildn purposes:
✓Signature (Owner/Agent)" �,!�t•'a' A ON) ) Date'�41
• BUILDING PERMIT PERMIT#
DATE 10"j,7j.1,"VALUATION .Si�ii.q LOT TRACT
TE
ADDRESSJOB si
OWNER
CONTRACTOR/DESIGNER/ENGINEER
;l� j';�j�1741X HID ES .
340 C LINNT .A1.'AVENWE.' $71E 325
:3400 F: ENI rtAL AVTN `!E .S.E325
RIVERSIDE CA !,.M506
RIVERSIDE 0-ot 912506
USE OF PERMIT
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RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR ,_N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I IDATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
-
Slab Grade
Return Air
Steel
Combustion Air
!
Roof Deck
GCl
Exhaust Fans
0. K. to Wrap
Framing
'l
�- W,
F.A.U.
Compressor
Z -
Insulation
-- :
Vents
Fireplace P.L.
Grill's
Fireplace T.O.
Party Wall Insulation
Fans & Controls
Condensate Lines
Party Wall Firewall
Exterior Lath
. ct/
Drywall - Int. Lath_
`fes
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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 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
Q '
Encapsulation
Gas Piping
Gas Test
_
W
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) Cd
COMMENTS:
SVT
CITY OF LA QUINTA
ed OF TRBUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner SHEFFIELD HOMES
Contractor�SHl?]i'F,'ll_,ll H OA4R
Permit Number 9909-285
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-140 CITRUS
SFD-LOT 9, PLAN 3. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
} TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -C
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
_ G .
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP S
GROUT O 4' O 8' i
FRAMING -
INSULATION dff{
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - C_'o
EXTERIOR LATH ,cl
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK , /G/ CU'
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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# 9
SITE ADDRESS: 79-140 CITRUS
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: CBATT BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLO
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: t6"
TITLE: PRO U TION MANA ER
DATE April , 2000