9909-286 (SFD)LICENSED CONTRACTOR DECLARATION
'ter 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
wProfessionals Code, and my License is in full force and effect.
O License # Lic. Class Exp. Date
' LLJ0U-) v
* 6"45 13 ON30V201
oZO t --Date F✓� Signature of Contractor
to—O
J 0 OWNER -BUILDER DECLARATION
W W r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ N License Law for the following reason:
Z_ ( ) 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).
C'')() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
CL Z WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent'to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) 1 have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
qt Z Carrier Policy No.
ob O M3 WOR NATIONA wrltr8f):rt.1
J (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, I shall forthwith comply with those provisi n .
Date: I�1
��1/r4 Applicant �"I
,,L� IIiI VU
Warning: Failure to secure Workersxofnpensation co erage 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
94 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 in�spection•purposes.
Signature (Owner/Agent) r� Date 1
BUILDING PERMIT PERMIT#
DATE tow/i ALUATION imminin LOT 10 TRACT
JOB SITE
ADDRESS 7161" CI'['RUS
APN 70.670-"4
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SHEFFIELD t;OMES
SHE?'FF ELD HOMES
3400 CENTRAL AVENUE SM 325
340tH CEN'CRAL AVENUE SCE 323
R1VERS11X CA 92506
KIVER81DE CA 92506
(909)682-5352 (78L# 5--W
USE OF PERMIT
.ANO .ai t�AA�1iL5` 13 l:LLll+i�i
SFD- W f W, PLAN 3R Pbbll+ ff lk)iS iv(:►T IWL*UM BLOCK WALL OR
!'(aEJli..7Y&/*ii&X1Cf10N ON PLAN 1,I*AI+ FhE FOR MULTIPLE ISMANC`!.
(W SAKE PLAN TYPE.
c USTCAN CONSTRU -W14 3, IM.00 Sr
PORL"H/Y 1 i 300 00 3F
0ARA(iW#_AP. K►1C1' 6371N1 '
l�4 INATED MST OF C ONSTRUMONf
IN021.00 .
PERMIT FEE 8111MMARV
LVNWFRLK-710M FEE 14)1 -OW -41K-000 x1.15M.Ui1
P1 AN (`FtM(X M'R.i? 101 -OW -41-9-3111t 124174
tLMILWCAL FM 101-000-421-000
ELE rWAL FEE 101-0oa4240Q0
K.L)M1N 1 "E 101-000-419-M =113-00
.
li"cwwo WMON F7W - Rt>;wl) 101 -M* -7414 M 3".81
r SRA -DMC 11I: 101.000- 23.000 111.00
� i
Aki,i MN 1'iJliLl�, k�1.At'E `i -1z ,,Uf: ?G1 -Old -255-000 �YS�y.3U
4 i
t*-, l.()Phx IMPAC -1, FM 31,907.00
ra IK-ImAf V01NSn:1 V'nON AND til AN ('11F '.K
�4,?n ,r ih
LESS I'RF PAIL) ITIS
$0.00
'101'AL FVRM111 V111 F:»11 DkIK NOW
$4.267.16
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs f7cl
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 2-- 3- GC/
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
_
Insulation GC> _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath — L
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
Appliances
'
Final
COMMENTS:
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
lamp. Use of Power
Final
Utility Notice (Perm)
eNOFCITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner SHF.FFiF.I.I) HOMES
Contractor-SHE]pFljgbD 149A4E R
Permit Number 99(19_786
POST ON JOB'IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79_160 CITRITS
SFD-LOT 10, PLAN 3R. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK/T• _Z. 79Gr
MAIN GROUND SYSTEM I I
PRE-GUNITE j I
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
74ONCRETE SLAB 1,2 - 2
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
Dd NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING O
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
FINAL GAS TEST
HEATING , NC
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE R GHT TO
TURN ON UTILITIES OR OCCUPY BUILDING