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LICENSED CONTRACTOR DECLARATION
,,F.fl.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 rf� Signature of Contractor(^~
OWNER -BUILDER bECLARATION
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 fo`r by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(tif 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.
SIVE E iii T Will :GIN, d'i
(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, s all forthwith comply with those provision
V,bate: (tr/'9 �lr,d/ 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-mentioned propert for inspe'9tion ur oses.'
IaSignature (Owner/Agent) _ R DateF.
kM;/ b i.
BUILDING PERMIT PERMIT# -7
DATE ity4nn."VALUATION LOTI TRACT -f
ADDRESS 79-190 �..�� RUS JOB SITE
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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CUTIA 33W)
USE OF PERMIT
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PSd"<i AHT VIPTls SUMMARY
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S.68
RECEIPT
DATE'
BY -
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROVALS
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
— - ev
F.A.U.
Framing
— city
Compressor
Insulation_
Fireplace P.L.
_
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Gt/'
Drywall - Int. Lath
- L Uv
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
Gas .Piping
y
Encapsulation
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
Temp. Use of Power
Final
Utility Notice (Perm)
fir- �/ I'�ru o1 f+► �-
s CITY OF LA QUINTA
c�boF BUILDING & SAFETY DEPARTMENT
m-7012
INSPECTION REQUEST LINE
m-7153
Owner SHEFFIELD HOMES
Contractor fiNERIELEl.n HOMES
Permit Number 9909-287
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-180 CITRUS
SFD-LOT 11, PLAN 2R. 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 ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB Z
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
GL
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF 6wU
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING CEJ F"�
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
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# 11
SITE ADDRESS: 79-180 CITRUS
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns - Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS CiR'
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:
I I L:�iA A0
TITLE: PRODUC ON MANAGE
DATE April 13, 2000