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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
f
686895 8 - Q�i13L�/'crib
Date (r-� Signature of Contractor ^ t=
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 mai(Wiri 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: are:
Carrier Policy No.
SIX MORNX*110NA
(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 ttiose'provisio s. 11
,/Date: lfy t def Applicant , f 7 � r I
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 inspection, p ru poses.
�!`� �
/ Signature (Owner/Agent)/} �A ` Datet !.,lr I_ h4l
BUILDING PERMIT PERMIT"
DATE i owam 99 VALUATION y'f.#Q LOT +� TRACT
i
JOB SITE,
ADDRESS 79-210 Crf )RUS
APN + 761-M-0.1
OWNER
CONTRACTOR / / ENGINEER
y 7 Z�
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9DESIGNER
� INTOA:r��Y
"4 /fe4 k. INTO"
3400 CENTRAL AVEN U
3400 CENd tRAL AVENUE 8`i L• 325
RIVERSIDE: CA !►2.506
,}t.li%.IRSIDE CA 91W,
USE OF PERMIT
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OF SAfV 314,A.N 'l Y I`8.
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MARY
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MRi01A.MICAL FRE 1014M.4-21-000 $ 35..A
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E,LE,S"7fLl.C,AL E'W. i0i••OW-420 " 8188.31.
PLUfvlB3:f 13Ft+ 101AW-4194i'11Si '$181.115
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SUrVIXYFA!, CONSTRUCTIOIN ANT) PLAN CHECK
S4.! 15 6R
LESS
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
ct}
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
��
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
cam/
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Hacks
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
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
Temp. Use of Power
Final
Utility Notice (Perm) - Gc!
r s CITY OF LA QUINTA
CF�Op���b BUILDING & SAFETY DEPARTMENT
%77-7012
INSPECTION REQUEST LINE
777-7153
Owner SHEFFIELD HOMES
Contractor SHIRF.FIEI 1) H()MIRc
Permit Number 9909-289
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-220 CITRUS
SFD-LOT 13, PLAN 2R. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK 12 -2 -
FOOTING STEEL L•--2
MAIN GROUND SYSTEM
PRE-GUNITE I I
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
jrCONCRETE SLAB 42
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH PLUMBING
ROUGH GAS & GAS TEST
•.-
HEATING & VENT - NC
FIREPLACE
ROOF
G
BOND BEAM
O.K. TO WRAP
--
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
-- 'f
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
L FENCE & GATE
SEPTIC TANK —/ 9
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST ') _
HEATING - A/C
HOUSE NUMBERS
TEMP POWER ` \-
. .. ... _ ....... _ , .,� as
ABOVE APPROVALS DO NOT INCLUD RI HT TO
TURN ON UTILITIFS 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# 14
SITE ADDRESS: 79-240 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 BLOW
MANUFACTURER: Gieenstone 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:
TITLE: PRODUCTI N MANAGER
000
DATE April 13,