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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. Business.
and
# Lic. Class Exp. Date
�- 686895 13 (� Q•i�3Qfi
Z
Date /r1�� Signature of Contractor
r f 1/ l
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).
( ) 1, as owner of the 'pr'operty, 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. are:
Cartier Policy No.
:►'C TRIO.' -t, i4A.T IOINA
(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 ofS.ectioQ700 of the Labor
Code, 1 t I shall forthwith comply with those -provisions. ,p 1j11
Date: Vq Applicant - Yl
Warning: Failure to secure Workers' CQmPensation 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 -purposes.
��ignature (Owner/Age j" ?"�, ) /, Date I nil
BUILDING PERMIT
DATE 1011 11,99VALUATION S,,2 4r %°IM1S.t�Q LOT
JOB SITE
ADDRESS 7.9 ,YAO CITRUS
OWNER
SHEFFIELD HOMEIS
Atli? CE13"CP.AL'ti.VENUE i•TE 325
RIVIE SIDE CA. 92506
USE OF PERMIT
PERMIT # •
I4 TRACT .
i
APN
769-693-604
HEFFIELD S,
3+100 CENTRAL AVENUE &M 323
WWASIDE CA. 92506
CB.1111� 5M6
L,FD LOT 114; PLAN 1 MNUT DORS MIT iP%;f.:iJl):ki t8JUX:XWALL OR
POOL. 730,lo Yi:} DVUA%JN ON trL.AN c".Hi:4CX .PW FOR NVULTYPI I. f SSUAT IC S
OF SAW.- PLAN TYPK
CUSTOM i'74"NS1'RY1("i ON Sr
PORCR(PA110 2S4.00 3F
litARAMYC~AI'+tPORT 501.00 Sk,
il_'nJ''AAd@it J:.{Li.i ¢.i,yf.'►k' OF X1.0.01.79 1A. ICTI'VN
23,756-60
PERMIT FEE SIMMARV
OGtvSTRUCCIONFIX
101 -OW -419 -OA sl'oi.00
V►..AN't M ECK STY-, Y-,
I014)00 -+139-I i A S2 i. t1
NMICT111,N1CA LFRX.
.1,01.000-422-00
rly.EcTfillifl,, ,.VkG
i'Lt1A1W,ifi�+: � ><�;BE
ttf ➢ �f3t)4?-41��-fDt)(t � 4ii I ,7� .
:�t'f'F�",f;€1�1C3Artf�'i,'4(>>�T i�1:!': -h'f5�f1'f
I(Ft•{)i')fl��ai"f'ttli! !iw2.FIR
GRAVING VIUM
10 1 -000-41,V. OW
l�tl',f1d:PtiKIC..A.AQ7tto'-RX-SI.Q13.i.-000•°Z-5-00
3x;121.99.
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TOTAL PERMITFEES DUE NOW
t.Y4_I6M.38
RECEIPT I DATE I BY
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
`111Q
Ducts
Forms 6 Footings
-o/
Ducts
Slab Grade
_ CG _
Return Air
Steel
Combustion Air
Roof Deck
2-77
Exhaust Fans
CK to Wrap
F.A.U.
Framing
Compressor
Insulation
_
�2— Cki
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
,'L Y/
Final
Final W
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
-
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
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 fy
Utility Notice (Perm)
COMMENTS:
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# 13
SITE ADDRESS: 79-220 CITRUS
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: ATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS �BLO�W
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: t, TQ"`
TITLE: PRODUCT N MANAGER
DATE April 13, 2000