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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
04/30i20(
at e✓✓f� Signature of Contractor ra-✓�
OWNER -BUILDER DECLARATION
I hereby affirm under•penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 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:
Carrier Policy No.
. 9M 1011 'A"EATIONA,
(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 provisions'
/bate: 1? -VD i Applicant—
Warning:
pplicant 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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application'be.comes 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 inspect of n,p ru poses.
'�
/Signature (Owner/Agent) • Date
PERMIT #
BUILDING PERMIT 9909 94 7
DATE 1.�r�T�)VALUATION '�ia�€21.431D LOT lR TRACT
ADDRESS 7! --260 4�ITRUN JOB SITE
APN Cl�U-�1�3J
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C7x'i?tJLo)-"F .jl . A
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HE�:�:lk�.�i
3,10 0-11rRAL A.N esNUE STE 3:5
RIVERSIt a3 s:ea �#2SC?ts
3 ',Vd.€�SIDE CA g2 -V6
cRr,# AIM
USE OF PERMIT
Z .i'r"i(yll'L Y 1ANT.l.1_ NC;
SFD..L )T i5,.KrAN 3 •- PERMIT DiIXEWALL CIR,
tut.. YS'' o- kK61+iX:11014 t:>N k`l.Ahb c.:#Il,.i:`li 1-%h FOR .Mi;3,'i'dYUry11r�i5�.'t;
(3Y%'3t3M_6 11LOW'I"Y-PE,
I D.ila.!]!3 31'.*.
+'O.RC.ILPATTO ?fN3.i#ii SF
rizarl.r '.4tiax.") Cos loa Ns"a�oeblm"a�'��`•�
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�aU S'I'#r.AfC':r,"ICi �' 3 lU1-f>�7tt Ikt-fttDD3 51,196.00
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f�l'•s�N 'r4
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7_000-
fill.
CIEC 1"KI IV. FIX $197.81
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�1'TlC�laf'i 4fi'1'i(3N S : - t2b?"iY?a 401-1,XV -7zf l••(ifpfi )'6141
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GRADING ME,
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ART IN IIIJTAJ4':' PLrA:.CES - It -'Si ; 70.14)0-255•000
D.; -V si..6: PFR IMPACT Mt S*Z.Sit3:.00
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51 IR" TTT,15 f . !_, Qi4_'8`l1 •f J(''.`{'j�C?K A1N{;jl PI.AV C'"ryf?,CY`-K
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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
Exhaust Fans
O.K. to Wrap - Gd` `
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
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)
_ e. r16. PTAN. 3A.
_ s CITY OF LA QUINTA
CF'�OFt•� BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Contractor
Permit Number 9909-291
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-260 CITRUS
SFD—LOT 15, PLAN 3. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION I DATE I INSP.
FOUNDATION & SETBACK / 7 - C
MAIN GROUND SYSTEM
GROUND PLUMBING - 1'
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SI NED
CONCRETE SLAB
JOISTS & GIRDERS _
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST — G�
HEATING & VENT • A/C
FIREPLACE
ROOF !
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNI iL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR —;/ll d
EXTERIOR LATH
POOL PRE PLASTER
O FENCE & GATE
SEM R SEPTIC TANK G:(/
FINALS
ELECTRICAL
PLUMBING
FINAL OAS TEST
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS D NOT INCLUDE RIGHT TO
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# 15
SITE ADDRESS: 79-260 CITRUS
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: CBATTS�l BLOW
i
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R-38
CEILINGS: BATTS BLOW
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
BYC'am (3�1�
TITLE: PROD CT N MANAGER
DATE April 13, 000
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LICENSED CONTRACTOR DECLARATION BUILDING PERMIT
I hereby affirm under penalty of perjury that I am Ii0ensed under provisions of
Chapter 9 (commencing with Section 7000) of Division' 3 of the Business and DATE VALUATIONLOT
Professionals Code, and my License is in full force and effect.
4)�ZOT.9U
License # Lic. Class Exp. Date 1
JOB SItE
686995 )4/+Quin ADDRESSI 79-260 RUS
/nate-h� `� Signature of Contractor ...- y �� OWNER
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the fallowing 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 and r Seon B&P.C. for -this ri .
Date Signature of Owner
WORKER'S COMPENSATION DEC /YRATIONM
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:
Carrier Policy No.
(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
Qdde, I shall forthwith comply with those�provisions
P
-,Date: �/ 1 P JApplicant Li'
Y
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 appllcaton agrees to, & shall, Indemnify
& hold harmless the City of La.Qulnta, 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
�t6t 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
co ruction, and hereby authorize representatives of this City to enter upon
th�above-mentioned property for inspection-pu oses.
Signature (Owner/Agent) t Date � �✓
vi -1(:F IELD :-HOMES
3400 CENTRAL AVENUE 911 325
RIVERSIDE CA 92.506
USE OF PERMIT
RESIDENT AJ, RPiviUDEJ,
PERMIT #
°)4.12-2111
15
APN
TRACT 2X490-7
769-696-605
CONTRACTOR/DESIGNER/ENGINEER
Sl;FFFMI'� Li�J`4iI.-
3400 CHN-I R AL AW, -NUE 511E 325
IUV)~..RSIDF CA 925W
(909)fi82-5352. c8f,14 e'W
I.O ft 15 - Su_;PPLIItIWTAL TO P i11 k9909-291, 01AiWCAK) PIAN 3
'ro t+1..AN 3f) tN&I..' 3QUARU1rQ:3'11A01i, CNANOE; t.i.VINcC —+163 S.N..
PLAN 01E%.X F.0i 12k>.UfJG'1s'9t r FOP, N41LIV IASSUE:)
CUZ;TOA,I CONSTRuCTJ0N 16:.00 3F
0
t.ONSTR '12I'10N FU, 101[-000-41.8-000 $:300
P1,A v C-10 (IC FFF 101-000-439-"11R gA. I
11 C'nts1T�ICi FEE 1f)I0'JQ-$d1-QQQ p6.Sl:
i ECTRfCAL F'FiFl 10i -000 -4.2,0 -ON 52.15
3TRONtI &irJY1QN Ffifi -RES 13 101-000-2.41-000 $.9l
AR -r oN ui'1RrjC Rti.Ar''FS - RHSU,- 701- 2.55-000 $2,10Z
fit its=1'c_7! ns, C;(?1vS'F�i7C',7�f)iv t1N1� :PE -AN �'N�:'C�,
LESS PRF-PAIIJ FEES
RECEIPT I DATE I BY
DATE FINALED
pp qq,�� pp t
;I�miiai •ivY
$70.2A
MOO
$70.26
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts
Forms & Footings
T1
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vic/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
CQ_
Drywall - Int. Lath
Final
Final
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
Utility Notice (Perm)
COMMENTS: 1 /
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Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
;r
CERTIFICATE OF COMPLIANCE
Date 12/28/99
No. 19846
Owner NameSheffield Homes
No. 79-260
City La Quinta
Tract #
Type of Development
Comments
Street Citrus
Lot #
Residential Addition
APN # 769-690-005
Jurisdiction La Ouinta
zip 92253
Permit #
Log #
Study Area
Square Footage 163
No. of Units 1
additional square footage -Grandfather fee paid on prior certificate # 19419
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
Under Mitigation Agreement
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 163 or $ 0.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By N/A -Jose Torres Telephone`a
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Exempt
Check No. N/A
Signature
(NOTICE: Pursuant of Ass6mbly Bill 3089 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting