9909-292 (SFD)r --
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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
,Date Cf f 7; -' Signature of Contractor
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 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.
( ,J) 1 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 S ct'1o�00`of the Labor
Code, I shall forthwith comply with those provisions.
Date: PV -1 I6tr Applicant o )
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 inspee.ttion,purposes.
Signature (Owner/Agent).! a; i11> Date
BUILDING PERMIT PERMIT#
�x
TRACT
DATE 1WV1#"VALUATION eTl �.� LOT !�
JOB SITE �I U C s RUS
ADDRESS a
1T�74F
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SHEFFIELD HOW,v
SHEFFIELD HOMES
-14W C:EVI"i3.AI, AVENUE SIE 323
AW CFNTItAL AVENUE S'IE 325
kIVf3ltNIM CA 92Sgti
R.1VERSIVE CA 112.015
i911'11KR?-Z3i?. (`RT.# 4ilit►
USE OF PERMIT
SiiNcia. FAN-UL1 uWRIA.INIO
SFU- TOOT W. VI.M4 ,fit - PI,3LIrilT DOEb NOT Itii;Ltiii,fi BLOCK WALL «ft
".)L.7YSro ttiS AX.` 11UN oN PLAN C,1iW-K FU- FUR MUL14PLTs 1W]AN(;V:..
k SAW PLAN T11%.
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0,AC.WPAT141 124.W 8F
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V4,131XVITT 11=T Or CMMTRUM01IN,
PERMIT FLX.**UMMARV
CONI IVIIX*TK)N FM 101-01idl41$4>R14i i. 129-N)
P1, AN rFW k "m 1014W -AV -118 V10 3"/
MCC1TAT+fICALFTX I01000-421.080 U3 50
t i
K.WMICAL FM 10140-420"
PLUWN0 FW 101 4 V -419-M
RT*0oW i W)TION FM - R"10 101^10-7414M VA 97
"'IL'u-M40 full', ' o 1 000--123 000 $20 00
AR f f N PLiBLk', !'LIT. L.a - idStC 701-OW25:5-000 S 3ay.2lt
r`
UtiYF�i.C.M'h:!( fl4ii'A("!' P'F�' St.5N1;'.Ut#
Ni fR-ivirAl.4Y>NRTIVI k •nOM ANI) PLAN t'N1?(°it
s„11S hR
LESS PRE-PAlUFFES
$01%
!'lA"FAL TERMS i Kil':US 1?if1+; NOW
304.1 IS."
RECEIPT
DATE
BY ii
DATE FINALED
INSPECTOR
iv
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
_ (s()
Exhaust Fans r
_
O.K. to Wrap
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
. Z
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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- 2j • Q&T
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
�� d , G/
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.
Smok'a Detectors
Temp. Use of Power
Final -Z _0-V
Utility Notice (Perm)
CITY OF LA QUINTA
ov�� BUILDING & SAFETY DEPARTMENT
m-7012
INSPECTION REQUEST LINE
Mair S14EVIFIELD HOMES -
Contractor SHEFFIFT n HnNITS
Permit Number 9909-292
POST ON JOB IN CONSPICUOUS PNCE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-280 CITRUS
SFD-LOT 16, PLAN 2R. PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION. DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL7 1'
MAIN GROUND SYSTEM
GROUND•PLUMBING
' PRE-GUNITE
DO NOT POUR CONCRETE UNTIL'ALL'ABOVE HAS 6 EN SIGNED
CONCRETE SLAB - L
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
-) r
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED '
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST C�
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP cCJ
GROUT D 4' ❑ 8' '
FRAMING
INSULATION 2 G'a
PRE -ROOF I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH - v
POOL PRE PLASTER
�90.LENCE & GATE
SEWEP SEPTIC TANK _ .
FINALS
ELECTRICAL r�
PLUMBING
FINAL GAS TEST - 6
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# 16
SITE ADDRESS: 79-280 CITRUS
------------------------------------------------------------------
EXTERIOR WALLS
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS:BAITS -':. BLOW
MANUFACTURER: Johns- . anville 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 -,
BY:
TITLE: PRODUCT ON MANAGER
DATE April 1S,12000