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9909-293, 9912-211 (SFD)U (V U) W O C) ' W o Z CDD 0 �( J D r� Z r) LIDN ON U Q D_ — Z IUD IM -0 W X W — mUU O rn Z_ oo Z) �0 Q J 61 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Cheer 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 ' uLiciisyC 13 %ilii"1d)i /Date Iry 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. ( �) 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 yy { Policy No. ate%�L'('q\ RM1"1 3 ">.tA • Y 4'{'�lO. ^St?fi :+.9 .� (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 provisionspgf..ISection 3700 of the Labor Code, I shall forthwith comply with those^provisions.�/� / Date: ! f.)/ �} %�� Applicant `. _ N /I�,Y) I `-Jf f! -'� 3 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 reprntatives of this City to enter upon the above-mentioned property for inspection purposes. t( Signature (Owner/Agent) � � ! ��� Date P40 f \J BUILDING PERMIT PERMIT# DATE �IarVALUATION $2,igi.� 4)�1• LOT �.� TRACTS JOB SITE ADDRESS 75-.300 �..i'�AUS APN 69.6.90-007 OWNER `( •�+,[ ` CONTRACTOR / DESIGNERS / ENGINEER .141^4 C.Ei "a xtAL AVE NNVR •.� I'Is K: ', 1400 s -.E:1` I I1.1 L A VENUE 51'E 345 it.iV It.SII�I CA 92506 RIVERSIDE #A 92-506 dVt}�21tiR7-5;Y52 (;TaT •f1 K: USE OF PERMIT SiNGLP, f f4,I'vf LV WtiLLINO 5F0- Lu e P. PLAN 3 - i e RW.s 13&i%S NII -t s IPvCLUDR Gi.;.>a K VIALL OF. KX)L. IS% Kf0.)UL: }'1(_'1N Q' N PLAN 1:111;Cr. i�?s .E' i5.tt. iblilt; �' f d'1,1, T:<.';t1l�1•ff�llS 01i, SAa"+11 PLAN'r: OunWT'oiv CON w.11ir,"WN «t, 1.02,00 >'i' OAR AS42Y;_'AKKX?T 037,otj UF lX f ` 571: 1, AA -4!,, 0'1.���.i 4.F��'�.1.aY N.�Y �, It -T �A1� . .vt�E!3`i ktilC"i tC'ti�i V*011' 101 U)0_41`814 it "n 1. W6.00 In1414141•d ?.40-11�y3gR Pt IAN e"l1gt'lvl T',fZ9yT $♦,4174 � Y�."yy�� EL.(kJRJCA[1 Ff1 i .. 10l4Kal?_4210000 *07.8f. !'#.l.lMBIiIQVFX it I.04* -+SI 41()i.3 18�.ilil 'f 6tf 1N(i MOTTON s'tJ d?t T FIV fif1') (11 i .CM04 1 •(3Fli} 4s^5 s 1 CRAIXI s' V02 It)I-000-422 00{} S: t.i►T� .ART W VU.1100 PLikCii-S - I?.1'.+4 D '701.000-,4:x,5.000 1095.34) 3)#'s'VFL�CA°]IiLNU-1A(."f irIASS, �1,�t�i7.fwf :ai3FL"i ;T 9.C'Ii;,F`'i'j?1if'F'i4')N A.i�ill f../1iJ�:kIC(",� . %rI•.e1� i i%/.-I�t,c�1.� I'`�.L�:9 RECEIPT I DATE I BY I V/ I DATE FINALED I INSPECTOR $4 ?67 1 ri r t. J,O 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 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 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 Fbctures Main Service Sub Panels Exterior Receptacles G.F,1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) L-* 17 PIAN 3C J 4r p4 CITY OF LA QUINTA 3°cFdoF rn� BUILDING & SAFETY DEPARTMENT m-7012 INSPECTION REQUEST LINE 777-7153 Owner SHEFFIELD HOMES Contractor ,Saggrilgi D UQA49S Permit Number 99,0,9-293 POST ON JOB IN CONSPICUOUS PLACE, INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-300 CITRUS SFD-LOT 17, PLAN 3. PERMIT DOES NOT INCLUDE BLOCK WALL OR POOL TYPE OF INSPECTION DATE I INSP. FOUNDATION & SETBACK 41' FOOTING STEEL / 7 _ a _ --'14-7t/' DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS 6 EN SIONED r CONCRETE SLAB JOISTS & GIRDERS r ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC j ROUGH PLUMBING j ROUGH GAS & GAS TEST i HEATING & VENT -A/C FIREPLACE ROOF Tr BOND BEAM O.K. TO WRAP , GROUT O 4' ❑ 8' FRAMING I INSULATION v'Y/ PRE -ROOF ABOVE HAS BEEN SIGNED r Vni 1I/\6L 11•Ir..nlVn EXTERIOR LATH POOL PRE PLASTER 13,0ft FENCE & GATE EW R SEPTIC TANK FINALS PLUMBING FINAL GAS TEST HEATINO a A/C HOUSE NUMBEF JOB COMPLETEI TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING •TAty44a". _ P.O. Box 1504 APPLICATION ONLY Buildin ` / / 7& Addres105 CALLE ESTADO s % 1'�'Ci LA QUINTA, CALIFORNIA 92253 Owner AD/e_/ Sm//BUILDING: TYPE CONST. OCC. GRP. Mailing Addressg/- � A.P. Number Legal Description /0T n1 Contractor Project Description V/T ( O rD h��tiC h o CAS/s�a� �e v, Address CitJy Zip / Tel. State Lic. City C �, & Classif. �- Lic. # / j Sq. Ft. g'� No. No. Dw. Size Stories Units Arch., Engr., G.- /�r Gh �P[ fs New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Designer R 3, Address City; U,/ue Zips / State �/- ( Lic. # Q LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I q,MI'-`ens d un er provisions of Chapter 9 ( ening with Section 7000) of Division 3 ojtfie Business an Profen ions Cod" , and tens 's in full force and effect. /! SIGNATURE DATE OWNER•BUIL E�DECiARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law or the following 3t9 • 06q,OO reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a t permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). [-J11, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. Q do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, Mech. !Z3 provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical Z of proving that he did not build or improve for the purpose of sale.) I 11, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing2-10,00 struct the project. (Sec. 7(144, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 3l, V such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 20- 1-1 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. —0— Date dDate owner Infrastructure 000 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of �� Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ,' , Policy No. Company [7 Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation R l A 0 I certify that in the performance of thp work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation / Laws of California. Date Owner NOTICE TO APPLICANT., 8, after making this Certificate of Exemption you should become ZONE: BY: I 1 subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant -Date— Mailing ateMailing Address Validation: City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES � Q $ �i ROUGH PLUMB. BONDING UNITS STORAGE TANK FORMS SEWER OR SEPTIC TANK 1ST FL. SO. FT. ng �qo ROCK STORAGE FOUND, REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE Y ARD SPKLR SYSTEM GROUT 2ND FL. SQ. FT. d SERVICE FINAL INSP. BOND BEAM WATER SYSTEM �o =$ LUMBER OR. MOBILEHOME SVC. FINAL INSP. BAR SINK / POR. SQ. FT. `• ROOFING REMARKS: GAR. SQ. FT. @ FO I POWER OUTLET ROOF DRAINS FIREPLACE DRAINAGE PIPING SPARK ARRESTOR CAR P. SO. FT. GD GAR, FIREWALL I LATHING WALL SO. FT. @ MESH DRINKING FOUNTAIN INSULATIONISOUND SO. FT. @ FINISH GRADING URINAL ESTIMATED CONSTRUCTION VALUATION $ CERT, OCC. WATER PIPING FENCE FINAL NOTE: Not to be used as property tax valuation INSPECTOR'S SIGNATURES/INITIALS FLOOR DRAIN GARDEN WALL FINAL 71 MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)IDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED r' LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET I COMPRESSOR HPPOLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. na c BATH TUB SQ. FT. @ c WATER HEATER qc> MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/- c SEWAGE DISPOSAL SO.FT.GAR @ 3/ac e 26HOUSE SEWER 2 GAS PIPING PERMIT FEE / PERMIT FEE —' PERMIT FEE DBL TOTAL FEES MICRO FEE M£CH.FEE PL.CK CONST. FEE ELECT. FEE SMI FEE PL MB. FEE ��i r i \`�� ' q (IT 0q, o � R 671'?40 o STRUCTURE PLUMBING ELECTRICAL HEATING& AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND, REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CU. yd. $ plus x5 =$ LUMBER OR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR, FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT, OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 71 DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 12/8/94 No. 13218 Type of Permit I La Quinta Permit # Owner Name Bradley Smith M.D Log No. 79-300 Street Citrus City La Quinta Zip 92253 Study Area 117 APN # Tract # Lot # 0 Square Footage 1 Type of Development I Single Family Residence No. of units 0 Comments Square Footage- 3826 under Grandfather Clause 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of 628.00 x 0 or $ 628.00 have been paid to D.S.U.S.D. for 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 By Cashier's Check Name on the check Dolores A. Ballesteros Telephone Superintendent -74 Fee collected /exempted by Ma Lou Lopez ; `� t Payment Received Signature - � �� g Check Ria 24308 Collector: Attach a copy of county or city plan c c application form to district copy'fo all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting JAMES O. WALLACE Agrloulhxal Commissloner Director of Weights & Measures OFFICE OF THE AGRICULTURAL COMMISSIONER P.O. BOX 1089 RIVERSIDE CA 92502-1089 PHONE (909) 275-3000 FAX (909) 275-3012 83-612 Avenue 45 Suite 7 Indio, CA 9220.1 (619)863-8291 CALVIN C. KAMINSKAS Assistant Commissloner DAN RILEY Sealer, Weights & Measures (909) 275-3030 FAX (909) 2164728 DATE ��/ �/% CASE NO. C-- Gl) L3 DEVELOPER'S NAME: �r--�`� 1.0 13 Dn 1£SO ADDRESS: 1--a, Q L• , CA TELEPHONE: ) °� - r ,1 n Dear Developer. -7c) c� C�� �s Sy -2.` u After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural Commissioner's Offic cc: Indio and Riverside i RIVERSIDE (TRAPPER'S TRAILER) AGRIC. STAND. INVEST. SUZANNE HORNIG AGRICULTURAL AIDES LINDA BURKE MICHAEL DISHMAN BRAD ELDRIDGE SUZY FERRELL DAVID.FINNERTY GRACE HUFF MICHAEL MADIEL SUZANN PHIPPS DANIEL ROWLEN HUGO SOTO ALVIN WATSON - RIVERSIDE (WEIGHTS & MEASURES) WEIGHTS & MEASURES INSPECTORS ALVIN BRADLEY AGRIC. STAND. INVEST. `= MICHAEL LAHTI DENNIS MILLER 2758 MONROE ST. P. 0. BOX 884 12949 FIFTH ST 25784 DELPHINIUM AVE. 12891 SUNNYMEADOWS 4810 ELDERWOOD CT., APT. A 16951 SENDERO DEL CHARRO 5954 MAYBROOK CIRCLE 20805 NANDINA AVE. 12910 PAN AM BLVD. 3450 COTE IN 1315 ROXBURY DR. 27185 HIBISCUS ST. 25567 8TH ST. 9690 SHARON AVE PAGE 3 RIVERSIDE CA 92504 (909)785-9192 NUEVO CA 92567 N/A YUCAIPA CA., .:.-... 92399 (909)795-4996 MORENO VALLEY CA_-'`, x,-92553 -(909)243-8615 MORENO VALLEY CA 92553 UNLISTED RIVERSIDE CA 92501 (909)787-8568 - WOODCREST CA 92504 (909)780-0815 RIVERSIDE CA 92506 (909)684-5937 PERRIS CA 92570 (909)780-0100 MORENO VALLEY CA 92553 (909)653-5972 RIVERSIDE `..CA, 92501 (909)781-4016 SAN BERNARDINO CA .. 92404 (909)885-3670 HIGHLAND HEMET RIVERSIDE OFFICE STAFF DAWN REITERMAN 210 W. KIMBALL, SP. #35 HEMET CA 92346 (909)864-2129 CA 92544 CA 92503 CA 92543 (909)927-5203 (909)689-2076 (909)925-0060 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# 17 SITE ADDRESS: 79-300 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: 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: ,Q TITLE: PRODUCTI N MANAGER DATE April 13, 2000 ESI/FME, Inc. STRUCTURAL ENGINEERS & CONSULTANTS SINCE 1974 December 06th, 1994. RANCHO CAPISTRANO DEVELOPMENT 79-687 Country Club Dr. #201 Bermuda Dunes, California 92201 ATTN: Grant Hornbeck RE: Roof Truss Calculations and Layouts on "Smith Residence" for RANCHO CAPISTRANO DEVELOPMENT CO. (ESI/FME 1094-6708 / BBG 129-1000) Dear Grant: We have reviewed the calculations and layouts by A.C. HOUSTON, INC. and they appear to comply with the requirements of our calculations and the plans by BBG ARCHITECTS, since calculations are the same as FOONSBERG RESIDENCE. The review of these drawings does not relieve the contractor from compliance with the drawings and specifications. This check is only for review of general conformance with the design concept of the project and general compliance with the information given in the contract documents. The contractor is responsible for confirming and correlating all quantities and dimensions, selecting fabrication process and techniques of construction, coordinating his work with that of other trades, and performing his work in.a safe and satisfactory manner. Thank you for your attention to this matter, please do not hesitate to contact us if we can be of further assistance to you on this project. Sincerely, ESI/FME, Inc. By: Danny 1921 EAST CARNEGIE AVENUE, SUITE W • SANTA ANA, CALIFORNIA 92705 • (714) 261-1811 • FAX (714) 261-8506 U) N C/) W O � � r�QLc.) ' W `— o Z Zo OO I.— C) J W LLI a - U) Z C0 u) N ON Ua) It 2a Cc Lo a 0 XW W co J Q QU pU,- d 0) It Z ob Z) r` O LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of .Chaff er 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 Ui,UK3j E �,� % a tDate 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. () 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: F Carrier Policy No. tii`"U"I"R iit.3R N,'i'T'ltJNA V! 'IVC14'0.0'33A. (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'proyis`o-ns. y6ate: 121-111112 Applicant— Warning: pplicant �4 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 inspe/c�tlo purposes. VSlgnature (Owner/Agent) %y lower' /,* Date f `� PERMIT # BUILDING PERMIT !W#2411 DATE A VALUATION � ' LOT 17 TRACT 281190-7 i- I JOB SITE 'a . ADDRESS 7Y--306 CITRUS l(US APN 769-690-00-7 OWNER CONTRACTOR/DESIGNER/ENGINEER SHEFFIELD HOMES SHEFFIELD 1101MES 3400 CENTRAL AVENUE ST..E 323 3400 CEI\ rRA]L A\tENUE STE 32 IUVEItSIDL CA � 92506 RWERSID1, CA 92506 (�f39Kfi�z-4352 f`�1.� S?$6 A USE OF PERMIT .ltrti.iUistRi'- Ai. UMOLDEL r ► LOT 17 - SbPPLEME T AL TO PERMIT i#490!; -53, CHANGING PLAN 3 `1'U!c'.LiSNS.F.; PIAN' (1t#ECK FRE 131/,1)LICEf) F -01t, 44U€.Tl-13SUE) CUSTOM CONSTRUCT ON 163.00 XF Si E,311AMTED (708T 01" MST1111.= ION CONSIRUI: t'1ON FFE 101 -000 -4i8 -OW $`9.50 1111,AN €'°t4 CK F'F f fl i-tNtfl-4 i9- 1 R $6 t't NW"C i71NIC.'AL 2101_000-4/b16.5E �t-(}[l30 ELECTRICAL FIT, FIT, 1,01-000-420-000 $2..tS S' RL)NO MOTION FEE - RES) D 101 -OW -241 -OW AWF iN PUBI.3r, MACT;S .. $T:SI!: 701411111!-255-11`1Ofl $ 3 02 STA!-MXrA , CONI T`1'Ii:t G110N AND PT A N C IFCK S7().26 LESS Pu-mb F'1,'C.a $0.00 'a' CAL P.C4 MIT FEES Oi3,1y, NOW $70.26 i�4i 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 l.Cf F.A.U. Framing Insulation tiU Compressor Vents Fireplace P.L. Grills Fireplace T.O. Party Wall Insulation Fans 8 Controls Condensate Lines Party Wall Firewall Exterior Lath 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 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 CPU 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: Notice: Document Cannot Be Duplicated Date 12/28/99 No. 19847 Owner NameSheffteld Homes No, 79-300 City La Quinta Tract # Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Street Citrus Lot # Type of Development Residential Addition Comments APN # 769-690-007 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 #19421 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 t r Fees Paid By N/A -Jose Torres Telephone : < Name on the check t , By Dr. Doris Wilson ; Superintendent 4 ` Fee collected /exempted by Olivia Aguirre Exempt $0.00 Check No. N/A Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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