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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
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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