0003-026 (SFD)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
686895 8 04'301201
ate —51 A Signature of Contractor -a
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 isnot 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:
(- ,4t ave 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
Code, I shall forthwith comply with those provisi- omens M
Date: r 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, indemnify
& hold harmless the City of La Ouinta, 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.
i17gnature (Owner/Agent) -� Date _` 110 4
�/d r BUILDING PERMIT PERMIT;1006
DATE VALUATION 32,39,7MM) LOT 11) TRACT - 28i"_7
JOB SITE
ADDRESS 79-340 CITRUS6
APN
R71,7-74911—
on
OWNER
CONTRACTOR / DESIGNER / ENGI EE
i' Tl WrI .T'l7
�T.ItIT.'s"TI., LY(1�0Rf1�
IA
.36iC
LAA., \l4pj
.i 1.,\G.� I ALL. Ai./V
3400 CFN'i"RAT. AVENUE S"iE 325
3100 CENTRAL A4`FNUE SrF 325
ItIVER8I'D h CA 92500
RIVEKSIDE CA 92506
(c jfifS2-.i3K2 r'BLfI 5386
USE OF PERMIT
SINC,i,EAMILYGW)RUN-0
5FEO-I.01- 19 PLAN 2 k-%L'i' IT DOES NOT IMMUDE 1:ii3OCK-WALLS OR
POOL.
.;v I I Ct�td � �r� rr�N Z886.00 sr
a 0kC1J.VP1V.r.1 1 324.00 SN
f. AkA(JfifCAR1-A J,V.1' 54U.00 SF
1ST1fl *1'ED COST O!7 CO,°4STrUt-TCI: N1
239.7,12,40
CONSTRUCTION FEE 1()1-000-4.t8_000
P1,AN('4Fr;? 101-111IM-r139-318 gy2t.nt;
1` il-CTHIAI ICAL FE31 101-L`00.42:1-000 IS 5-4M
ELFT III ICAJ.'.EE 101-000420-000 $188.31
t't.,►,_If16BINCY FEE 1.01-000-419-000 $181.75
3 P►2.!)tr*C1:M6?'If1N u.!F . Fj Srn 111J -000-14! -()ffl523.97
GRADING f7EE 101-000-422.000
fNFR16TRtdCTU R M, 225-000-443.342
Ai`# IN E't: AJAC PLACES - .KF;S1C 701-000-2554A0 $349,28
s p
(TB -10TH-, C_OfO,"a".RUCTION AND Fl..AN (,fT
$4.,906.79
LESS PRE -PAID FEES
U0.00
W1'AL I'ERIWIT l.+CC$ t31%1NOW
$4.N06.79
f
RECEIPT .ti
DATEBY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
- DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
—Gr/
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
CPO
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
_
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
1
N . I
I
� I
n s I
CITY OF LA QUINTA
`cp�oFo� BUILDING & SAFETY DEPARTMENT -•
777-7012
INSPECTION REQUEST LII
777-7153
SHEFFIELD HOMES
Owner
Contractor SHEFFIELD HOMES
Permit Number 0003-026 /�• <1
POST ON JOB IN CONSPICUOUS PLA Epi.
INSPECTOR MUST SIGN ALL APPLICABLE SPACiM,'
JOB ADDRESS _ _UI$
SFD- 'r�19'P N 2A PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
ROUGH PLUMBING
FOOTING STEEL
G cy
MAIN GROUND SYSTEM
HEATING & VENT - A/C
GROUND PLUMBING
ffz
PRE-GUNITE
ROOF
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
/ -
JOISTS & GIRDERS
GU
ELECTRICAL GROUND WORK
DOf4OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
7_77 Cld
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GU
GROUT ❑ 4' O 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR _( '� :4e,
EXTERIOR LATH CW
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST - (y U
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
0