0003-027 (SFD)M
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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
686893 13 G4130120(
Date . 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 Policy No. { Ay
(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.
Date: Applicant
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 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.
Signature (Owner/Agent) -"" - Date
BUILDING PERMIT PERMIT#
I � 00O x.027
D TE VALUATION LOT TRACT
� !�2 et4,i"21.0t! 40 :18490.7 '
JOB SITE APN
ADDRESS 7"641 f: F T1s 7 6!J_ O - o t
Jo
OWNER CONTRACTOR/DESIGNER/ENGINEER
SIi£:FF NE11,T? I•IOMES SHIETTIEL D HOMES
3400 CEl;i 1"RAL AVENLIL STE 325 3400 CENTRAL AVENUE ST'E 325
KIVEk.S1DI's CA, 92506 RIVEitME CA 92506
(909)tin-" m.. CBI.# . g3fie�
USE OF PERMIT
SFU -LOT 201Ni AK 3C-PEIRIOIT DOES'KO 1' 1XCLLrDF, BLOCIS.WALLS, 01.1
poo..t..
CV STi7ivl C, D N,3 eiUCT:ic7N 3.10100 CF
i 3itc t1Jt�ATIv+ 300.00 SF
t3AttA(%l!( A1ijE'i�I2'1' 6317.00 SF
w
EST JANTAVED CO✓)h OCG°, COM'SsRU`W610N
.1&53,121100
i,�Erma 1"ET sum1Vs"'Aw
Ct: iNS'I'R LICT1:)N .FFE
101 -ow -A18-000
W, Am (71100K. FFE
IM40"34-319
U7di U7
NT, :CIfA;%RCAf4 F 512
101-000-421-000
S:S.50
.IUXAr ''.1IUC:.ALF03
.101 -000 -420 -OW
�tg7.6f
pl.t.lPvfk3iN(31'I:E
101 -OW -419-000
S18310)
STR, ONO M011 ON FFHE - RLE ill)
'!nt-0(�(D-241.4)(1
?7.5.Ri
:.fttAf)[T%'O 171T:
1,01-000-423-000
$20.00
tNF'ItA;;TRUMPX,'F (%
225 -CM 443-342
$1,907.06
Alt! 11%,PL1.B1,1C 'Pt Ar- is .. ISESW
701-000-735-•000
$395,361
RECEIPT I DATE
Lf,SS Pt': -PAID ITES $0.00
"6tOTNI,1<'1i+:ltMIT PTES DUE l\ OW $4,998,39
DATE FINALED I INSPECTOR
INSPECTION RECORD
OL OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
, GC1
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Q- CJ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
ff -
Final17-0-ZYPOOLS
BLOCKWALL APPROVALS
Steel
- SPAS
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
cis
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
CZ
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
SutSPanels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final • GU R
Utility Notice (Perm)
COMMENTS:
A
CITY OF 4A, cfboerr+�° BUILDING & SAF PA
777-7012-�f.�
«. INSPECTION REOUE9T LIE
777-7153
Owner SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0003-027
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 24,,3 ITR
SFW_ �T2Q1LAN-=3C PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
G(/
MAIN GROUND SYSTEM
GROUND PLUMBING
.Z D?J
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
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
-
HEATING & VENT- A/C
FIREPLACE
ROOF
-
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
CIO
INSULATION
r 3U CiI
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH - C�
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK CU/
FINALS
ELECTRICAL GJ. GU
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING