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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
G>iciE��S fLi 04/30120(
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: ,
( ) 1, 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.
4?Vf`fil V
(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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to ,the .conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work,for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)=�-"-�-~Datej`��'�":
•J
1 "J BUILDING PERMIT PERMIT#
`5
fil9ll.i-190
.DATE VALUATION s2n,-Im t LOT 72 TRACT 284• Ie'! -7
JOB SITE
ADDRESS 7r.)-400 CITRUS RUS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
., HE�'1.1.� 11.1.) f IMI IE,S
c.111.1 I�':hT,T) t'O"�4:?S
3,1000 C:EN IRAL `iVE'I UE grE 325
3,100 CEWRAL AVENUE STE 325
RIVERSIDE C.A. MW
IUVEI'1,�IDE tti.`A. SWW
(%".K.2-5352 C,T3i.9# 5z13fi '
USE OF PERMIT
SINGLa FAQ ILV DWELLI.N'G
D -LOT 2' RLAN Irl .KW1'v11T DOES NOT :INCLUDE BLC}*;.'KWALLS OR
11001,39%;,.LAN C:t-!hCK. V,G,.'.E ItlslaUCTI.t N b -OR MULTIPLE ISSUANCE' 01:
ti�1f�{!M: PLAN �^Ic'I't3. • .
C1 TON3 CO`i3u; RUCa 10'N' u, i v2.CQ10-11
d�CJztlrfL•I'ATIO :z�I.ut) S�
_
t3AItAG±k7(:Akl%CJ121 91)1.00 8F
kS"1IJMATE R COST Opt1`:� ;: 'C .� 'N
223," 5.6.601
�$.tRMT s+'.EP,Sa.3�t' MAR �
{.`c` NS!J1, JCT1UtJFHE 101-000418-000 $I,t►JI,+���
P), AN CHIF(M TTF 1(01-f/)�f(l�(1--x22 iA./t�7�9 $RRw rR
!.R '^i1 fAV1Ctl.i� f'i;e A��•Vl!V"4ah.1 ^VV1e .lU i.J�)
1sT i:t:"i7;EICAt; f I Ji 101-000-420-000
PLW A 8 1 No FE131 10:0-0i)li-419-1)019 $181.75
C'1T{PYATC7 Mf1' ION F- - 01-( M-241-O(N) S ljii
CRADINO 1037 101-000^423.000
�tVI3iA�i'1't�ilC: l / 2J:1iLTs 225-000.443-342 t.Nil l.tit�
AWFIN PTJ.BL1.C'P1.AS;E"S - atwS1L` 701-0)00-255-000)
t SUJITOTALCONSIRLit"-10 AND PT.,A i 041' .K,
$ ,705 Rq
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$0.00
I O AL VElLA19 I' F.fik+ % OUt.' N AW
$4.74)5.89
RECEIPT
DATE
BV
t I.7 /.
DATE FINALED
INSPECTOR
/ - a- — '
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- Gv
Underground Ducts
Forms & Footings
Ducts
Slab Grade
G(/
Return Air
Steel
Combustion Air
Roof Deck
UO&g LCi
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 -On I A&Z
BLOCKWALL APPROVALS
Steel
POOLS - 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
, Ccf
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
- O
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke, Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
CITY OF Ate'
*4v"BUILDING & S , DEPA _,)
777- 04z
a INSPECTION REOU'kST LlNE'Ci x
m-7153
Owner SHEMELD HOMES O�
Contractor SHEFFIELD HOMES
Permit Number 0003-029
POST ON JOB IN CONSPICUOUS PLACE
t INSPECTOR MUST SIGN ALL APPLICABLE SPACES
rjlig
408 ADDRESS
SFDtQ. ASI..' , « PERMIT DOES NOT
f INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION b SETBACK
FOOTING STEEL Gd
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB O0 j
JOISTS d GIRDERS
ELECTRI AL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 3 GAS TEST
HEATING b VENT -NC
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP p�
GROUT 0 4' 08,
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
wn 9 "PW6 11191 cnwn le — -
1
EXTERIOR LATH
+;
'
CITY OF Ate'
*4v"BUILDING & S , DEPA _,)
777- 04z
a INSPECTION REOU'kST LlNE'Ci x
m-7153
Owner SHEMELD HOMES O�
Contractor SHEFFIELD HOMES
Permit Number 0003-029
POST ON JOB IN CONSPICUOUS PLACE
t INSPECTOR MUST SIGN ALL APPLICABLE SPACES
rjlig
408 ADDRESS
SFDtQ. ASI..' , « PERMIT DOES NOT
f INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION b SETBACK
FOOTING STEEL Gd
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB O0 j
JOISTS d GIRDERS
ELECTRI AL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 3 GAS TEST
HEATING b VENT -NC
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP p�
GROUT 0 4' 08,
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
wn 9 "PW6 11191 cnwn le — -
K-/ ,
EXTERIOR LATH
+;
'
POOL PRE PLASTER
POOL FENCE d GATE
SEWER SEPTIC TANK _cU (/
•r
FINALS
ELECTRICAL cd,
PLUMBING
r+'
FINAL GAS TEST
HEATING -AIC
1A
HOUSE NUMBERS
' JOB COMPLETED
TEMP POWER
;
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
I