0003-030 (SFD)U)
F-
N
W
O 0 �
1 r-
o Z
O O
(O
LLIWa�
U)
Z
M
L0
N
ON
20)
CL
Q
Z
Lr) QCl
0
0 J J
mUU
O
LO H
Z_
ob 5
�d
J
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
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
4W09KER'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,1,`as;Provided for by Section 3700 of the Labor Code, for the
performance'of the1work 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.
il11, Z'iOR NA't'IONT�. +
(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: 'K"%. Applicant Z "
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. / �y
Signature (Owner/Agent) Date
0 • ()'u13UILDING PERMIT PERMIT#
1 i19;Qii-.it iH
RATE VALUATION LOT 11-4 TRACT
e
JOB SITE
APN
ADDRESS 79-4ZI; i..I .ti Ti9��S
_
00
OWNER
SIGNER
CONTRACTOR / DE/ENGINEER
4
yy*
e�'6Ff17 i►;r7i1 11 Lliot'rf;'i —"
A/e,11. a .f4", t i[ k
K'"f i.7 '7T:7 n �.1'!�7►•1i!
3400 C.EN T fU. L AVENUE 51*E 325
400 C:ItJ'I'iu L A VVFR E V13 325
€iiV lttii.l.Jl f�'A 92504
RIVERSIDE CA 9230o
1
0,M161r2-5352 CATS _5W,
USE OF PERMIT t
SIN -GL E ! kRtvijLf- UWE1.1.. NG
.'FD4.GT 23 i wL N 2CR-KERMiT DOES NOT r C.LUDi3 EIL%,) �bWrU..LS OR
KkJ4,.73% PLAN CitWK I-'hH I&OUC ION FOR t4 LIVi:tt°LE ISSUANCE OF
SAbf , NLAN 1'V01i.
1
LU,110At COINS TR.UCitOIN k,b'Sci.f3{i yi•
;'OiiCiQT AT10 324.00 SF
t; FrljtJh0EY,,UA#f0'Q1Cf M0.00 Si+
X'STUi►ATE1) COST OF CC'N.7MT.Rb./i...Y.ae�iN
239,712.60
6;t: NS.'. UCT'li)t FEWL I0.t.-WO-418-1000
PI,ANC.;F€rm- ur.;F, i(l1-pll().43s;.3iR V -1A 37
Nii..C1IiNICAL FILEa0i `�1 2i.-0€3(7 :fS.Stii
6LEi:`.iIUCAL F 3 (ijI-uuu •iLO Iiu&,3t
;i't"f rlt3<: MC1'ffra�i !•'1 rS)n 101-0M, .?.41-0M
G12AVU140 FEL 101 000.423.000 $20.00
_1NFRk,A1 JC7TU4'J;F0, S1.967.0tj
ART IN PUBAAC; PLAC28 - n=, 701-000-253-000 $30.2)ff
RPA-"tMAL t;(1MOMt'".T_10N A}\fil IN 'Am C.;HECAK
IRA,1 t S 69
TOTAL PERMIT VC&S DUE NOW
9�.�t;ieftti
RECEIPT
DATE
BY'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- Lc)
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ Gd
Return Air
Steel
_
Combustion Air
Root Deck
Exhaust Fans
O.K. to Wrap
- ,2 - xa
F.A.U.
Framing
Insulation
Compressor
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
_ 4j
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
10L. 0 LIU
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."
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 19 -IT. C3 g
COMMENTS:
• s CITY .La'��,�!'-A
cF v� BUILDING & SA� TY DEPIA ,TMENT
^+oFr 77A47.du2 e-
'/ -IX
♦ •"YNp INSPECTION REQVPT LINE
777-7153 �!
Owner
SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0003-030
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 9A2ftrJT U
SFD :2IPLAN 2C PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP. I
FOUNDATION & SETBACK
FOOTING STEEL''—
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB 1
JOISTS & GIRDERS j
ELECTRICAL GROUND WORK
' � s
+
DO NCFT POUR CONCRETE UNTIL ALL A O E HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C f
FIREPLACE
ROOF
721- c -
BOND BEAM
O.K. TO WRAP -
GROUT O 4' 0 8'
FRAMING I
INSULATION
PRE -ROOF I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
r EXTERIOR LATH C_Z}
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS `
+ ELECTRICAL
FINAL GAS TEST d - c�
HEATING - A/C I
HOUSE NUMBERS ;
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING