0003-032 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of f
Chapt3: 9 (commencing with Section 7000) of Division 3 of the Business ander
Professionals Code, and my License is in full force and effect.'
License # Lic. Class Exp. Date
686895' it 0.00/"20f
Date s// �'�4;�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 p �� r Policy No.
1
(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 provision .
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 (OwnerdAgent) "'" � - Date, ' !"
%i
- /0 UILDING PERMIT PERMIT#
�3��f3.�-�).;Z
DATE VALUATION LOT TRACT
228,756,61) 25 9490-7
JOB SITE
ADDRESS 7)'.60 CITRUS
APN *'
-767-070-0/6'
I
OWNER
CONTRACTOR/DESIGNER/ENGINEER
13f113'e 1 L,t� EIORoL S
3400 CRN T RAL AWNUE SM 325
3460 CENTRAL .&ViiNUE MT, 325
Et,1vii"1.1A, A. 925W
itIVF,"lyf)H CA. 92506
'
i�3p�11f,R2.53�2 C:'131,� Ski
USE OF PERMIT
k A.WLY %i1,i,LiN3•
'Wil. -LOT 2115 PLAN 411-PERfUlT LEIS 14t7i ' iNCLME,, Bi,in:'i;tir ALAS OR.
P -10L.1:516 PLAN 4URIX& YEL 10iN.KA-10N FOR M.Ut.'I iPLL, ISSUANCE O
�AA1fs 1.4,AN T.K.
—4^ n - "162 n <f F
41 'n...•. co
C.r3:, TOM d.ti�n,..,3 icCl� I'iC,iv �.,, uti.vt� .aC�
;�E,2C•%i���TIii - 284.60 S
C ARA QI_-fC:ARk'c)IC`1' ts.l.uU tit'
&S"1 ENV t IED MS`s' fib? : KON&A OUC 4110N,
223,,755 0,60
PERMIT r1Z STuRILvliriRY
C CQ4S .KtfC'r10N k}--6 i1Jt-000-418-000 S1,091.00
PT, .a N(71�w w Te iTF. 101-(N 0439-3 I R $n'A� 17
NIE-Cf1r MCIAo. FfiL: 101-000-42:, • 010 sft +.50
U.I,tt;TRICAL FEE 1.01-000.420-000 $183.19
IfLUMLMNO Fa.' 10:1-0(XI-419-000 t 181.73
s;•s?0140 k4o'noti F'F - lmgn) 101-OM-2414xxf $2Z8N
C,f2A,DINC, rrX 1101-000-423•060 $20.00
WIUE SIRUCIWE FEE 225-000,4433-342 51.907.ttU
ART 1N 1•U13IAC PL Af.X3 - RE-Sif: 701 -000-'455-000
SI.T.N 1TYTA1, CC1NVf KLJTM_. AN ANT) Pf.AN 0,I1117CK.
LESS PRE-I'A]b FEES
$0.00
RECEIPT
DATE
B)( I
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
/
Slab Grade [i — -G(/
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
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 - UU
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _ Cv
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection IPAEncapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) ( p _
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fbdores
Main Service
Sub Panels
Exterior Receptacles
G. F,1.'
Smoke Detectors
Temp, Use of Power
Final
Utility Notice (Perm) - C76 Lf-
COMMENTS:
�l
CITY oF,47A o, ,
�i
BUILDING & SAF rr�� DEPAe`IM iNT i
A ` �� 1
�.,... INSPECTION REQUgST LINA
777-7153
Owner
SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0003-032 '
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
«:
JOB ADDRESS f
SFD4214t2j'W&PERNIIT DOES NOT
f INCLUDE BLOCK WALLS OR POOL
r
TYPE OF INSPECTION DATE INSP.
FOUNDATION 8 SETBACK
' FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
! CONCRETE SLAB
JOISTS d GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING 3 VENT- A/C
FIREPLACE
ROOFra-
- �tJ
BOND BEAM
O.K. TO WRAP — 6
GROUT O 4'- O 8'
j' FRAMING —
I+ INSULATION
i PRE -ROOF
i
i COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
i DRYWALL INTERIOR . -
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE d GATE
I SEWER SEPTIC TANK l ?_ �/ • 4.,- .mow
I I
+ FINALS
I! ELECTRICAL C
PLUMBING
FINAL GAS TEST
HEATING NC `
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO F
TURN ON UTILITIES OR OCCUPY BUILDING
u