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0003-033 (SFD)U) I— N to W O M W `— � IX o Z O O �0 IW a Z co Ln N 0C\1 U Q CL — W Z `r - 0 LL X W — mVU O MLO ob5 C) LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9�,(commencirig with Section 7()00) of Division 3 of the Business and l''rofessionals Code, and rn) License is in full force and effect. License,#o,nLic. 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 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 „`,vi'E ER10R NA:TIONA 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 sha I forthwith comply with thos.e.,provisionst� Data: ��' it ms's? 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 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 � j,6 a©0 BUILDING PERMIT . PERMIT# j iltNi!.D-1! 0,# DATE VALUATION 15258,121-00 LOT 26 TRACT 2k490.7 JOB SITE 7§1-44 CITRUS APN ADDRESS -76 0 _ 014 OWNER CONTRACTOR/DESIGNER/ENGINEER CYTLr1:r,rgnse'G ao+ Qii,IVij✓tjnNr,C .i .3,100 CENTRAL. AVENUE Mii 325 3400 C:kNil AL A IHNUE STS, 3.25 kIVERSIM, CA 02506 RIVUSIDE C:A 92_5W ' (90)687-W C13T.4 533: USE OF PERMIT SINOYL. F'A�.lLi,1 UWI.i„t.lNLi 'uF)-L012fiP1.,^N3141�-fti"A1f3.0ESNU IFfCLjJ1J�i.�3LEJC:ItVFt1lX.sUli 1100L.75% PLAN QfIEC K FEF, ROI)tk:' 10N Y01( fv1UU1101S ISSUANCE OF SAW, PLAN 17VIPE. Cu^, 0AI CO+ICUs I UC'T10N 3.102.00 al: s ui�y TI�A.TI() .300.60 8F OAkA( XARPORT u37,{►I) Sly t l�.r,�STIM Ai',E D COST OF CONSTRUCTION 2. 414 112 14) fl fi'tWIT MSIR SUMMARY CONSTRUCTION r.ION EE101-000-1.18-000 si,1woo 1"T, AN (If • f F,CIN t'F?ft 18 ;a 1,'r4 ;viks("1IANIC-AL FFM ]OI -M-4211-0005 1".) CLF:: TR TCM, FEE. M-000-420-000 k�Ltittif}311`�t k f l 101 -WO -419-000 3183.00 ,siv! too fvlt'1't'fom f4zm, . f Fsi;'jy ti11-(YT I► IL414)on �_R1 CRAMIUC ;Tim I^ 000-A„3-00fl SZO,M INHRt3Tffi,IC'rU.1tE;tWi 225-000413-342 x,1.9ol.co ART 1N:WUBLIC PLACES -1RESII. 701-000-255-000 SUB-71TY)DAL, CON MUCTION ANT) MAN CHECK KIP16 LESS PRE -PAID FEES Mw TOTAL OMMIT Fl,"ES iDITF, NOW $4,267.16 RECEIPT DATE BY',V DATE FINALED INSPECTOR INSPECTION RECORD 1p OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Insulation phalw 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 ' co 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 _ 4J Heater Final Water Piping w 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 Fixtures Main Service Sub Panels Exterior Receptacles - G.F.I. Smoke Detectors Temp. Use of Power Final Q Utility Notice (Perm) —� COMMENTS: , CITY OF LIN��%� 1. c BUILDING & SAFETY FITAAE�iY'`< Fb of "+ 777-7012 � INSPECTION REQUEST epE A% 777 -7153S'4, Owner SHEFFIELD HOMES ` Contractor SHEFFIELD HOMES ' Permit Number 0003-033 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES ` JOB ADDRESS �` 19 48(I;CITRUS I SFD1126PL`AN�-PERMIT DOES NOT I INCLUDE BLOCK WALLS OR POOL I ( TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK _ FOOTING STEEL G. I MAIN GROUND SYSTEM GROUND PLUMBING p• cif PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELESIf ICAL GROUND WORK /-e,-S -�� DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST 7. c�_J HEATING & VENT- A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP orf GROUT ❑ 4' ❑ 8' FRAMING G s� INSULATION - PRE ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR 0'f U' EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK i f FINALS ELECTRICAL Cl T - 00} PLUMBING ! I -FINAL GAS TEST Crj 1 ' HEATING -A/C HOUSE NUMBERS JOB COMPLETED I TEMP POWER i. ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING 1