0003-036 (SFD)U)
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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.
Licer-se # Lic. Class Exp. Date
686895 B OAV30/20i
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:
Carrierpp (� 7'J7�77 ll y,v **t� p • Policy No. T
(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: ADDlicant
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
BUILDING PERMIT PERMIT#
00113-036
DATE VALUATION S'228.7$6.60 LOT 29 TRACT ".7
JOB SITE
ADDRESS 79-540 CITRUS
APN
OWNER
CONTRACTOR / DESIGNER /ENGINEER
Q ILSE2/, Alr Ir 1% 7iVlYl li41,
d
:3 -*0 CEY4"ft AL AVENIJE SPE 323
3400 CsilvMIAL.AVENUE STE 325
ttYill3ESC .E CA 925W
lUVERSIDE CA 92506
(W. )tom -5:52 CMA 53K)
USE OF PERMIT
_ _ -i
SI.NUTA" FAIMILY I)W,ELLINU
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3"IEPLAN'1'YPE.
TION 14_11(124.00 SF
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C� aN A'-ta.1(:1710IN FiE 101 -WO -41t 100 1.lt9L(K)
K - AN C'i3TTy?f `K FrT 10 1-00{} clog -3 f R $271.17
A'et�kl�lVll�kiJ,. 1'Fifa ,f0i`�,.+V"�A3-if .na J.lV
E1.ECA'i3.l.t W. FEE 10] _000 -4,20 -ow M183o 19
P LUMBINQFFE 101 -000 -4.19 -WO $181.75
31,R(C)NQ $b1C)`CION FT,, _ YFFCin I,t Loon_- Ai -MO -V
0Rtt11��t,sNO rM 101-000-41^1000 $ ?t►.rM
INF TItN.S'1`iti3tJ1'tX9FEE 225-00()-41.3.342
ART TN PUBLIC PLACES RE;WL; 701 -000 -255 -WO
5t� •T rr_A 1° CON sT.T1c�1� N I A. f,w.;;t"i,-
$4. )�:
'i't`)TAiL V,IUMIT i{'U4 ES DUE NOW
564.036,38
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— Q
Underground Ducts
Forms & FootingsDucts
Slab Grade
- CU
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
v
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 p
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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
C.0
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
Utility Notice (Perm)
COMMENTS:
0 o i,l r
- CITY OF LUtA�h.,)
cF'bOFlt���`' -BUILDING &SAFETY fiF�.,PAR nZ.
777-7012
ww+ INSPECTION REQUEST; kINE��%'
777-7153 t/
SHEFFIELD HOMES 0p
Owner
Contractor SHEFFIELD HOMES
0003-036
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
V9
JOB ADDRESS
D Q2QP_.ir PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
L _ezj
FOOTING STEEL
_ _
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
pc7
JOISTS & GIRDERS
ELECTRICAL ROUND WORK
DO NOT FfOUR 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
INSULATION
-
(J
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
i JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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