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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 iri full force and effect.
Licens€-# Lic. Class Exp. Date
oC f335 B 041301'20(
Date'' USignature 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 providedfor 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.
a 0) qq^ A S / N17 3
(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:-��1� Applicant j-�-=�
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. I
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
- 0 ()BUILDING PERMIT PERMIT#
%
,DATE VALUATION LOT31115-1��
TRACT
$239,712,60 10 28,190-7
JOB SITE
ADDRESS 79-564) CITRUS
APN i� /�
16q -6, TO —�/;-?0.
`
OWNELR�
CONTRACTOR / DESIGNER /��ENGtINEER
! s rh tr,� ����
S'Hrl'.1iia.. 'C111 417
:ilvllxlelii.ri�J.�41;t
3400 CENTIW, AVENUE TrE 325
3,100 CEISI U.L AVENUE ST.E 325
RIVERSIDE CA' 9:2506
ILI.VERSIDE: CA. 92500
01(39x82 5352 CI911H. 5396, .
USE OF PERMIT t _
SINGLE FA WRI.YWELLITKO
5I ii-1,vT' 31) PLAN :'Z-.'t11!a2Mi i 7`098 isO i INCLUDE E BLOC:KWALLS OR
.P00L.750A PLAN CiiWK.111M 12F.;UUt:h0N FQK WLTIPIX ISSUANCE OF '
SAIVIk PLAN 'f PE.
CUSTOM COMM VI! ITON 2,98010 3F
P01ZC*'PA'N0 ! 37A.00 SF
GAXA0 JCAIWtJ.RT 540.00 SF
E'STIl4IAi IIEID �f..OS T OF! OONSP:MU .! ION
ti 1,7 s.6.ibsCl
PERMIT FEE 5;1;1fiIMAilV
C.'ON31RUCTIONFEF 101.-000-�tI8-00(3 31,I:t9.�!3
PTI AN 0W. (11K VU- 3
W*01ANICA:L .ITS .101-000-421-000 S tS.50
CLEC fW All FEE 101.400-420-000
PLUNI14IN a FEE, 101-000-419-000 SItt.(.75
4'TY2ONO lVlt-)°t10N F'{!»E-.RP81D 101-0{3ti 241.000 t2z,U7
CJ7'v1f�r;iC rE r W.11 .000-4223-000 $20.00
NFRA.S' RWTUPWM, 225-000-443-342 S1,907.(A)
ART IN P11,13JAC PLACES--RIMIC 701 -WO -255-000 9"34 .25
;SUR 7'C)'C'n crws 'Itl}G'`noN .END MAN CHECK
"J 1 68
LESS PRE -PAID FE'S
$0.00
'IWW',11EitNI Ir`'.fr%,%WC, NOW
�a11`l:E.�►.61I
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
O
Underground Ducts
Forms & Footings
Q - G!/
Ducts
Slab Grade
Cp>
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
Framing
Insulation
O p
- _
F.A.U./
Compressor
Vents
/off
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
. GLi
Final 4�
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
GO
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
on A JePool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
GtJ
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.
Smok1k Detectors
Temp. Use of Power
Final 414
Utility Notice (Perm) 60
COMMENTS:
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CITY OF LA QUINTA
CE.'yOF'Mt'�E`' BUILDING S SAFETY DEPARTMENT
777-7012
INSPECTION REOUE�T LINE!,
777-7153 `�
SHEFYIELD HOMES
Owner
Contractor SHEFFIELD HOMES ,�• `%�'�,,
i
Permit Number 0003-037
POST ON JOB IN CONSPICUOUS PLACE p
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS �i u&
&n,M_?,j, 7'ERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE I INSP.
FOUNDATION & SETBACK - 0Aj 1 1/`
MAIN GROUND SYSTEM
GROUND PLUMBING GZJ (i6{
PRE-GUNITE
00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
, -2 _
} 00 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE H!§ BEEN SIG
DRYWALL INTERiO Y. Gr
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL -2 CW
PLUMBING
Fl—NAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
a