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0003-038 (SFD)N C14 W O =) M � CY ' W o Z O o ( J D LLI F--a� Z Cl) LO N ON UCY) C Q Z U-)QO L X W L — OJQ mUU O rn H Z_ ob ry� V 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 i3 a{.1i 3(3i2tii Date C,'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 oroffered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors Jo construct the project (Sec. 7044, Business & Professionals Code). f ( ) 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 performancevof 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. il;_If .L:A.��i117! 1Vd�d,.ittlil+, YLr"�i.7�Nc�fl (This section need not be completed if the permit valuation is for $100.000 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 sh II foithwith comply with those provisions. Date: —2, Applicant -7--i ---""- 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. x I certify that I have read this application and state that the above information i's 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) _ W ="�-- ^�-�-"�" Date - o - 4yo v BUILDING PERMIT PERMIT# \"I - 0 13-038 \ D TE VALUATION��.g) LOT �� TRACTJOB SITE ADDRESS /9-580 CITRUS RUS AP OWNER ,p� CONTRACTOR / DESIGNER / ENGINEER ITyy� j xy VIA,rf'Cw§R-.frs lJ .iS .�tY •?C"t.A.FFIX1. 1l .I�iF.i.y1` (i .100 CENTIT AL MINUTE STT 325 3407 % ERI'IR L AVENUE STT 325 011 Vt li `.ali li; C.A. 92_`+(1(^ RFVL:tt.S[OE. CA 915W USE OF PERMIT t 8f 14t.0 ' V,tVfv11L.v OUTI.,1.SNO v.,D,L0T ,3A S�l..r N 00 P.�idt�111`,.f3t3L5,l OT .rN �Jl.a&.T�i.4_tr 1't�ca.L.'J go PLAN i;:11FXK ii1 LAJC:1.10N F -OH AdULT IVIL r ISSUANC-F O I'iaiiCl:b A .I 3U0.00 S 1: � V AYl-! e AKI-'0 W 1' 4"47.00 S Y ITIV AA.g. 6ID 0..Q$7 OF ra.FV1' N a 51�l6..i4..�`l�IN A.'"9AAA.1,0 yy^^ �� }' §t, yy,, ��xt �� �pp��56' t3'aa,�qS i'�.:R1l+<%E �!ik;.l�..7GiY.ldYErUIX7 C0N3T'Ki C'Vk N h'fF: 1(10-(1iH1.41K U(N} 1,1y5.Ua� PT,,A'r7�rTcA'pr�prd :(_ FF �/t f►�-Ot/iyd�?-rf 9a/3�� 1 ST43.774 NIEC) IAINIC:,NL M 6 V.i `©00-f2 1 `ti0f� S93,50 t t.i�;TRICAL F& $197.81 RL UA4HINQ FEE 101-000-419-(M ,rrRt;A Q M1011ON Ya'!?[± .. RE T1) 101-0-241-001(1 GftAD YN0ITT, �'; �^[;'('� ��10i1��.:Oy{00-4239-0�T0('^0� i ($y{20.00 1M'RAAR F(UC11TRE 1� 225-000-44i.Y342 WMA✓! Attf' 1_,N PUIM C PLASS - kBSS3:f'701.-000-255-000 ',TA TOTA1v, CnNSMUCCION ANh NA,N CHECK $A,267.16 LESS PRI -PAHA-1 FEES TOTALVERMCCIFU4 X8011F. NOW $4.267.16 RECEIPT DATE r6 / DATE FINALED INSPECTOR INSPECTION RECORD DPERATION 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 • pct Exhaust Fans O.K to Wrap d 0 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 — - U c� 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 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 D d 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: .� cw •� w _CITY OF LA QUINTA BUILDING & SAFETY DEPARTIlq�NT, Fd OF 777-7012 INSPECTION REQUE3T.,.INE-�';L,<� 777-7153 :� t- •'� Owner SHEFFIELD HOMES Contractor SHEEETELD HOMES Pwmit Numtor .. ' 0003-038 POST ON JOS IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS,,.,,_ ERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL TYPE OF IN8PWnON DATE INSP. FOUNDATION A SETBACK FOOTING STEEL i MAIN GROUND SYSTEM GROUND PLUMBING G C) PRE-GUNITE ` DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK I DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC l 0^1 UIMu n1 I IuoiLn 1 & VENT - ' ROOF _ o BOND BEAM O.K. TO WRAP { GROUT O 4' D 8' PRE -ROOF I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I DRYWALL INTERIOR ' cu PRE PLASTER FENCE & GATE FINALS R i�