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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.
License # Lic. Class Exp. Date
6895 B 04/3012(
Date � Signature of Contractor �.2
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.
(y)-11 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 OUPERIOR WATIOVA Policy No. WCN'R:03?A
(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 sha4l forthwith comply with. o e pro isions.
Date: 24 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 (Owner/Agent) -m° "' " DateA-la,
/ . .BUILDING PERMIT PERMIT#
__
DATE 7 /R _ VALUATION LOT TRACT
TRACT
f 6
<e- ; C S? t 7 6.�t3 34 - 28490.7
JOB SITE
APN
ADDRESS 79-670 CTIRUS
76.9-710-W4
OWNER
CONTRACTOR/DESIGNER/EN (NEER
ME;F1FT&D FTCA&, S
a , : LD Hubm
3400 G2 +1 12A1. AVE NU T 325
3400 O'14b1`rRAL AVENUE UrE 32.5
PIVER "II7E CA 92506
RILTRSME CA 92506
(909)682.-5352 CBL* $386
USE OF PERMIT
33A ALE PAWLY DWM.7_WG
SPID, LOT 34 PLAN I PF"IT T DOES NOT INCLUDE BLOCK "WALLS OR
POoL.
CUSTOM CONSTRUCTION 276199 SF
PORCHIPATIO 294.00 SF
c3ARACIBICARPORT (SAF) 9.819.60
ES'x°0"7" COSir OF Ct. NS'.CRilC'l OK
` .. 2.St7%.C�
1.
CONSTRUCTION FER 101.000.418.000 $1,041.06
PLAN CHECK N'X9 101-000-439-318 $892.68-
MEC14ANICAL FEE 101-000.421-000 $8.5.50
2 ?.
ELECTRICAL FU 101-000-420-000 $183.19
PLUMBIT40 FRE, 101.000-419.000 $181,75
t, �
STRONG} MOTION FRE * RFZM 101-000-241-000 $22.88
ORADING FFY, 101000.423.000 $20.00
DEVELOPER'IMPACTFEE $1,907.00
ART IN PUBLIC MACES-11ESIL 701.000.255.004 $71,89
J
SUB407AL CONSTRUC`NON AW) !FLAN' C11EC''IC
$4,455.89
IMS PREPAID 110
$0.00
TOTAX, X'ERN1: T :TEES ]R19 NOW
$4455.89
RECEIPT
DATE
BYf/ :Z
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
C: 0,0
Underground Ducts
Forms & Footings
Ducts
Slab Grade
iG(j
Return Air
Steel
Combustion Air
Roof Deck
40 Lp Zef
Exhaust Fans
0. K. to Wrap
C Lj
F.A.U.
Framing
Compressor
Insulation
pd
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
zz
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
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
66
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 O
Utility Notice (Perm)
COMMENTS:
a
j s
. _ loCITY OF LA QUINTA
BtJILDI& SAFETY DEPARTMENT
- 777-7012
rIaSPECTION REQUEST LINE
c 777-7153
Owner SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0006-277
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79 -620 -CITRUS,
SFD- LOT 34 PLAN (PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
-F�
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
-
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL A L AB VE HAS BEEN SIGNED
CONCRETE SLAB
Q
JOISTS & GIRDERS
ELECTRI AL GROUND WORK
DO t4OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
, '?, C
HEATING & VENT- A/C
FIREPLACE
ROOF
/ % . -7-6. ccs /�
BOND BEAM
O.K. TO WRAP - ?O
GROUT ❑ 4' 0. 8'
FRAMING - G�
INSULATION /• {�
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR //- /s c Q
EXTERIOR LATH Gy/
POOL PRE PLASTER
!gRL FENCE & GATE
%EWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST O
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
-
Certificate of Occupancy
City of La. Quinta
Building. and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3
79-620 CITRUS
Bldg. Permit No.: 0006-277
Type of Construction: VN Land Use Zone: RL
Owner of Building: SHEFFIELD HOMES
Building Official
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 2-27-01
POST IN A CONSPICUOUS PLACE