0006-278 (SFD)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
686895 D 04/30/20
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.
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 9UPEP.IOR NATIOTIA Policy No. .C+> CN79038A
(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 Shay forthyvith comply with those provisigns.
Date: 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) """" Date <<
BUILDING PERMIT PERMIT#
�
DATE /� VALUATION LOT TRACT
-' / 0/ W937t2.60 35 26490.7
JOB SITE
APN
ADDRESS 79-rao cnnus
769-710AW
OWBNyEgR7
CONTRACTOR / DESIGNER /EN61NNEER
cT%6Li1! L:A ./ Ac'A 1Vi.0 G7
ftACF1LD iONM
3400 CFRrRAL AVE13 U.0 .Trk 325
3400 CWn AL AVM�1'UL++` M; 325
1ttI1 KRSME Ck 92506
RIVEMME CA 92506
(909)682.5352 CB16 5386
USE OF PERMIT ,
SYD- t.AT 39 PLAN 2 PERMIT IONS NOT fUCLUi]f,' HLOCK WAI. IZ OR
PERMIT.
CUSTOM CON11TRUCTION 3,806.00 OF
POACWPATIO 324.43 SF
4.A.RACfF?!C`,"tPURT (,F) 10,5&4.00
FMMATM COST OF C:OFdS`iTT< UC"f"lon
COrig3TRUCTt(N PEEP 101=000.418000 $1,139,80
G 3
PLAN CHECK FEF 101-000-439-318 $931.49
f`•F � 3 �.
MECHANICAL FEE 101 »000.421.000 X5.50
• : 1 'f ` • �
ELECTIUCA1, FEE 101-000-..420-000 $198.31
PL'UIv1BDIO FEZ 101-000.419.000 5131.75
- ••
f . 0-e
STRflNO MOTION FSK a RESI.A 101-000.241-400 $33.97
GRADING PEP 101.000.423.000 $30.00
I)ZVEMPER IMPACT 4?I,E $1,9n QO
ART IN 1;i38UC PLAC'• - R�:SIE 701-000.255.000 $99,2,8
x
SUB -TOTAL C:0X8MU'L"T:{0tT AND PLAN t.nTWICK
$4;456.79
USS PRE -.PAW YMIS
$0.00
i' fAJA P -VOW -1 Y1' EN. DDE NODI
$4;-V 79
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
v 3 . Ota _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- cd'
Exhaust Fans
O.K to Wrap
77
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
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
--
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:
A
CITY OF LA QUINTA
/��llJ�ILDING & SAFETY DEPARTMENT
Fb t eta � Q i�pUv 777-7012
rECTION REQUEST LINE
777-7153
Ow4r.SHEFFIELD HOMES
-
Contractor SHEFFIELD HOMES
Permit Number
0006-278
POST ON JQB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-630 CITRUS
SFD- LOT, 35 PLAN 2 PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -2
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
NLA IINU6 VtNI -A/L;
C10=D1 Arc
U.K. I U WHAT'
(:RrN IT rl d'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .
DRYWALL INTERIOR l Ta
EXTERIOR LATH cJ y
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
61
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
79-630 CITRUS
Type of Construction: VN
Owner of Building: SHEFFIELD HOMES
Building Official
Bldg. Permit No.: 0006-278
Land Use Zone: RL
Address: 3400 CENTRAL AVE STE 325
City: LA QUINTA CA 92506
By: KIRK KIRKLAND
Date: 3-20-01
POST IN A CONSPICUOUS PLACE