0006-279 (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.
License # Lic. Class Exp. Date
fk� 895 B f ^ 04/30/2(
Date 47 Signature of Contractor Mr lE
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
perfor • ance of the work for which this permit is issued.
7(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 SUPERIOR NATI NA Policy No. W047803iiAA
(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 provisio sem.
Date:
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 propertyfor inspection purposes. /
Signature (Owner/Agent)Date
WILDING PERMIT PERMIT#
/
,DATE J� 7 VSA UATION LOT X2'79 TRACT
JJ $258,121110 36 284911-7
JOB SITE
APN
ADDRESS 79 01 C17!`tws
769-710-006
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MWFIEW HONM.
,
81MYRLD .C1 OWS
34010 C.E TR.AL AVEN E = 325
3400 CL-.'N1M. , AVEN"U B VI'E 325
RIVERSIDE CA 92506
PIVMME CA 92505
(903)682-3357 CB.14 5386
USE OF PERMIT
,`�ftJGI,T TA2t1.'Sf DW =1 G
SPID-LOT 36 PLAN 3 PERMIT DOM NOT INCLUDE BLOCK W.A LL.N Oir'.
POLI,. 75 $'o FLAN C}iFM FEE REDUCTION M ISSUANCE OF SAME
PLAN TYPE
C138TOM CONSTRUCTION 3;102:00 OF
PORC HtPA.TIO 300,00 SIP
GARAWCARPORT (Si) 12,433.20
3
ESMIKYRD CyOIST OF CC+1�T fRUC17O.N
z2 ,121.00
P3s:1d.11/1 T 197RE StI ARY
{
CONSTRUCTION FEF: 103►fl00.415t-000 $1,190.00
PLAN CHECK FEE 101-000-439-31$
MECHANICA[, ME 103000.421.000 $98,50
ELECTRICAL FEE 101-000-420-000 $197.81
PLUi+l33W FEE 101.000.419.000 $183.00
STRONQ MOTION FEE • P.L;IO 101-000-241-000 $23.81
t� ~-
01RADTHO FER 101.000.423.0001 $20.00
>< r
]DEVELOPER IMPACT FEE $1,907.00
ART IN PUBLIC PLACES • RMIC 701-000«255.000 $145.30
S,TB40TAL CONS TI U'MOM AND PLAN 6UCK
$0,017.16
1..= PKVI-kPAID FEW
$0.00
RECEIPT
DATE
BY- �
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
y
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
- (,t
Ducts
Slab Grade
Return Air
Steel
r
Combustion Air
Roof Deck
O.K. to Wrap
O ^-
- C -(f
Exhaust Fans
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
C/ -
Dr Zli - Int. Lath
2 00
���` F 7• Gd
Final
QI AC
_
Final
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
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:
p
® �, GI�Y OF LA QUINTA
cfdSo ��o BUILDING & SAFETY DEPARTMENT
2Q�
INSPECTION REQUEST LINE
777-7153
Owntr SHEFIFIELD HOMES
Contractor
SHEFFIELD HOMES
Permit Number 0006-279
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS r.79-640.CITRUS: -
SFD-SLOT 36 PLAN 3 PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
6�
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
-CONCRETE SLAB V& . C�7
JOISTS & GIRDERS
ELECTR AL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH GAS & GAS TEST
HFATINr. A VENT- Alr "v
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR �7
EXTERIOR LATH 2-
POOL PRE PLASTER
ENCE & GATE
SEWElk SEPTIC TANK J =Gl
FINALS
ELECTRICAL - 12 0 1 46(Y
PLUMBING
FINAL GAS TEST - Q
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED V.
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
79-640 CITRUS
Occupancy Group: R3 Type of Construction: VN
Bldg. Permit No.: 0006-279
Land Use Zone: RL
Owner of Building: SHEFFIELD HOMES Address: 3400 CENTRAL AVE STE 325
Building Official
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 3-08-01
POST IN A CONSPICUOUS PLACE