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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
f 8fi$93 B U4/10/2(
Date +/� )Signature of Contractor•!'-'�-1=—
.�n
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.
(V 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 SUPEI JOR NATIONA Policy No. W.ONW039A
(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 forthwith comply with tho e_provisio s.
Date: , 7i?ii Applicant ,-
Warning:
-
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;
� c
UILDING PERMIT PERMIT#
DATE / _VALUATION - LOT ��0
TRACT
Y�
37
28490-7
JOB SITE
APN
ADDRESS 79-w ainuts
769 -71G -W7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
STEWY BEELD HOkAW
13HPI7+WU) FTOMI~5
3400 C:4: W I X,, AVEN UE SIE 3 U
34.00 CINTRAL AVEMM ::M 325
RIVERME CA 92506
Ri1ERME
CA.
92506
(909)682-5352
CU
5386
USE OF PERMIT
;Dt► GLE PV&LY OV41I+.i..IING
S?D, L()T 37 P1.AYJ I PEF:iNiT DOES NOT INCLUDE. BLOCK WALLS OR
POOL, 75 % I'.I.A CHECKPRI EDUCTIC)N I:-k)P IBSLIANCE O ZvAMP,
PLAN TYPE
CUSTOM CONSTRUCTION x,7$300 aF
POR.CHIPATIO 284.00 3r
GAR&ONCARPOR-1 (0) 91819160
ZD COST OF G0X9nZVCF10X
�,
',=.756.W
�Xh-XXM
o
C-OAISP UCTI )N M 101-000.41MOO $1;091.001
PLAN CHECK FEE 101-000-439-318 $223.17
ME, GHANIC.FL FEE 101.000.421.000 $35.50
EIAf3CTRICAL YZE 101-000-420-000 $133.19
PLUMOTNO FEE 101.000-418.000 S181.75
4,11
9T'RONO MOTION PEF-11ES1D 101-000-241-000 322.E
CERA INO FFM 101,000-423.000 $20,00
�..�
D)WELOPER IMPACT FEE $1,907.00
ART YN PUIUC PL CES - RESIT 701.000.255.000 $71,99
SUB -'MTAL.COM.iRYTC'1"IONAND PLA14CHM,C
$3,786,38
IMS PRD, PAJDFR
$0.00
TOTAL �'R--W kTES 1311E NOW'
4
67136,3£I
RECEIPT
DATE '—'BY-
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
.42- y.- cd
Underground Ducts
Forms & Footings
— Cl?/--
Ducts
Slab Grade
=�'� �/ ��
Return Air
Steel
Combustion Air
Roof Deck
_ W
Exhaust Fans
O.IC to Wrap
/: ?
F.A.U.
Framing
Insulation
Fireplace P.L.
—1 C
/���� _
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
_
Final
Final _z
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
C-40
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
{
�` �6
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 - p
Utility Notice (Perm) l?> Q
COMMENTS:
`
CITY OF LA QUINTA
.Bt��DING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
�L 20�� 777-7153
ow�-LS
HE1,FfJf LD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0006-280
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-650 CITRUS
SFD LOT 37 PLAN.I PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
/ - Cif
FOOTING STEEL
-
MAIN GROUND SYSTEM
GROUND PLUMBING
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
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE '
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
INSULATION - _ d
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR Aj
-
EXTERIOR LATH !�
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL - Q
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
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: 79-650 CITRUS
Use Classification: SFD Bldg. Permit No.: 0006-280
Occupancy Group: R3 Type of Construction: VN
Owner of Building: SHEFFIELD HOMES
Land Use Zone: RL
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
last
Date: 3-08-01
Building Official
POST IN A CONSPICUOUS PLACE✓