0006-282 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 U) W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
L 686895 B 04/30/2(
oZ r- Date Signature of Contractor+ -
(D O
Ji,_ C) OWNER -BUILDER DECLARATION
HW r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ) 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 y he project (Sec. 7044, Business & Professionals
Code).
cr)() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
O CV
O)
Q WORKER'S COMPENSATION DECLARATION
CL
o< Cc I hereby affirm under penalty of perjury one of the following declarations:
U.)
FZ O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W compensation; as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q () (have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn permit is issued. My workers' compensation insurance carrier & policy no. are:
oo Carrier 6 UFE RIt*R �I,�TIONt�a Policy No. WCNW-038A
C)
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sha I forthwith comply with those provisioos M1
Date: 7��ryO Applicant 77>
.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.
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
to above-mentioned property for inspection purposes.
te'
.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
D 5()/e*+y@1�1L IQN LOT 0006-282 •
TRACT
\%_~,— S.:9a7t�t.6t3
28490.7
JOB SITE'
APN
ADDRESS .9-66o ,4= -us
76.9 -710 -ON
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1M',F.EZMIC)M
aI'i"i1 I,i) kC11v1
3400 QF -WEIR- +AWNAIR Me 325
.400 MURAL AVATUE Me 325
1 V1~E7 E CA 92506
RNMIDg
CA.
92506
(909)682.5352
MR 5386
USE OF PERMIT
040jil IRAWLY Dwn. '.I.W{
Sffl- LOT 38 PLAN 2 PERMIT DOES NOT INCLUDE HL LCX: WALLS Ci11!
POOL, "Q% PLAN CHECK FEE RK.DUCTION FOR 188VANCE OF 0AME
PLAN TYPE
CUSTOM CONSTRUCTION 2.881 Do 3F
PORCWPATIO 324.00 Sig
(1L4RA0TYcA11PORT (8F) 104584,00
E ►3ZTV.iATM COW 03V C:C?l+1'MUC7170H
Re
W91712.60
PKRAW IME WAD"RY
,
CONSTRUM ION FRE 101.000.418.000 $1,129.50
T
• t :)
PLAN CHECK FEP:. 101-000-439-318
MECHANICAL, FEE 101.000.421-000 585,50
-
ELECTRICAL FRE 101-000-420-000 $188.31
�
f
PLUM91140 FZF.. 101.000.419.000 1181.75
•4 d `'"
STRONG MOTION IEE - ItE'SID 101-000-241-000 $23.97
6RADINO FEE 101.000-423.000 $20.00
DEVELOPER IMPACT FEE $1,907.00
ART D4 PUBLIC PLACES - .RESir 701.000-255000 594.;18
€ UB -TOTAL CO1:aMUCTIOW ANO PLAN C11t, CK
$3,86:5,68
FM
ESS T7�•�
$0.00
ay'q�a 2 gay �9y /ry r�17I p'»PAAT/•!3
TOTAL AL .Ll l eAI.SYIS r 8 loS �.✓UR .! \ i/� 9T
�..g
RECEIPT
DATE
BY J
DATE FINALED
INSPECTOR
11 •...,✓
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOFr
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— c2S
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
y,— � , w �/'�
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
l .��, C/r✓ _
F.A.U.
Framing
.0�_
Compressor
Insulation
_rir✓ GG--
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final G f
Final
_
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
_
�l
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_ U / LL
Appliances
Final
COMMENTS:
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
=7
Utility Notice (Perm)
G(
a
WTY OF LA QUINTA
�CFMOF��a BUILDING & SAFETY DEPARTMENT
777-7012
SPECTION REQUEST LINE
777-7153
Owner
SHEFEIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0006-282
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS ` 79-660 CITRUS
SFD- LOT 38 PLAN 2 PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
EXTERIOR LATH
FOOTING STEEL
POOL PRE PLASTER
MAIN GROUND SYSTEM
POOL FENCE & GATE
GROUND PLUMBING
SEWER SEPTIC TANK
PRE-GUNITE
-• Gd
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
Gr/
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
D NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
Z,2 -
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
12, Gr}
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS r
ELECTRICAL
PLUMBING
FINAL GAS TEST _ Q
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIFS OR OCCUPY BUILDING
Certificate of Occupancy
City of La QU'inta
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
Type of Construction:
Owner of Building: SHEFFIELD HOMES
Building Official
i}
79-660 CITRUS
Bldg. Permit No.: 0006-282
VN Land Use Zone: RL
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 3-08-01
POST IN A CONSPICUOUS PLACE
1