0006-283 (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 04/30/21
Date 7/7 5/ ignature 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).
O I am exempt under Section B&RC. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
1 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.
(1,)I 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 SUPERJORNATiONA Policy No. WC34=38A
(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 sh I forthwith comply with those provisions.
Date:
Applicant—
Warning:
pplicant 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.
r
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
BUIILIJING PERMIT PERMIT#
DATE j OVv @05TION LOT "3 TRACT
39 28490.7
JOB SITE
APN
ADDRESS 7,9-ov Cmus
769 -710-OM
OWNER
CONTRACTOR / DESIGNER / ENGINEER
9F1EFF:lF.= HC>1a-8
S M.IEW HOMES
3400 CENTRAL, AV.C?N E 3`PE 325
3400 CENTRAL AVLWUR ME, 325
RTVM1DE CA 42505
RIV1MME CA 92506
(909)682,5352 CBL# 5386
USE OF PERMIT
SiATC1•I. E FANOL Y IYWW.MC3•
SVD- I.OT39 PLAN 5 PERMIT DOES NOT INCLUDE BLOCK: `►AI'AL S OR
POOL,. 75 % PLAN CHECK FEE REDUCTION i+OR. ISSUANCE OY SAME
PIAN TYP1x
CUSTOM CONS`FRUCTIOW 3,102.00 By
PORC1•i/PATI0 500.00 Sp
GAR/1CIFICARPORT ( P) 12,433.21
r
ESTwA'Z'w c6sT OF C0wimucnC?Pt
?1 ;123,t90
O MXP,Wr FEE &V M iARY •
1�e Y ( Y�y
CONSTRUCTION FEE 101-000,418-000 $1,196,00
€..,. i in
PLAN CRECK ME 101.000-439-318 5243.74
MECHANICAL FEE 101-000-421.000 S9t3.3'0
ELRIC PLICAL FEE 101-000,420-000 8197.81
PL UMBrHo F7?E. 101.000-419-000 $183.00
STRONO MOT ION ",Ft - RFSID 101-000-241-0100 825.51
ORA1DWO PEE 101-000-423.000 820,00
I)EVELDPEI TMPA1 T 1°FZ 81,947,00
Alta' rK PUBLIC PLACES - RESIN 701.000.255.000 $143,30
8't3'B-TOTAL C014L'I RtTf i' 0X.AND PLAN Crl-XW.IC,
$4,017.16
1 V3 PRE -PAID k
$0.00
TOTA1 X'MMU V=S DUE , 90W
$4,017,16
RECEIPT
DATE
BY r /`
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- CIO
Underground Ducts
Forms & Footings
- c(,(
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-
Exhaust Fans
O.K to Wrap
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
Steel
POOLS - SPAS
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-
��(
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:
/ / .r2 t
.,2 3- co �1v
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 Type of Construction:
Owner of Building: SHEFFIELD HOMES
79-670 CITRUS
Bldg. Permit No.: 0006-283
VN Land Use Zone: RL
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
�--� By: KIRK KIRKLAND
Date: 4-9-01
Building Official
POST IN A CONSPICUOUS PLACE
313
' CITY OF LA QUINTA
cFyOF a ,,L*RILDING & SAFETY DEPARTMENT
777-7012
-�I�la tCTION REQUEST LINE
"
` r 777-7153
Ow r'
SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number ' 0006-283
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 19:079 CITRUS
S F D t4OT_39 PLAN'3 PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK -
FOOTING STEEL ct/
MAIN GROUND SYSTEM
GROUND PLUMBING --��
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
G4
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK/i 7/ �� _
FINALS
PLUMBING
FINAL GAS TEST _
HEATING -A/C
HOUSE NUMBERS t>
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING