0006-286 (SFD)LICENSED CONTRACTOR DECLARATION
V. a 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
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r1L LU 686895 L3 04/30ia
Z r- Date 2 7 1�r Signature of Contractor "= "=iZO �---^
00�
J U C:) OWNER -BUILDER DECLARATION
LI W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co License Law for the following reason:
Z_ ( ) 1, 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).
m() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
rn
Li Q WORKER'S COMPENSATION DECLARATION
C, Z I hereby affirm under penalty of perjury one of the following declarations:
Lo F2 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X Lu �= compensation, as provided for by Section 3700 of the Labor Code, for the
Oro � JQ performance of the work for which this permit is issued.
Q (> (V1,o rhave and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier SUPlERIOR NATIONA Policy No. W�"N73D38�:
r` C7
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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh ll forth ith comply with those provision .
Date: – J pplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its offices§;'agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)r-� - Date
PERMIT PERMIT#
`BUILDING
0�W28$TRACT(/
DATE / J VALUATION LOT
Oe� 4/ $M,121= 42 23490-7
JOB SITE
APN
ADDRESS 79-710% CITRUS
769-71.0-012
OWNER
CONTRACTOR/DESIGNER/EN (NEER
S1.10FELO 140IM19
SIWFFIEW 1101v1L'S
8400 C£NTRAT, AVE ' ST1? 325
.1466 C.FaTIAAL AV EMM =1 2325
R1V1f113A� C.A. 92506
WI%28Ti3F CA 025016
(909)682.5352 C7A.4f 5386
USE OF PERMIT
SINGLE FAIAfLY 17Wh: t.1JNG
VD. LOT 43 PLAN 3 PF. M.IT DUBS NOT INCLUDE F1WOK U9'.AJAZ OR
POOL,. 95 Ota PLAN CHECK FFK REDUCTION FOP. ISSUANCE OIr faA3ui'I
FLAN TYLE
CUSTOM CONSTRUCTION 36102.00 SF
PORCH/PATIO 300.00 SP
CARA(�t',�ARPORT CF)' IZ,485.20
Enm"TED COST Ole COM UCnom
��.5g,121.i1U
1.'ERNIff,YEE StIM&ARY
;
CONSTRUCTION FEE 101.000-418.000 $1,196.00
PLAN CHECK "' E; 101-000439-318 $i3b3. �s4
•1 �
MEC ANICAL. rEt 101.000.421-000 $98.90
ELECTRICAL. FEE 101-000-420-000 $197.41
PLUMBINOFEE 101.000.419.000 $123.00
STRI014 t MOTION FEE; - RESID 101-000-241-000
0RADING 1 E 101.006-423.000 $20,00
DEVELOPER IMPACT FEE $1.90.00
,
ARS` IN PUBLIC PLACES - RESM 701-000-255.000 $14$.30
9CIB-1 aAL CONS°1LttYMON AND FLAW CMC,'i:C
$4,011.16
LTM PRE -PAID FM
$0.00
'IX)TAL.PM.AlYrM10DUE C)W
$407,16
RECEIPT
DATE
BY^ � y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
- DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- G(f
Underground Ducts
Forms & Footings
Ducts
Slab Grade
7 ::21
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
li
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Drywall - Int. Lath
C's
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines �3
Water Piping
Gas Test
Electric Final
Neater Final
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:
V
CITY OF LA OUINTA
°cFboFr� - BUILDING & SAFETY DEPARTMENT
777-7012
INSP CTIONREQUESTLINE
777-7153
it
Owner SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0006-286
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 7,9-700. _CITRUS
SFI4r,L0T 4..LAN_3 PERMIT DOES NOT
INCLUDE BLOCK WALLS OR PERMIT
TYPE OF INSPECTION I DATE I INSP.
FOUNDATION & SETBACK /—
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
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH Q f
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
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: 79-700 CITRUS
Use Classification: SFD Bldg. Permit No.: 0006-286
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SHEFFIELD HOMES
" -r-'-'
Building Official
Address: 3400 CENTRAL AVENUE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 4-19-01
POST IN A CONSPICUOUS PLACE