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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
MOM
,Date Signature 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).
( ) 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.
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 Policy No.
(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 provisiogs<of'Secfibn, 3700 of the Labor
Cpde, I shall forthwith comply with those provisions.r
ate: t gr a rA' Applicant—A
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 i spection purposes.
Signature (Owner/Agent,);'-- lEj�jDate
BUILDING PERMIT PERMIT#
DATE f 1 VALUATION LOT ()101.188 TRACT
vR" =V,1121.00 X2100 ;rte zwt,510-7
JOB SITE APN
ADDRESS
79 -'ice"
OWNER I CONTRACTOR/DESIGNER/ENGINEER
AVOC'EMMLAMME; M-325
RNEMSME CA 92506RWEPME CA 92506
USE OF PERMIT
s41.0MFUD HO :S
(9t*)682.3 X52 csu5396
SM- PERMIT €Nt,;I. OP,
POW, HIPATIO 300.04 9F,
QUA€ ICA3iPO T (s£) 12,4t# n
� t��.XuBAIMD
COST OF �'t�.>��'k�I�l'4'"�`ION
256,12 .00
vy y�y�� y $ ��jf)
!!.� `�tl';'$+ii�d�1r.�9.S' R SO.�'.B%MARY
CON311MUC` IOA1M
101.01DO^418.000
$1,.196.00
N CA:�eHECK4 P'S5cn'FM,
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$98.50
RLIEZITRICI:,R,1,'Nb;,1 "
101_000-420-000
$173.01
D'TAIMIS6P-0.r`.RE
101-000419-000
$103.00
S fiRi NIG :l OT)O
101-000-241-000
$23.31
C13t9,i INO FR
101 -000 -423 -NO
V0100
DkIT?K"A 1'IRUC'I'ErFtls,FZI�
.225-00e0-443—,342
$1,007.00
Ala.`)' Fi`1,P11BLIC PLAC - .t ii 701 -000-255-000
S14:1130
MIS PRE-PAIDTHEM
RECEIPT I DATE I BY f! i I DATE FINALED
INSPECTOR
TA, 114.3.
MOO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans '
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation r " w
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
POOLS - SPAS
steel
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 - �f- Q ( ��
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
Fiderior.Receptacles
GTT':
Smoke Detectors
Smoke
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
>
,
a7 ;sok,.
CITY OF LA QUI + Ao t4,�
cF Eo BUILDING & SAFETY DEPA�1
MI�NT Q
OF r'{ 777-7012
INSPECTION REQUES INa CZ
777-7153 O
Owner SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0101-288
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-780 CITRUS
SFD-PLAN:3BR LOT 50 -PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP. .
FOUNDATION & SETBACK
FOOTING STEEL �DE
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB �J
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
t =-27
DO IQOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST AW
HEATING & VENT -A/C
FIREPLACE
BOND BEAM
O.K. TO WRAP
_ d
GROUT ❑ 4' ❑ 8'
FRAMING
- U`
INSULATION
_ d
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR ,
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK fr,110ZA1
FINALS
ELECTRICAL
FINAL GAS TEST Q
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER v
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
il(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: 79-780 CITRUS
Use Classification: SFD Bldg. Permit No.: 0101-288
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SHEFFIELD HOMES
dam%
Building Official
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 8-01-01
r
POST IN A CONSPICUOUS PLACE