0101-278 (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
Date y y & I Signature of Contractor^—~ ---,�y
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.
MI have and will maintain workers' compensation insurance, as required by
Sedtion 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:
Carver ��yy`yyuu,6 1� MAD
Policy No. 137M-99 Rp�q(y r'y�
4T'�i ATE E fl" r.�AD 13 KLi1T -NQS
(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
Codd shall forthwith comply with those provision's.,
j DAfe: Applicant
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 inspgction•pLirposes.
r
� A i
Sig lure (OwnedAgen) `"^---� � � Date � � .
i
.. J
BUILDING PERMIT PERMIT#
DATE `` VALUATION LOT 0101-2448 TRACT
922&TA6.60 47 1.814 90.7
JOB SITE
APN
ADDRESS
7941.q')VI."Rus
769410-017
OWNER
CONTRACTOR /DESIGNER / EN INEER
WM-FfiIELDHOMES
MIFFMD}f
3400 s:�MypL n4WMEMT, 325
-49
'44.00 (MURAL AW7K .s 31 5
iaEd'.F;RSIDIF. C;.1"•'+, 92506
]VIVFASIDE C/,!, 92506
' Ci3Ir0 5 380
USE OF PERMIT
i
;•3Pf't7q�yt'�yiAFyXIC ISI?TAt?pgP,yP.,��P�'.}l�lIT DOES 1,10T iNCCCL.UDS s
.G LI�IA..I•.. tlP �}!{���4M RRiW,'G �9W 3f i �.1'l`l`iu��i ii.
i
CUSTOM GC?Nf3iIRUC IO'1e 3,1"43,00 SF
PORMIIR TIO 294.00 SI?
0A11. GE/ClARP OXY (S.+) 9,3moo
Y
dRe➢.s58.LY.&f:R•M 01101 .4, tyle 'N.rO SITERU MON
229,736."
FERMTr FAT MADIAnY
C 0148d'1?tFS:VO4«1 YEF 101.000416--000 $1,091.00
PI„d'a.N C:H%. K k7% 101 ••000-1439-3 18 $a3if5.5N
MECRANIC:ALFEE 101-0CM-421-000
i� UMBIANC1IME 1111.000.419-000 �Sgl."iS
STRO'NO A1071117N I.2 N PLESID 101,-000-.241-.000,
(I RADI.NG FEE 103-000-423-1000 $20100
�
f P AAS"I'IF.f.If:'f'EfPM PEZ 221-000-4A3.342 $1,907.00
ART 10 PUBLIC PLACRO - IMIr'101-000-255-000 $71.89
LEW 31" RIE -11AID ;ITERS
$0.00
+ Ta All PERM.xl` YEN'S DUE Now
RECEIPT
DATE
By" -J
DATE FINALED
INSPECTOR
,4
INSPECTION RECORD
1 -
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab 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
POOLS - SPAS
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
//
Waste Lines
Gas Test
Electric Final
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:
/4*1,1 1. c .
CITY OF LA g!JINT
BUILDING & SAFETYff PAgl
777-701. o
INSPECTION REQ S711
777-715,M e2
Owner SHEFFIELD HO
Contractor
Permit Number ' 0101-278.. - 7 _
POST ON JOB IN C01ISPIC000S PLACE
INSPECTOR MUST SIGN ALL APPLICABLE_ SPACES
JOB ADDRESS 79-750 CITRUS
SFD-PLAN IC LOT 47-PERAUT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
11
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
/
FOOTING STEEL
e., l
MAIN GROUND SYSTEM
GROUND PLUMBING
= G
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
7 Q
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
Q
HEATING & VENT -A/C
ROOF - O
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION /y d
PRE -ROOF
,.1
COVER NO WORK UNTIL AB E HAS BEEN SIGNED'i
DRYWALL INTERIOR -O
"EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK rIlylAl lZOF
FINALS
PLUMBING
FINAL GAS TEST .- - t7/
HEATING - A/C
HOUSE NUMBERS i
JOB COMPLETED 41 YEE
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
ollowing.
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: - R3
Type of Construction
Owner of Building: SHEFFIELD HOMES
Building Official
79-750 CITRUS
Bldg. Permit No.: 0101-278
VN Land Use Zone: RL
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 8-01-01
POST IN A CONSPICUOUS PLACE