0105-009 (RPL)(2
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LICENSED CONTRACTOR DECLARATION, �^ —
1 hereby affirm under penalty of perjury that I am licensed under provisions of
Charter 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
x.53 (.7.7— i
/ate `7 Signature of Contractor' !/
OWNER -BUILDER DECLARATION ter'
I hereby affirm under penalty of perjury that I am exempt -frog 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.
211 1 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:
Carrier ST AVE FUNID Policy No. 100437401
(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 Calilarnia, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 tithe Labor
hwi�hCo e, 1 shaVortcomply with—those—provisions.
Date: %Applicantr
Warning: Failure to secure Workers'..Comperisati0n?overage)swunlawful and
shall subject an employer to cfiminal penalties and ciyilllfines unto $100,000, in
addition to the cost of compensation, damag"s 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 hi -s
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.
1 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
2agnaiure
habove-mentioned property for inspection,pvtppses..
+-- r 1�
(Owner/Agent) `^'`' 11 A, -/'% ;�' •,,DaZe
BUILDING PERMIT PERMIT#
DATE VALUATION y p y� yip LOT 0:105-aw TRACT
JOB SITE V F�
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
i��;!��'�I�� ��faid:�L•�
�,%�.i°� :rr'� 1:�1'3'�t�"R:?�L97C,�ci
Y?00CM YJ R AL, ANINU.: M. 1325
81961MQIN'.CAWNT!M1.",d .
f1�JRs CuA SI.2,506s
3..,!>,QI;]SA r,& raA 922S3
M4 1809
USE OF PERMIT
P00JAPE's 0141,B'.M.A.PiVISIB bRRIERS ,SH.Ad.4 BE, 11q r`' A- CE.t3Y
PRRi PLAN "3a t 1#� fV+�Y1rJs#, IaOft . t"�tpffa Nlk" k" i4N�i..c ,gLtl�E N T
T3dC'.'LUDED IN THIS PERMI'e.
M.A. ANlC1IOR 01PA, 1a,000,00 W
1e:51':FMATKO) (MUT OF COANSV9::IM ".000.1`P
F��.�:"d�'.11.29 WIMMARY
H AN s:1'1ECII- FEE 101-000-439-318 MAP
CC:fN STIR.M.TKYR Mr, 101-000-4118-000 �IAS.bJ
NW%IARSMAL FEE -- P001,. 101.000.421-000 1); -fto
F42C l RIGAL P'>tZ -- PGOL, 101-000-420-000 $45,00
PLUMMIN0 E -- FOOL 101 -000-419-000 $ g7.00
�'C't.. - I`C?'i"A.O1?!"TR11lt)Y A1`di i')I.MC%C'
;33:.60
u.1CrluSX .0`��? i<1i94� IIY
U��oT�e��)
!J M AY - 2 2001
CITY OF LA OUINTA
RECEIPT
BY� /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
" BUILDING APPROVALS
MECHANICAL APPROVALS
let 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
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
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:
CCpJ� �C
/ C
�O OS
CITY OF LAIl jTjq
�FCFyoF��a� BUILDING & SAFETY fPAaT6
M,
T
777-701„ Z
INSPECTION RECOES4I
777-71%
SHF,FFIELD HOMES
Owner
Contractor SHEFFIELD HOMES
Permit Number 0101-279
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-770 CITRUS
SFD-PLAN:2AR LOT 49 -PERMIT DOES NOT INCLUDE
BLOCK VALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
CJ
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELE TRICAL GROUND WORK
(-.2/S
DO 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
0. K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
'- --Q
_ 0�
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK S /5� n /
FINALS j
ELECTRICAL
PLUMBING
FINAL GAS TEST - - 0
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
i
TURN ON UTILITIES OR OCCUPY BUILDING