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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
Zo
Date.16 /6 i 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 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:
Cartier 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, aq,�_agree-th'at.if I should become
subject to the workers' compensation provisions of Section.3700 of the Labor
Code, I shall forthwith comply with`tho'se, ron sI ns�
PY P_ W Y ,
Date: %/'^i k ! Applicant -` ti 1p••� / 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 fordhspection purposes.
Signature (Owner/Agent) `,-^ no �+ t��J`: t Date r4) E
BUILDING PERMIT PERMIT# y•
1
DATE s/Q O ) VALUATION LOT ()'-101._2W TRACT
JOB SITE
ADDRESS
APN
OWN�EgqRyy..qq
CONTRACTOR / DESIGNEREN 1NEER
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,44 00 QWMAL �1 15
3400 Ml.NTRAI, ANTNIM, UTE 3Z5
WIVERSIME CA 9-150f,
IdVERSME CA 92506
(909)68z-5352 CI3LO! 5386
USE
((OFpAPERMIT
'HYD, I;3,AW.ak 6 rff.5I= PXMIT DOES 'NOT 6d+fCLU119
531�3�: 'f�'7�< E+�f�C1 T l ��i �A► ,A:PPROACK TANI PLAN C14N.. K YKE
REDUCTY.01MI FOR 1idtJ>j:T1 ILZ 1SSUATIC E OF :,WE 6'1 A;N 'f"4 PIL
SI7
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CONSTRUCTION M. 1.011 000-41 B-000 13,129.so
PLIKO Ci"IE'e K FEE 101-000-4-39-318 $M.37
MEC HAACAL FEE 101 -OW -421-000 $5151:30
1U,kC:'TP,1CAL ME 1.01-000-120-000 9l,64,3.1
PLUMD11410#9I01 101.000 -41.5 -MO SICU 'S
U TRC'Y1dG1h 07"10N FEE - RE ID 1014M-241.000 �23, 97
10RALANG F"s+:l 101-000-421111-000 S20,10
W`6',A 'I'ittYi:T LJR10,YZZ 25-000-443-342 $ 4ry7.(w
RT IN PUBLIC, .PLACES • W1.1 701.000.255-000 190.28
aar:;,F.�;
aYOTM YXIVOU.I` S`— + 6 DUH •Vf0'V
W842 M
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pate
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)
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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
Date 7D 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.
0,TATF FUND 076582-04
(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 shall forthwith comply with those provisions_ (,•
Date: I+ ; c: /i '# Applicant :`Y`f tl�ti Il
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives' of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 6 1.� I I Date(��'
BU11 ILDING PERMIT PERMIT# 7
DATE VALUATIONLOT ��_ TRACT
C' lGF t .1`R ,6s) 'E4 2R49n .1
JOB SITE
ADDRESS
'��.1t2 C�.'li '7 W
69L,710- ..21.
:EN
OWNER
CONTCCiiRACTOR /DESIGNER /(NEER
�yc
; 400 CIF�''MI ATT., AV W R IR RE, .325
34400 (AXtF 4, A'S1':&�' ,1XI S 32.�
XWER-1+Mc.,°.�,. 02506
wt?XF CA 92506.
pos?)682.5352 CT IP 5 865
USE OF PERMIT
0401€, :C.F 1J,Y DWS-11MG
S,kr& IyA; ia: dt i.p3:51� tlN:7;tlht IT DOWS NOT 11RC'LU Di
akaMOI CH, 75 %e PLAN CHh= NV,
{Z9DUC°`t I(IN FOR MULTIPLE ISSUANCE OF;7.r ME? P3. A14 T Wlt_
CUS'T'OM i:O1@3/3�, �T�RUC�iI'C?�hl' .^�,v}$y�f♦3,.(c�o BF
PORCHIPA0 SF
0, IlACRICARPORT (,U) 10,55x.00
i
R
3•
�rry�Af q.g IVPl�e t n da Ertl? ¢�� tY �v CSR �,Y57�
.K^�G&dJ�tiINMD C�s'�S 4�°i«.6'"�'4.:L.A.'F�STtt'S�i.��.•AJ!i✓.ii
sq DW ^f
J.'��'1712.60
PERM A YET 91MMAR11
a^,ONASTYMSC II'Mo FEE 101-000418-000 $1,12 oto
PL&N CHECK, VEZ 101-000.439-318 $233. s'r
M.R.C:RANIC:,1 L FU 101-000-421-000 %95.10
1",C�C't RICAL FM 101.4 00-420-000 $164,31
pz¢illiq"INO FAR 101.000.4.19-000 $19,117.3
S"iiiitNO dis)TtON FE - RES1.0 101-000-291-000 $23.57
O1tAE INOTd'U 1,01-000-423-000 8110.02
TNFRASTRIVC7CURE k €dao 225-000-143-342 $3,907.00
ART IN PUBLIC Plst1M - RMl 01-000-:755.000 $99.28
MP,TMALCOMTRUCT".ONAMD MAX CI�Y"sCYlr
$3,84.1.68
I SES PRE—'AM FIRES
CEO.00
110ML VNIM � 119V DIIN n0w
11 5,eft„fit
h
RECEIPT
DATE
Y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I 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 =- C, (
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath ( f�
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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= ��� �G�
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
COMMENTS:
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. R
Smoke Detectors t
Temp. Use of Power I
Final
Utility Notice (Perm)
ON
ems- •�O � �
CITY OF LA QUI Az� Uj,
�c BUILDING &SAFETY DEP frIVINT0.
F,y OF,�,N�,O 777-7012
INSPECTION REOUE E INA
777-7153
Owner
SHEFFIELD HOMES r
Contractor SHEFFIELD HOMES
Permit Number 0101-280
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-790 CITRUS .
SFD-PLAN:2C LOT 51 -PERMIT DOES NOT INCLUDE
BLOCK\VALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
I PRE-GUNITE
DO NOT POUR CONCRETE UNTIL AJ.4 ABOVE HAS BEEN SIGNED
r
CONCRETE SLAB �-
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
.e „ T %- U
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
{ HEATING 8 VENT - A/C
FIREPLACE
ROOF f -
BOND BEAM
I O.K. TO WRAP
GROUT Cl 4' Cl 8'
► FRAMING
INSULATION — -
} PRE -ROOF
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
COVER NO WORK UNTIL ABOVE HA BEEN SIGNED
DRYWALL INTERIOR
- —�
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
(f
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:
Use Classification: SFD
Occupancy Group: R3
Type of Construction:
Owner of Building: SHEFFIELD HOMES
Building Official
79-770 CITRUS
Bldg. Permit No.: 0101-279
VN Land Use Zone: RL
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 7-30-0.1
POST IN A CONSPICUOUS PLACE
D