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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 1 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 Siqnature of Owner
WORKER'S COM?ENSATION 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.
S1ATY RM15 ;iM021W
(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 the -provisions
Applicant �'�
Date: ✓� r, / `�%> V` %)tk_f+
„w os ` „I f r
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 inppection°purposes.
Signature (Owner/Agent] ![ ') �T,1'1 "IN Date A
rJ
BUILDING PERMIT PERMIT# ,
DATE VALUATION LOT 01.01w2ft TRACT
6
511-1 28490-7
JOB SITE I ' }
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
3400 CE WIRPAL Ai1kNUE X111325
3400 ChNi`i AL A'4V.1� ' OR IT17: 325
RTY)WIDY11 Ch. 92306
RIVE&IME CA. 92506
(909)6,82~5352 C"Eff-4 5386
USE OF PERMIT
a, NCTI:I?
SPC,. Pl-a1K1+IAR L.iX 2- PIVR MAT DOES NOT 114Ca,UDR
II,Int:'�t."'Ki11 AL,L 00?_IDI.P,IN F,WA`'Y"' APPROACH. 759+0PLAN CHFIt Y: P'FE
Itt UC TION FOR IbIUL7.11PIX 1.33SUAIACI, OF 5AME PLA.14 YPS.
M=1,101M 010 CONS RRUCTION 2.886, 00 87
PORCH6i',Ai`IO : 24.00 Sig
s;LOi!RAORVA.% .RT (uF) ! 4,'594.09
't"M&O r-091' 1.10' C3C}NSTRUC:d�C N
7_39,712.W
CONSTRtdMON FEE Ilii 11000,418-000 $},DASP
WCHAh.NXIAL PEP, 101.000.421.000 $85.50
IMW TRICAL P99 101 -WO -420-000 $164.31
PLUM911,40 Vii`` IVI 1.01 -000-419-000 W1,73
S TRONO MOTIUN DU - H,511) 1X01-000 241 -000 S27.5'r"i'
Ol3.d~tiDlftx I Va )01 -OW -423-000 $20-00
`I*RXi%' ZUC:'I'LE" IEEE 225-000-443-342 $1,9411.00
MT 64 PUBLIC PLACES- RESIr70,1-0.10.255.000 91~9.x4
1OB-,tOTIA3, C*OMMUf".I1014 A 14D PLAN CET MX
$3,M1.68
LEW 111WPA,Y l3 'EM
$0,00
"MMAJf,A FW -MIT XWES : ATE BOW
$23IB b aim
RECEIPT
DATE
ABY /
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 4 -`
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 Pibg. 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 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)
Owner SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0101-281
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-800 CITRUS
SFD-PLAN:2AR LOT 52 -PERMIT DOES NOT INCLUDE
BLOCKNVALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
Q
FOOTING STEEL
CITY OF LA QU@i TJ
MAIN GROUND SYSTEM
Fy OF M�0
BUILDING & SAFETY DEPeTA�NT�
O
PRE-GUNITE
777-7012 GQ
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
INSPECTION REOUESLI a
777-7153 _® -�
JOISTS & GIRDERS
Owner SHEFFIELD HOMES
Contractor SHEFFIELD HOMES
Permit Number 0101-281
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-800 CITRUS
SFD-PLAN:2AR LOT 52 -PERMIT DOES NOT INCLUDE
BLOCKNVALLS/POOL/DRIVEWAY APPROACH.
FINALS
ELECTRICAL Q
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
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
Q
FOOTING STEEL
MAIN GROUND SYSTEM
I GROUND PLUMBING
O
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
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
r
I BOND BEAM
. i O.K. TO WRAP
GROUT O 4' O 8'
' FRAMING
INSULATION
PRE -ROOF
Ye- f
COVER NO WORK UNTIL
ABOVE HAS BEEN SIGNED
4 DRYWALL INTERIOR
-e7l
EXTERIOR LATH
O
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL Q
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:
79-800 CITRUS
Use Classification: SFD Bldg. Permit No.: 0101-281
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SHEFFIELD HOMES
Building Official
Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
By: KIRK KIRKLAND
Date: 8-20-01
POST IN A CONSPICUOUS PLACE