0101-289 (SFD)U)
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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
i Professionals Code, and my License is in full force and effect. 1
License # Lic. Class Exp.. Date
Date 1 i - �_�04N 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, 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.
;EC) 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.
STME MUIND
(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-'Sectibn 3700 of the Labor
Code, I shall forthwith comply with those provigi•Qns
Date: ` `-141 ,fid)1 Applicant '. I i�j � 1..,{ �
�.._ v U.-.- . _ ,
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 inspecti6h purposes.
Signature (Owner/Agent)"""'" 1� 1�3f f, , Date)11 fn''
BUILDING PERMIT PERMIT#
DATEVALUATION LOT ���jij)TRACT
1 1,-' 1-1 1 rr: i 71IR1*90-17
JOB SITE i
APN
ADDRESS
79-610 O'DRUS
7459-720•004
OWNER
CONTRACTOR/DESIGNER/ENGINEER
34001,M!,IRM, AV'.+~�V)B 3 e v 25
:400 G� nRAL AVMM- 2 3 2. 5
RMER, CA x2 %
6 IUVERZ31DE CP, 92506
(909)682-5352 CPU 5386
USE OF PERMIT
I�1'OLET FAI A MY 7 WEI °. 0
SFD- PR.KIWIAR LOT:53 VIRMT DOES 140T INCLUDE
BLOCKWALLWOOLMR111WAY APPROACH. 15% PLAN CHECK FUJI
RE -DUCTION POR I.SSUAAIf:',.1C OF SAME PLAN TYPE
C:'UST OM CONSTRUCTION TION 2762.00 SF
PC.piLfal"sM&TIO 294.00 SF
C.¢'LP.A;6TT�^OZt2' (Sf) ar�lf�,ts
ESI1MIrD C;`a)ST OF C014MUC.CI4.3N
,CSI
CONSTRUCTION FER $1,09100
PLN CHECr. FrSF $22317
MECHANICAL FEE 101-000,421-000 S95
S0
ELEC;TR:+CAL, ASM 101-000-420-000 $15919
PLUI+04B11t O MR, 101.000.419.000 MOM
STM40 MOTION FES - RESI£1 101-000-2A I -000 $32
tai
GRIA.ii1HL1.n114 101-0004,23-000 $2000
T IPRASTAUCTURE FFY, 2,25-000-443-342 $1,9117
00
ART IRS PURL -10, PLAL`'4 S - ,itl SIE 7014f3430nM000 rh
39
S'L1:4'3� T'OT.l L. a"ONS'f:4'tUC'YION NM }?LW M#�..C'X
$3,762.38
L?ID PRE -PAW PinS
i $11100
- TOTAL 11MOUf FRES DUE H3tJW
V1762.38
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 — /. 0 ( LGA
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap �A_ 3--
Framing
F.A.U.
Compressor
Insulation
Vents
Grills.
Fireplace P.L.
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 I I
Gat Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �. OJC % ��'
Water Piping
Heater Final
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)
o� 3
s CITY OF LA Q00A
CF'b OF o� BUILDING & SAFETY DI!5RpjE U '
777-7012
INSPECTION REQU6T I&
777-7153 1
Owner SHEFFIELD HOMES U -
Contractor SHEFFIELD HOMES
Permit Number 0101-289
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-810 CITRUS
SFD-PLAN IAR LOT 53 -PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
7�
FOOTING STEEL
Z 6C
MAIN GROUND SYSTEM
GROUND PLUMBING
- C
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 TESTY•
Ol
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
p
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
{ SEWER SEPTIC TANK
FINALS
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
79-810 CITRUS
Occupancy Group: R3 Type of Construction: VN
Bldg. Permit No.: 0101-289
Land Use Zone: RL
Owner of Building: SHEFFIELD HOMES Address: 3400 CENTRAL AVE STE 325
City: RIVERSIDE CA 92506
.rl---
d4-t
Building Official
By: KIRK KIRKLAND
Date: 8-20-01
POST IN A CONSPICUOUS PLACE
WEDDLE u
SURVEYING MAPPING, IN'0- .
t
Boundary • Construction • Topographic Aerial Surveys • ALTA Surveys • GPS • Consulting
July' 25, 2002
Mr. Kris R. Schulze
City of La Quinta —
78-495 Calle Tampico
La Quinta, CA 92253-15.04
Re: . Pad/Form Grade Verification
City of La Quinta
Lot 15 Tract No. 24890-4
Citrus Country Club "
Dear Mr. Schulze:
We have performed a field survey to determine the vertical location of the building pad
and form for the above referenced project. The elevation's observed are as follows:
PAD (DESIGN) PAD (AS -BUILT)
37.5 37.4
FORM (DESIGN) FORM (AS -BUILT)
38.00 38.02
ti
S '
i
These field observations are, in substantial conformance with the grading plan prepared
by ESSI SHAHANDEH, CIVIL ENGINEER, dated May, 2002.
=Sincerely,
WEDDLE SURVEYING MAPPING, INC.
�t
David L. Weddle, President •rt f go.
L.S. 5570, Exp 9/30/05 cop. WW/5 .
1� 1. • '' N��►// _c
P.O. Box 2020 • Cathedral City, California 92235-2020
68-625 Los Gatos Road • Cathedral City, California 92234 • 760.322.7693
E -Mail: WedSury@aol.com • Fax 760.325.5465
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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 o -f the`Business and
Professionals Code, and my License is in full force and effect. `
License
C#C� C Lic. Class Exp. yDate t4 of
Date r *�{ Signature of Contractor
• .,,,� 'J
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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those. -provisions.
Date: �" 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 f r inspection {{purposes.
Signature (Owner/Agent) lx�l /1` • Date yJ
BUILDING PERMIT PERMIT#
DATE 3 I O O VALUATION LOT 0101.21TRACT
28490-7
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
X4.00 CEMAL A 4NTU WE 325
RTVERMUE ° CA 92.506
12x`V'J~:RSID CA. 92SO6
���jfe�2•"5352 C:�•�.fo 53�ea
USE OF PERMIT
�Jf�3.J 1�0i'�� �,lirJi C 10 1Vti°iP E?�CJ�Xsi19� square footage correctio
f�:lC3Q�:i�FtEi�'F;'�3'.�'�,icS�l�9�t�AE';ai�T.
R 1HSXhVNCE OF S&ME PIAN TYPE
�•r,yl��Rirdti
SF
P-1,FMAAWD C.10=1 OF C(MMUC17.0w
238 11 XA)
P3t;1?s�.'�' Me S;RY
Ca<?"s�i�7 RV;Fa1`iON FEE 101-000-418-000, $1,196,00
F'E.Ja'W CHFC; S+'.I+,t; 1 Cs'.4-t�4?D- •3'� ? 2 &� sk i
duux>,Ci�{����t1S;.Fl,'�.6y1yy�E a 101.0�00�.ryy-421ryry-000 S99M
'91111 .�.f'tll�.�E�Rfis Y�'F:•.�i YO! -0000-4204,100 W4.91
PLUM(No (No IMIN 101-000-4119-000 T123.00
STIZ-014 0 M0 J`:i,F)N FES * REBID 101 -C 00-241-000 $25.91
G RA DIM 0ilr 9 101-04'i043:3400
3J+iJ'1"�At',}7'JtC9ti'T$Siw'?3" ny, 225-000-443-342 $J,f407,00
.SRT . PUBLIC PI AC"A'S - RP91L 701.000-25s-000 SJ45;30
9M.ZoTA , F'XMIR.t` IKI TIT01 f N PLJW C11M.CYC;
$3,993.16
KIM MR-PAED AM
50.00
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 Wali 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 I
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
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
os CITY OF LA QIMNA 4
cFboF��o� BUILDING & SAFETY DR5R*E J
777-7012
INSPECTION REOU "f AIE
777-7153
Owner SHEFFIELD HOMES u_
Contractor SHEFFIELD HOMES
Permit Number 0101-289
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-810 CITRUS
SFD-PLAN IAR LOT 53 -PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
. �
FOOTING STEEL
Z
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
_�✓�
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
r ,e--
_ `� - G (I G -
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
y Ol
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
p
INSULATION
PRE -ROOF
! COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I DRYWALL INTERIOR - Q
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK /
PLUMBING
FINAL GAS TFST
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING