0101-285 (SFD)U)
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LICENSED CONTRACTOR DECLARATION i
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!�� �j� 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. 7041, Business & Professionals
Code).
( ) I am exempt under Section , B&RC. 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.
3s'Tft,'1'WFUND 1.5i:5L�;d
(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 provisl ns of Se6fibn 3700 of the Labor
Code, I shall forthwith comply with those-provisions.
hose-provi ions.1 i p
Date: '✓ �� %� + Applicant A >l i� tt!_.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 Ea 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) `��}�; ��� ► Date'
�..
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
t3t�:t�31f"•23 7i afl 44 7S490-7
JOB SITE
APN
ADDRESS
1i�'pp �(}y 0 (+p •MTY
119-8120
.169 7.y Wg
OWNER
CONTRACTOR/DESIGNER/EN INEER
91MI i1r.M HC;MYS
r '£ 1 T� '� WYN40
21400 (',024�M AVEIM 611325
34010 f.:wr1w,.r4wW:1E W, F, 321
RIVER 1iAId CA. SQ.506
RIVERSIDE CA 925
(909)682 -5352 (Mlif, 5186
USE OF PERMIT
6 iib GLE MWILY ai ! icy Eaee�.a LUNG
3Y0 - 1'9:,x?, 4:1 W'P:V4a b� >3:,iA1Y .13(1 ; NOT INC;s UOP, square footage correction
BW.4.WAJ.,UWOO!A.)R'1 •.1:W:i1.3' Eb.P!'RC'ik3CH, 15% FL04 C,Fi4!;1:K FEE
'PLI .f ,'TIO14 FOA ;! U L 't': P'LE 1SS1:lAWCE, OF SAMa! LA.14 TYPE.
CI3k32`OM CONSTRUCTION 6�,�00 uta
PORCH PA.T102184,00 SF
upaA lwcA,RPOR7 ("IF) ca
Eis'Y'rataMSM aC«✓67 •Y� "L,}.iZ'•w.L'F i�.7,iSA gr Ai4BFl.Y
LS•4r4:T� i'. �S?:e.liy
MUM— T' R1*M S'CY11l4MARY
CONSTRUCTION ME 101.000.4.16-000 S11091A
K.A.;d C; ki,W K MR,
I~RCRAI1RCA11ITER 1(31-000-4.21,111000 �1a5, Ct
CLW,TRACAL F Y, 101-000-120-000, $159.19
PLITMOPA13 FEE 101-0004-19, 00113 $191.?5
S2`i..C+NO MU!'ICAMHVIZ -,RkMI D 101-000-241-000 $22.88
GRADI (i FiR IM -000-423-000 $30.00
.11HY tAS'%kIilCTURF 110, 225-000-"3-342 V,"7 0
ARTIN „N Pi;9M,1C1Yi.ACi ! -R&K ` 01,000.2 55-C+ O
M-7101.`A,T.. C 0.Wkr[', .UMf0 AND PLAW C.'.1•f:1',.0 K
$3,76Z.38
' Y.i: TO 1AGxl•0'Si ER10,11V .W!'K09 !K UE :i OW
Sri, I62.2Y'fP
RECEIPT ^ -
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
L 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
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
Electrio 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:
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
1— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CN' w Professionals Code, and my License is in full force and effect.
=) t ;� License # Lic. Class Exp. Date
LO ��. _ .
LUr
r- MOM
q
o Z r- g
Date + / ^ " �+ Signature of Contractor _dr 6
O/
~I.— CD OWNER -BUILDER DECLARATION
LL)
d r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
fn License Law for the following reason:
Z_ ( ) 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
LO
N Date Signature of Owner
N
Q WORKER'S"COMPENSATION DECLARATION
EL
o 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w Y= compensation, as%`provided for by Section 3700 of the Labor Code, for the
0-1 Q performance of the work for which this permit is issued.
Q 0 1 have and will maintain workers' compensation insurance, as required by
O 0-
Q Stiction 3700 of the Labor Code, for the performance of the work for which this
Il 0) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cCD O STATE F"1 1516."71_00
J (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. k
Date: G ! Applicant—
Warning:
pplicant 4 ter! !> •1(1,
Warning: Failure to secure Workers' Compensatio c"overage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
' correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) _7> 1/ ahAA t Datei A 6
.. rte... ..
BUILDING PERMIT PERMIT#
DATE p VALUATION LOT 01 01_28.1$ TRACT
/ t f . I VM.121-00 54 28490-7
JOB SITE y
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER? EN (NEER
3400 MURAL AVENUZ MIK 325
24 00 (MY11RAL AWNLIE ME 3&5
P 3"d FIR 311DE CIA 92306
IM1M90F. CA 92506
(909)682-5 352 C`i11il 5326
USE OF PERMIT
fg-W ILE FrAMMY D -VIM -LING
IRI.)- txLd;143A J.ePT.54- PERMIT D014.', NOT DICLUDN
�i1ri)«=5'o P A ,S.tit+' AC�ddrEll?A'� LST. `I F'P1 4'1Ati�C>fi.. %,%° PuN en-mcm F
it€'�ltlCTIC_IN Poll Mt21.TIPIZ1SS€JA.3J' CZ C.1r AE F P1.A 34 TYF',+.r,.
t'.iJ:7'3OM CONSTRUCTION V021414 OfF
PORC;HMATTO 306.00 S?
r ,
.A.T'.K0 COST OF CC,�1�5F�.Ck2FH.710A1i
/y r'��` '[F.
1E �7.i1�➢,M.OPLi�.3C .
C.C?MPLUC TIONT FLI% 101-000-41R-000 B1,19coo
PLAIN Cklw* FIFZ 101-000-439-318 00.74
MEt',': IANIC.AL PUE. 101-000-421 0GO $1.4&30
MEC TR.1C,A1, ME+: 101 -000-420- 000 $173.81
EA?AdM,BING FEE 201.1'iC1C3.419y000 $183.110
S TROW0 140170N ME?, - RERSIn 101 - 00-241-000 $2.11
ARA1dlIN0 IVY, 101 -000-03.000
FldsFR.S'fMUC ;1'%1.Et.ir 1�. P US -000-443-342 11,i?ti7.00
ART tH PUBLIC PLACES - RNM 701-000-251-000
fly -as PRE -PAW MKS
$0.00
IMAL M0.'WMI'M DUAR I'TO a'
;�r2
RECEIPT
DATE
B�Yi
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade_ p ( �l��
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
F.A.U.
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 I
Gas Piping
PLUMBING APPROVALS
Waste Lines L�
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
zt04 � _
CITY OF LA QIQQTq
BUILDING & SAFETY DE5R-MEh
e�OF .777-7012 �?
INSPECTION REQI(E `T _OEC
777-715 >
Owner SHEFFIELD HOME CL
Contractor SHEFFIELD HOMES
Permit Number 0101-285
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-820 CITRUS
SFD-PLAN 3A LOT 54 -PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
�•
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
O
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
I
( DO OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
• O.K. TO WRAP
G I
GROUT ❑ 4' ❑ 8'
FRAMING
1 INSULATION
"' d
PRE -ROOF
I
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I
DRYWALL INTERIOR 4 —// O
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK / o
1 L 1 1
FINALS
ELECTRICAL nJ
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:
79-820 CITRUS
Use Classification:
SFD
Bldg. Permit No.: 0101-285
Occupancy Group:
R3 Type of Construction:
VN
Land Use Zone: RL
Owner of Building:
SHEFFIELD HOMES
Address:
3400 CENTRAL AVE STE 325
City:
RIVERSIDE CA 92506
By:
KIRK KIRKLAND
Date:
8-20-01
Building Official
POST IN A CONSPICUOUS PLACE