0101-284 (SFD)C&
04 W
r�r0.�
I- LLJ
rZ CC�ii '
oZr�
Zr-D 0.O
H CO
J
LLJ CL
N
Z
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 I Signature of Contractor—
OWNER-BUILDER
ontractor
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.
b�) I have and will maintain workeis' 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 Policy No
43 SATE -4D 1.106582-00
(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•provisionsi-\A
Date: t r'� �Ir, j Applicant—
Warning:
pplicant 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 'ttiis 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 isnot 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) 'u�- yt j�1� t i-- A/`)
BUILDING PERMIT PERMIT#
VALUATION LOT�� TRACT
VE
CIO
JOB SITE!
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN &NEER
3400 t"WnTWL 4VLg4`t3F, FIX 325
400 MX.t.RA",AVLg4"UF, r: TE 325
RIVERWE r- A, 921506
RIVU&t;.ilgr CA 92e06
(909)8.2.5352 t`.B:LO 5386
USE OF PERMIT
`II'Ll• PI. 04.21AR 1.,t`ST,60 ir''krRMIT rit."}?S NOT fNC:;;v.t VAE
til: ry Sal' ,,#,�° If•At�t� AOF�i ' 4'I�xd An��wPy.OPRACK W"a PLAN CH.FCK [r,82
PEIY.YCTION F0R, k,A'01,T11�L P S lt�'a1f.` CY, OF SAME PLAN AN Tii PE,
CWTOM C'ONSTRUCTdON ./gQvKIOD SYS
"PORC'dHIPA i 10 324.04 Sig'
OAR-4,43pICARPOR
NUMECED COST
239.712-60
PLAN C FISC K WE 101 -OW -439-318i' $2:30.37
1}.SX.CF' V,11.tGJ? L PER 101-000-421-000 $145154
V111 "11WC.#Q1F r.,101 -C 00-42W-000 S.%M.31
NIUMBINO1?VIR. 101-000.419-000 $181,74
STRONO MOTION FEE . R&SID 5 O' -000441-000 $n-91
QW -4. 7THO FIER 101-000-4231-000 $20.00
MYRA-TSz.'UCTi11?.L^ 1oP0 225-000-•443:,347
:ARS' IN k'E OWC MAC'E$ _ Wir. 701-000-256-000 S9S>.28
�" D-�'GY1T.A��',. C ONTS"1"�Y.�G�EIL" N AND 3'�I ���;i C".i�
x
$3,841.+`
LUSS PRX-MM MW
$0.00
RECEIPT
DATE "
BY J
DATE
DA7E 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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �� G a
BLOCKWALL APPROVALS
Final
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Ptbg. 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
I 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:
LqL
s CITY OF LAO UI�T,
OF
c BUILDING & SAFETY DE TIoI�N
• F'b '[tn•�
777-7012 4
INSPECTION REGI ``T !_f EV
777-715.
Owner SHEFFIELD HOME l�
Contractor SHEFFIELD HOMES
Permit Number 0101-284
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-880 CITRUS
SFD-PLAN:2AR LOT 60 -PERMIT DOES NOT INCLUDE
BLOCKWALLS/POOL/DRIVEWAY APPROACH.
BOND BEAM ' '
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING - Q
INSULATION
PRE -ROOF
J.� ��..� r.f c- I i f- v I Afar —
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR LATH - r I-
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK / �J
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST /. (J
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 12P.
FOUNDATION & SETBACK
- 10 ifT_
FOOTING STEEL
ear
MAIN GROUND SYSTEM
GROUND PLUMBING
�j d
PRE-GUNITE
_ DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB - U
I JOISTS & GIRDERS
ELECTRICAL GROUND WORK
r
O'
k DON POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
BOND BEAM ' '
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING - Q
INSULATION
PRE -ROOF
J.� ��..� r.f c- I i f- v I Afar —
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR LATH - r I-
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK / �J
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST /. (J
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING