0106-099 (SFD)M
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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 ✓' +I ! Signature of Contractor N -��a Al
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 la is 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 prgvisions
Date: 1 f ✓ 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 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 inspegtjon.purposes.
Signature (Owner/Agent) ._ !' �� r Ly Date! (ti W i
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0106-0" TRACT
JOB SITE
ADDRESS
(".1'ATIMIS
SWUM 110ma
.34 00 MURAL AVIS 14'17 32-
:k11RlWIDE C:A. 92506
USE OF PERMIT
APN
CONTRACTOR/DESIGNER/ENGINEER
0;"fWHE'9..7) I501.
3401 CENTRAL AMME OTE 325
I*'.NIMSME CA 92506
(mg)OVA-5352 CB1,A 5386
S:41k,iTX1r' A)1'1C MES
STY -0 - LO &% PLAN 36 r PUMIT DOFS'NOT .IN CLUDF, BLOCK. ` A.L1 q
POOL Cil DRIVEWAY APPROACH.
WSTOM CO) M�RAUCTJON U0.00 OF
POP-C'MPA11d ' 560.08 SF
.�tS.R i+�!✓i�.6:�.tt�63�` V.�4.ON1v.R PIPE= '?.P4.�Cq��.6.A0.M\vJl.S4:�w11
:yi7tf�!i6.F ai+"'{/
pabAj� ��,(��(��QQ ,,([TWST UARV
COUSTRtJ'C'k'ION IFU .
101-000-4)8-000
$1.127,30
PLAN C� XCX Fite',
101-000-439-318
509345
'I:t ECHA'N1C'AL riii:
101-000-4,21-000
$105,00
101-000-420-000
PLtX1i4}v-No FEE
101-000-419-000
$1013160
S1'R,£YNO M(.Yr10?;-' • :Z ,10
101-000-241 -000
$36.73
M01140 FIFE
'101.000.423 MO
$140,00
DSVF0PZR !'MI'ACT P'ZV
$1,993.00
ART IN 1=UBUC" .1'i.AM . MIT '701=IdDf3+b4:55u000
9169,32
AMD PLAN a=_X
ElrY IAF EA (1UINTA
F'ICVNI`y6`� dPl"
RECEIPT DATE By-, r i 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 ��_0—(
Exhaust Fans
_
O.K. to Wrap
F.A.U.
G
FramingCompressor
`vim
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 t�
,-/
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
Tamp. Use of Power
Final
Utility Notice (Perm)
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I "'CITY O.F LA QUINTA
c 5 BUILDINg & SAFETY DEPARTMENT
ey o
_ 777-7012
SPECTIQI REQUEST LINE
CIFINf CEDE? ..� --777-7153
FFIELD HOMES
{SHEFFIELD HOMES
Contractor 0106-099
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-93101 CITRUS—
JOB ADDRESS
- L T 65, PLAN 3 MI
- PERT DOES
NOT INCLUDE BLOCK WALL, POOL OR
DRIVEWAY APPROACH
f
s
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK -0
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
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 PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
- Q
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
- p'
INSULATION
_ C)
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL, INTERIOR
EXTERIOR LATH
Q—
POOL PRE PLASTER
FENCE & GATE
EW R SEPTIC TANK44a
2Q
FINALS
ELECTRICAL
- - 0 �
PLUMBING
FINAL GAS TEST
MFATIINC.. Air
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING