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LICENSED CONTRACTOR DECLARATION
I hereby,affirm under penalty of perjury that I am licensed under provisions of
Phapt6r S (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-/-.- '57` C Signature of Contractor 4" V_ n tg �A A A f
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'6e 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.
3TATE P510"
(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: f ., t E. • i Applicant • „`,:7/12 �A. AIR �
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.
IMPOR :ANT Application is hereby made to the Director of Building and Safe jr,
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 inspectio ,_purposes.
Signature (Owner/Agent) '") AAA Date I- 2S 01
w.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
,"39 i q,.,6n gig. t�r�
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
SlIER'YELT) 110140
3400 C'.�� R.AL A�l �m"1 TF, Mx; 325
3400 CE AL, ANTRU :. STS 325
lilVERM:1?, CA 92506
CA 02506
(909)682-535Z C'BL# 5386
USE OF PERMIT
SYM.F11213.1) HOMES
r
dOX, 1PAbL .DVpWQ
?400 rM'J1TAL AV'N ViS X 321
SP'i1- LOT 6k MAN 2.G::R. - PERMIT 170LKS'?P#ar 1-14C DUDE BLOCK IWALL.,
PC3OL, OR DRIVEWAY APPROACH.e�% 1Z.ii TJ�"pA`IIcO14 'w1AO LAN CHECK FEE
VP
✓' PP LIVED C'i. R tiA:'I.OAUi'.EPLE, Sv h✓.1N I �, t.✓ 11 OF SMA B P.LA Y T 3 PH.
CUSTOM C'.GiN1 TRUC1'ION 2r1126.00 OF
POR.CiI-OPAT10 "' 3M.00 Sty'
GARAWcsAPPORT X11 1101,584,00
D CO J, 6/:t: C0A1613ZtT(7170V
239,712.60
2.Y,70
•yam •�q� p �,� y � yyESd,.7l:9A1'12.XJ
Cr}l ' !' UC:TION Fi% 101.000.418-000 31,1291,50,
PLAN CHECK ftrl, 101-000-439-318 $730.3;
MECHANICAL FEE 101-000-421-000 ssslio
Lx1 TRrC.1,FFE 101-000.420-000 $164.1
P1.ttMI4i1'p0 FEZ 101.-0004:19-000 1181175
37`110NO MOTPER • kiESID 101 -000 -241 --OW $,?.1.4)
d71.LtAD1M) fRA 101.000-42:3.00£1 $20,00
INFR41TRUC'tL.1R KuiG 2,25-000-4..3-34.2 1,shr?%ito
Awr 114 FOBLIC° PwIf:s - R1.iM41: 701.000-255.000 $00.28
AND D*LAX CM -M
$3,841.68
1X33 PRRmPAW FM
$0.00
JUN 1 5 2001 '
CITY OF LA 6UFi IA
RE
EIP_
a
BY j , j
DATE FINALED
INSPECTOR
INSPECTION RECORD A
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel r
Combustion Air
Roof Deck / Q t _ _
Exhaust Fans
O.K. to Wrap_.2. =Q__
Framing ��D(• �"
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 !�
i
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 _ _
Sewer Connection �U ��' �(�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
,r
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
jOB
TE
J
�G+' 7tltiltty Notice (Perm)
04
,OF LA QUINTA
cFboFE� BUILDING &4SAFETY DEPARTMENT
`�, 777-7012
q,%PECTfPN REQUEST LINE
777-7153
Ul"I NSiGEo ED HOMES
Owner
ntractor SHEFFIELD HOMES
0106-102
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-960 CITRUS
JOB ADDRESS
SFD - LOT 68, PLAN 2CR - PERMIT DOES
NOT INCLUDE BLOCK WALL, POOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION
DATE INSP.
I FOUNDATION & SETBACK
p
` FOOTING STEEL
(/ .
F
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALLAB9YEHASEIEEN D
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
I ROUGH PLUMBING
ROUGH GAS & GAS TEST
pl
HEATING & VENT- A/C
FIREPLACE
ROOF
—
BOND BEAM
O.K. TO WRAP
0 - (�
! GROUT ❑ 4' ❑ 8'
FRAMING
2ryL
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK S ti
F
FINALS
ELECTRICAL - 1
PLUMBING
FINAL GAS TEST T-7 2 -HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING