0106-103 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date n / Signature of Contractor �--�• /��fj rah.
UWNER-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 &fProfessionals 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:
( ) (••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 o` 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: -E; (,� Applicant t'�� • "i1.+'l i t d, n i R.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
I,
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. ;
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to [�
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 160 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectionpurposes.
Signature (Owner/Agent)' i ! `t.A V/ Date. (r,` °
�, ' ^ -, T^� Ar
BUILDING PERMIT PERMIT#
LOT dj`�j 11Q 1 I
DATE VALUATION TRACT
++yy,pp����{ L
69
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
VA"ERIID Hamm
fffb;Ym1eUM1D Haws
;#400Tr`,f T.� AV.M I:fa X17, 325
'34.00 C,*RNnALVVENCU i '� 325
MXR6ME CA 92506
RIVERME19 CA 92306
(909)"2-5352 2-5352 10111d.O, &386
USE OF PERMIT
>v+Ht RIELD HOMO-
"t;$LF, FAMaX 1:i%9RY T.WG
34LI4 C.MT.R.AL IiY ENUZ aSTE 335
S.t'11 n S= 69, P2. All L - lYE MITI'E 0i U.S. -NOT JWCL.UDIS,H1DCK WA1,11
POOL Oil Dit113'1%-1�!AY A1'PRyOApy�qCH,1,50A'Et.EDUCTiOlit `1'O Z'L&N Cyf FXK FEE
Ak''PL4ED rOR MU LTIPLE SUB"t I T` A.L OI, ar"a1i F, PLAN TYPE,
CUSTOM CONSTRUCTION d,W2,00 SF
P0RC:`WPAil0.. 2&Q.00 S9'
i'
0AA0VC&RP0:KT (9Y) 0191 91,60
E{snug,.i) COST OF C10146111fUcI:t'.i.om
229,156.60
C9KrOTRtiCTI..ON FEE 101.000,418.000 spa 01.00
Pl..E's.N CHECK VVE 1,01-000-439-316
MFZ*HAN1CX1, FREE 101-000-421-000
l:L ECTRICAL, FEE 1101-000420-000
P.LUMBINO PRE 101-000-419-000
S��yy'fyp R{�O{{��N1�Uf P!ly1i�y3`l�c; IO24 FEE • 1 EM0 101-000,241-000
j/��(n/� �g�
101-01DO"-4 GYI"S/0
Q 7ELPSD NO C�aJi�IyE�r4
p��p Y
I)YTti'M��.1 UCI A'U' PCI:, TOES 225-000-443-342
AIT W PUB 111C FLAC S - REPIff 701.00045;3.000 onto
4 ,
°JIq MID XyLl'ew CIRM,
A,
$3,7a_
LE98 FPX. -PAID FM
JUN 1 5 2001 ; .PKTOUII 113.17.6 DIN. NOW
CITY of LA OUINTA
Fl,'d;,NCE UEFT
$0.00
RECEIPT•
DATE
BY
DATE FINALED^
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
i
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs,
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ _
l �� – 07
Exhaust Fans '
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
Q ��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath •
_
0– �rO • ��
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
Q�—� f
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
emp. Use of Power
-final
Utility Notice.(Perm)
CITY C
V ` BUILDING &
INSPECT
.'� Owner
,tor SHEFFIELD H
Permit Number 0106-102
POST ON JOB IN C?
INSPECTOR MUST SIGN
.LOB ADDRESS 79-970 C
SFD - LOT 69, PLAN
NOT INCLUDE HLOI
DRIVEWAY APPROj
TYPE OF INSPECTION
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GI)NITE
DO NOT POUR CONCRETE UNTI
CONCAETE BLAB
JOISTS a GIRDERS
ELEC1 ICAL GROUND WORK
r 6..
DO NOT POUR CONCRETE UNTI
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GM TEST
HEATING A VENT -A/C
FIREPLACE
ROOF
BON0 BEAM
OX TO WRAP
GROUT 0 a' 0 e
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL A
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
L FENCE & GATE
E EPTlC TANK
FINA
ELECTRICAL
PLUMBING
FINAL QM TEST
HEATING • A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS 00 N
TURN ON UTILITIES OF
.A QUINTA
:TY DEPARTMENT
-7013
REQUEST LINE
7163
ES
ES
DICUOUS PLACE
APPLICABLE SPACES
.US
PERMIT DOES
WALL, POOL OR
. ABOVE HAS BEEN SIONED
ICLUDE RIGHT TO
:UPY BUILDING
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