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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 R� 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. 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.
( )y 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 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 provisio0,s,
Date: ^ + Applicant r� -�- .
Warning Failure, 1o°'s'ecure'W6-rrkeFs'-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 f;,
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.
"SigriatiJFF((5wner/Agent) '"?^ ' %�' I �m Date
BUILDING PERMIT PERMIT#
DATE/ 1 VALUATION LOT 0106-107 TRACT,
F� �ti </.7 73 294904
JOB SITE r-----
APN
ADDRESS
?P14945 1F'�riA ST.
7169-M.(Y24
OWNER
CONTRACTOR/DESIGNER/EN INEER
I
H01vOM
3440 t, �'.�Jt7r�"�'•ALAV.,^'�i"U 91E 325
34.00 C'TNJ`RA41a���t� `�T�:res
IUMSIDE CA 92506
MV RSWE CA 92306
(q, w)682*54332 C. iJf 5386
USE OF PERMIT
SHEFFIELD HOMES
SINGLET1f..q&117CDWR1T1UWG
3400 CENTRAL "i NUE ST'S 325
SM) a YZIT 73, PLAW X , PERMIT ilOFM ,NOT TNIC1rd1DS BLOCK IYALA,
!'CSL 09 jyllUVEWAY APPROACH, 71% PED UCT ION TO PLAN CH. E K RE
AWPLIED nXI 3AtFLTIPLZ 51UBM1'3".f'.AL OF SAMZ "P'1.PM1 'C'S+'ft "
("'USTOM CO1`3'STRtic'noli X102.00 31:
PO,RChflaATIO 3130JJ0 SP
Esn (MVI OF COYSM67cdoff
2581121.
AURSdA77PS' 9069Wy
C,'ONS'1'Rib0'1IONOKE 101-000-338.000 $1,1316,07
TIL.AN CHECK Z"I '^ 101-000-439-318 W334
Pv1WWWAL P',1}; 101400.4214000 $98160
?,'FAC'F•1IQ�L r Eg. 101-000-42"00 $173.81
111.01UMB11101? 101 -GW -419 -WO $1133.00
S'1'1tifJNNO MOTION PRE •- T3'ESED 101-000-2.41.000 825.81
O1t.A$ YNO RK.9 103 -000-423,WO 5.20.00
WRASTITUCTUREFZE W-000---342 S1,m.09
AttT 12i 1'i33sIX 1'IAAW - 3(F31f 701�007nit.4'S�O�J
LE W M -PAW FRES
$0.00
AUG 16 2001
'b '9< d .F'fx..3MY' MS ;(3UE NOW
CITY OF LA QUINTA
FINANCE DEPT.
d' 3
RECEIPT
DATE! / "
qY ,a
DATE FINALED
INSPECTOR
INSPECTION RECORDr:
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROVALS
Q
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
_�_ Q
Return Air
Steel
_
Combustion Air
Roof Deck
!! �� _ L
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
Electric Final
Waste Lines
3�=G
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
ll'—�d `� �`
Pool Cover
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) �— —0
COMMENTS:
'
CI OF LA QUINTA
e�op v BUIL a & SAFETY DEPARTMENT
0 777-7012
ccv I CTION REQUEST LINE
co g W 777-7153
Owner a S c� D HOMES
Contr>Ilct S D HOMES
10 -107
Permit N
P CONSPICUOUS PLACE.
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-996 FRESA ST.
SFD - LOT 73, PLAN 3C - PERNIIT DOES
NOT INCLUDE BLOCK WALL, POOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
DO NOT POUR CONCRETE UNTIL ALL ABRYE HAS BEEN IGNEC
CONCRETE SLAB If
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST - - Cl
HEATING & VENT- A/C
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' ❑ 8'
Ing
INSULATION — — Q
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR _ O
I EXTERIOR LATH
POOL PRE PLASTER
PqP4fENCE &GATE
?tWEI SEPTIC TANK
" FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO t
TURN ON UTILITIES OR OCCUPY BUILDING f