0106-200 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby.afflrm 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 irrfull force and effect.
License # Lic.:Class Exp. Date .
a �f72140.4s�, ti10
✓ Date Signature of Contractor��
OWNER -BUILDER DECLARATION y
I hereby affirm under penalty of perjury that I am exempt from the.C6ntracto;,rs
License Law for the following reason:
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).
as owner. of the property, am exclusively contracting with licensed
contractors to construct :the project (Sec.' 7044, ;Business & Professionals
Code).',' .
() I a. exempt under Section • •B&P.C'. for this reason
Date Signature -of Owner
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty, of perjuryone 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 haveandwill maintain workers' compensation insurance; as required by
Section 3700 of the Labor Code, fog the performance of the work for which this
'Permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier
Policy No..
.Z✓RIA OAA.UM-14 gy11YWD643
.. F ...
(This section need not be completed if the permit valuation, is for $100.00 or'less):
_(-)—Vicertify-that-ir the-performance-of-if-for_which_thi s.permit.is-issued,
_
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the. Labor
Code, I shall forthwith comp) r_with those provisions _
'bate: o. Applicant' ._ _
Warning: Failure to secure Workers',Compensation coverage's unlawful and
shall -subject an employer to criminal penalties and civil fines up$:.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
fora. permit subject to the .conditions and restrictions, set forth' on his
application.
s
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 cf.such,..
permit, or cessation of Work for 180 days will subject 'permit to dance Ilation:•>
yF
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 toYenter upon.
the above-mentioned property for Insection purposes. f F
Signature (O 6r-/Xgen't)��' � + "�" �4�J .�,• , Date 1f z•
s ,BUILDI,NG PERMIT PERMIT#
i. ��'
DATE d VALUATION LOT �,p `}Q TRACT
i
' x ;tea �� d� ' i 28960
JOB SITE
ADDRESS
W., lj73A
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENM Haim
MID WA WIVMMEi M.'rB 150
1280 Wa CA3V'rX., .150
C01?.0X +r.; CA .9112a
CORONA CA
' �•�. - •'�- i
yq�!�1�720 . � Q
r�ICJ ,1
(909)?,7i"•' 000 ! (MI- t 5761.
USE OF PERMIT," '
o.7Lt*4.Y,6gL:of°.�9Y:f.L1d xDV^' uOANG
5M!, Idf�" 47PR t.4CR .Ia 'i.tU IT DOES NOT INC,,LUDF, Y31OCK WAL1.4'
C:US T` DA C014STRt36" M4 3,142:100 SP
Pt33I.MP. -310► : 434.00 SP
0ARA+MI ARPORT 683.00 OF
:02,51THATM COST OF;
'264;MAW
'
PU/4�f.���iY}d�M1 11 FRE STyRgsy+y��'y1iL wy .}
y _n Q r.� p �, f�/�
5.:'4/fVAY7 �M'G.r76 Y DBiT..+ 101-010-41.84"o .07'21!1110
i
'
PL€12.f CIRF',=i. K VEP. 101-000-4.39-318 $98714
M:�Cl•1AIQCAL. M 101-000.1,21:1000
&1.L+CMIC".A3., FE8 131-iJ O -420-M $11-116.23
P1,0,1MPTNO FEE 1011.000 419.000 $.049.15
aSTPOW NO T ICAJ FEE - WI D 101-000-241-•000 $24.4'
O1{1•tCtMi11;`,BE 101.000,42.5-wU $20,00
4MMTRUCTUPM ME, US -a' W -443 -?42 • �1,5�s7bI0.
ART 11+ PUDLKI LAM - FW11:701-000451..000 '. MOM
:
�Lrp.Q�"g'C11�pi''C,ya4�Zw���:YAT.t�a✓1.
ClyMUCAYWV4AAv
qq 1!y6 . G
0SUS-V2��pp,
,��:.'',;gy
yAt ' r
$i,W/ylyq
f§p
i .«r0�7
SAL P; Rwr V7.96ME Now
$43M27
JAN 02 2002
i
RECEIPT _
DATE
BY
DATE I Q/1
INSP R
1
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
_ �� �Qk/
- [ Q�
_ TT I
/A T� eZ
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
O.K. to Wrap
�� p2 I
F.A.U.
Framing
Insutation
Fireplace P.L.
_ _
�_ pl�
- _
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Final _a�
BLOCKWALL APPROVdLS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_ _ /_ _
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
QZ
Encapsulation
Gas Piping
Gas Test
Appliances
_
. �!/=� i ; 7z_
r
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
Temp. Use of Power
Final
Utility Notice (Perm)
10!23'2UO2 WED 1.0.16 FAN
INSULATION CERTIFICATE
This is to certify that insulation has boon installej n ��n r:iianix. With the current energy. `
regulation,, Gobi,, i'itl52d, Sta'e of On.lornia; in the building located at:
La_Ouinta, California r
CEILINGS:
TYPE: SLOW MANUFACTURER: Certainteed Thickness: R-38 -
WALLS:
TYPE: BATT•S MANUFACTURER: Certainteed Thickness: R-13 ,
GENERAL CONTRACTOR: CENTEX HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
rf f•1•r !i4
l�:� .T'_--. �fi' •t!•3,!
INSULATIO.DN CERTIFICATE
This i� to cer*.Ify that insulation has b•.en rxm112n-nance with the current energy
reaulation, ('allfornia Administrative Code, Ti`i�.."'.::(%;t. �:f'�al f r�:fa,.:::'tie building located at:,
80-319 Spanish Eay, Lot 38, La Quinta, California
CFU INGs. '
71' F.LO\N ' ? MANUFE�CTUR.EF::=-I-ERTAINTEED THICKNESS: R-38
WALLS: _
TYP;F, 5ATTS +. MAN U"71-, I"-;P.ER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTEX HOME -S. i tC5N.`�c.
BY: • TITLE:
y
s PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 f
q.
B'T'TLE: AC MINIS', RA•, iVE ASS1CTANT . DATE: 10/18/2002
� s
- F..• ......, .J:_m.ViZ.^>.�•II.'��Re:'T.9•'a/. � 'a^.� /.7/N:l✓.w/r.�i'/.'A^tf.aYOT.fWi.n!'Ni�i♦r::WN.1,P.M.-]w. I.YI:v!.•.:ri^'.V c9. tib .-.+.'tri �,R.N' :.J i::"I.•�rw'Oe: o. w. -:-.o.
Certificate olf Occupancy
City of La Qutnta
Building and Safety Department
This Certificate issued pursuant .to the requirements of Section 109 of the Uniform Building Code,
certifying that, of the time of issuance, this structure was in compliance with the various ordinances
of the .City regulating building construction or use. For the following:
BUILDING ADDRESS: 80-301 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-200
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150 .
City: CORONA, CA 91720
By: DANIEL P.. CRAWFORD JR.
Date: 10/30/02
Building Official
POST IN A CONSPICUOUS PLACE