9908-050 (SFD)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.
Licen'se,J�3409� Class 1Exp.fDa0te„3 ;
ate. Signature of Contracto
OWNER -BUILDER, DECLARATION-`' r,,7
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). • • ' ..
O 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 perju-ry 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.
(`��e�+► I have and will maintain workers' compensation .insurance, as, required by
Suction 3700 of the Labor Code, -for the performance of the.work for which this
permit is issued. My workers'. Compensation insurancecarrier .& policy no. are:
Carrier P►flr1F �3Uea3t�id' - Policy No. lfv8f396'-tt
(This section need not be completed if the permit valuation is for. $100.00 or less).
O 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:subjectto the
workers' compensation. laws of California; and agree -that if 'I should become
subject to the workers'.compensation.provisionsoflSection 3700 of the Labor
Code I hall folk it compZy�with those f rovisi'ns!
ate' � - "'V t1—___
Warning. Failure to secure Workers' Comp ns�atio coyerag i 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 ihe'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 Istate 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 inspecti 'n purposes. "k
Signature (Owner/Agent)- --� ' � � Date f
�1_
�UILDING,ERMIT PERMIT#9-
� Y��
Yii'1tal: 30
DATE VALUATION . LOT p TRACT, .
J.OB SITE �� > A MCI, A
' APN 6V-• . �i}- HJ:S '
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C ► nix 140& Es
Hokylts
TIM VVMD.L0W.C1 tC'TX. SU 'E 150
2 ,803 Vh1ARDWW ClRrLF., SCITF '15D
. : L'i?RON.t1 CA 91720
CORONA r:A. 91720
('409)V0,400(t C13i.f 5761
USE OF PERMIT
SII+1C3L,1E; Ft`LIM LY DIVE:LLiNG
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-V -
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6 .S'. I'll I UV A:' LUu 1y r,.5 4 ; EY4_ ,Ac .COPi tu.L UK
_
1?C3OL
CUSTOM CONSTRUCTION 2,973.00 W
PORC,:lfiftPA.'i'.Iu 30f'a. o V '
GARAGLi t`,AMPORT : , fiv5] .d(t SF
ESTIM&TEIll'1 t.,`C3�1�0-Cdr ..'.'4RvC`9!V0N
M,346JO
I''[I:3A°14i T FEE MMMARt'
C` 01113TRUMON r”- . 1,01-000418-400 S1,I61,.00
k''t.A24 ClilECK FEE 5.956.32
NVICWWWAL FTE 101.400-4*214100 X111 5f)
:�i�.EGf`13.i�:A[. dt1j.u�•4:2fii 9193.48
-.
i I U,'bi23il C F 1�' ?-0,1-Oiil-119-Mo $119.75
STROla G hiOTIOIN ME - E31i) 101-000-2241-00
CRS D3'Nt3- V9
ART €N P1YSUC PLACES -:1 asit 7il.I-f}ti11255 3` S370.57
F
MVELOPM IMPA& FEE
� "'
A .�q�Bj .
�� Aid. • 1._ -
y�� ivy.
Ji.IE-'rOT`Ai.,i (',O2�1ny RUC riODi'A14:.J I'LAIV CHECK
14,944.85
:,. .:._. ,,.LESS PILE I3:t Fk.�
�0.titi"i
T13W:,.PELRMIT FE.1,�3 DVENOW
S4,944.95
RECEIPT
DATE
BY t
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings g
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck %9
Combustion Air
Exhaust Fans
_
O.K. to Wrap �� 9� _
Framing
F.A.U.
Compressor
Insulation _ ,fy,��
Fireplace .L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath V%/4
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 I I
I Gas Piping
PLUMBING APPROVALS
Waste Lines%
Gas Test
Electric Final
Heater Final
Water Piping 7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection_ _ _
Enca ulation
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
Temp. Use of Power
Final
Utility Notice (Perm)
X08/31/2000-7 E)8:-47. 9092920499 SCHMID' CONTRACTING PAGE" 1 12
` INSULATION CERTIF
. This is to certify that insulation has been installed In conformance with the current energy regulation,.
California'Administrative.Code, Title? 24, State of Caiifemia, in the building at ;
PGA WEST! PHASE 1A / TRACT 289601 l.A QUINTA
• LOT 30
CEILINGS:
TYPE: Fiberglass BATTS. MANUFACTURER: Owens/Corning THICKNESS:.F�-38 12" BLOW
L'ALLS: t ,.
.TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNES&R-13 3 1/2"
GENERAL CONTRACTOR:.CENTEX HOMES LICENSE:
BY: TITLE:
SCHMID INSULATION COORACTORS, INC, LICENSE 42215.17. C-2 '
BY: TITLE: PRODUCTION MANAGER DATE: 08i30100
a
INS�CON SRT B ATS
This is to` certify that insulation has been installed in conformance with the current energy regulation,
California Administrative"Code, Title 24, State of California,, in the building located. at
- PGA WEST /.PHASE 1A /TRACT 289601 LA QUINTA CA'
LOT 30
CEILINGS; ..
TYPE: Fiberglass SATTS MANUFACTURER: Owens/Cornlncg THICKNESS: R-38 12" BLOW
WALLS: :
TYPE: Fiberglass Batts. j
9 MANUFACTURER; Owens/Corning THICKNESS: R-13 3.112"
GENERAL CONTRACTOR: CENTEX HOMES LICENSE # _
:z 6Y: TITLE:_ .
SCHMID INSULATION CONT CTORS, It4C.
LICENSE 4221517 C-2 '
1TI-E; PRODUCTION MANAGER DATE: 08/30/00
r
rl�
FAX NO. : lu 1. 27 2� 10 : 31 H m P?
11t0 l AJ -ILA IIVIN 1.�--e'j 11r'1UA'1'E (PPI L—A nf 71 ('Ir' -AQ
An installation certificate is required to be posted at the buildiAS sits ar mads available for all appropriate iospecdoas. Me
information provided on this form is required; however, use of this farm to..provide the information is opdowLL) After
completion of final inspection, a copy must be provided to the building department (upon request) and tete building owner at
occupancy, per Section 10-103(b).
KVAC SYSTFMc•
Heating Equipment
Equip' d or FtIlciency Dua Dna or F "mx Floating
Typo (pkC• CEC Certified Mfr Natno Idatieal (AFUL ao.)c Ioca¢i00 Plein= Load Cagsaeity
heat p�mTp) and Model Number Stistems laCF•IR valuel (ante, ate) R-valut (Bttt/hrl (B RUM
Cooll►rg Equipment
Equip. CEC Ccnlrrcd Compressor it of Effid"cy Dna Cooling Cooling
Typo (pkE• Ureic Mt1 Name and Idertrlcal (5F5R a+Jt Loerttort Duct Load Cslsteit.,
heat Qvmp
t Model Numbyrj2CF-IR valusl la[da etc) R-valuo (QeW)t►1 (ate/
1. > reads realer than or equal to —'
1. the undersigned, verify that equipmcm listed above is: 1) is the actual equiptaattt installed, 3) equivalent to a more
efficient than that Specified in the cettificata of eompliaaca (Fottri CF -!R) submimed for. compliance wf h the EnerV-
Efflciencv Standards for residential buildings, and 3) Nuipmont that nets:: or exceeds the appropriate requirements for
manufactured devices (from tete Appltamv Ergcieney Regtrlarloh$ or part 6), where applicable.
lgnautre, Date
InsW14
Subconaaaw (Co,
arae)
WAIER HEATING SYSTEMS-
OR General Contractor (Co. Name) OR Owner
He=" CEC Ccruticd Mfr
Type Name Sc MWci Numbs
�45 .5 5
Disuibi tion If Reelr-
Type (Std, eularion.
Pointof-User) Comm)
ye
sof
Idontied
Sysiesru
Rated+ Tan);
Input (kW Volume
or BnUhr) (alloro)
gtfi-
Glancy
W, RP)
Staved
boss IK
External
r,-mlation
R -value'
2 For smaH gas storage (rated inpm or' 1W than or aqua! m 75.000 Bnbfbr). ck-arie tusisf%aa and bear pomp weer beaters Itu Fncrgy ra=w
For large gas storage waptr hearers (rand input of psaacr thin 75,000 BuVhr). 11" Rowvwy Effteiaaaq, Standby Loo and Ra W Input.
For lasraaum-us gas water beaters. list Raravery Effielanry cad Rated hent.
3. R-12 extcmal Ir sul;tlon is mandatory for uaapa %Kant heat#% with as snare faoror of less tban 0.$i.
Faneers & Shower Heads-
All
eadsAll faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111.
I. the undersigned, verify that equipment 4$W above my sil namm is: 1) the actual equipment installed; 2) equivalent to
or rause etfic(crtc dean that specified in the certificate of Compliance (Forth CF -1R) submiud for compliance with the
EnffV FffieiencY &andards for residential buildings; and 3) equipment- that meets or exceeds the appropriate
requiremwE, for manufactumd devices (tiom the .lppll uxe � Regulations or Part 6� where applicable.
JD Mechanical, Inc.
Signature Dace Installing Subcontractor (Co. Name) OR
COPY TO:
General Contractor (Co. Name) OR Owner
Bui! i:na� Dt;part�ent
HERS Provider (if applicable)
Bui!d:ng Owner at Occupancy
July 1. 1999
! rr 08/301, UO 10:56 FAX 7149211631 A:lllance C�14
x„
Installation Certificate: Residential
Uee of this corm to sadsty the requirement& of the Administrative Code la optional, but the information count be provided and posted.
la OT *3 9-gj-7 GLPLA Q N # g% d 9, 1,. -b
9lte Addeo"po mit Nwmi—w
An Installation cenfficate is required to be posted at the building site prior to the issuance of the ocaipancy permit. This form
may be used to meet these requirements. All apOance categories llaied below are the actual equipment installed. Note that
the efficiency and type of the appliance installed must be equtva,lont or better than the appliance so4cifie4 on the Certificate of
Compliance (CF -1 R). ibis certificate (or as equivalent) shall be prepared and signed by the person(s) assuming overall
responsibility for the appilance installation.
1, the undersigned, verify that the equipment listed in the category aboys my signature Is the actual equipment Installed and
that the equipment MOMS or exceeds the requirements' of the Appllance Efficiency Standards. In addition, l have verified that
the equipment is equivalent to or more efficient than the equipment specified on the Cenificate of Compliance submitted to
demonstrate compliance with the Energy Efficiency Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronic bOLOf information is entered here. 0h4r hydronio or combined hydroma equipment Is listed
Water Healing Systema.
under
Heating Equip. CEC Carolled Actual Distribution Dual or Hasting Load
Type (tumaee, fdlanuf, Make is Efficiency Type and P(pping Sefors over.
host
Heating
Equipment
urn etc, kPodal Number (A FUR, ata Location R•Yalum Stain 13tuh)
Ca®ao (Stu h)
FLJ "Pt _.. UC,?
� �-r��li"�2JiZ. '0
A PUT
CEC Cartltted
Cooling Equip. Comprsta w Unit Actual Distribution Duct or
Type (air pond., Manut. Make i6 Eftleloney Type and Pfpping
host amp, ate. Model Number SEER Location A•Vslue
-
'
e wilding gn at lose and design heat gain rata hays been determined using a method so®ciied in 5ecan t50(h) cf
the c orgy ten Standards, and at two of the criteria used for equipment sizing and selwwn.
M t �iLi
`7
NCAlc
Sig e l�`_F'.Ti
Date HVAC Sut>mtractor t Co. Name) or Ganerat Ccr.traR:*xr
or Owner
WATER NEA NG SYSTEMS
erl Water Heating CEC t: ertff lao Rated' Tank Factor
System Type Menut. Make b ar
k ►3el
a
Input (kW Capacrty Flawyery Standby
(storage gas, ate.) Modal Number or Btuh) (gallons) Efflciene Loss (.1
Ina,ulatfon
R•Value
I.. For &mall gas atoraga (rated input S 75.000 Stu/hr), electric 16e10141`10 ane hest pump water heetsys.. list Enargy Factor.
For large gas storage *else hamom (rated inpu(a;:,000
2turhr), list aatea Input, Recovery Ellkieney aro -:yidby Loss.
For lnstentsneous gas water heaters, list Rated Input and Recovery Elficiancy,
For Instantaneous electric water heaters, list Raw
Input,
FAUCETS & SHOWEn HEADS
All lauce;s and showerhescs inslalled are lis,ed in the Ccmmtsston's Dire�ory of Conified Faucets anc Showerheacs,
pursuant to Title 2e, Fan o. Subchapter 2, Sect!on 111
S cnaare _ Care
q,isw ,ianusry 1992
Flumotng Subcontractor (Co. Mame t or Ganerat Contricwr or O,vner
�,.,: e r.> �F� fi atom: ,® v
i
cit. of L -j -a' Quinta
r
and Safety Department,
Building
This Certificate issued pursuant to -the: requirements of Section 109 of the Uniform Building Code,
certifying that, at 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: 80-472 SPANISH. BAY
Use Classification: SINGLE FAMILY DWELLING Bldg, Permit No.: 9908-050
Occupancy Group: R-3 Type of Construction: VN Ladd Use Zone: RL
Owner of Building: CENTEX HOMES
Building Official
Address: 2280 WARDLOW CIR STE 150
City: CORONA, CA., 91720
By: DANIEL P. CRAWFORD JR.
Date: 9/7/00
;'POST IN A CONSPICUOUS PLACE