9908-052 (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.
License # Lic. Class Exp. Date
k
71ignature
'10(^�Qete ' Sof Contractor-
�/. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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.
(\A 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.
ANM, CRIARAWM
(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, Od agree that if I should become
subject tgrthe workers' compengationyprovisfons'jof Section 3700 of the Labor
Warnind: Failure to secure Workers' C'ompefisation coveragelis 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
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 r p'resenta Ivt es of this CitoyAy to enter upon
the above-mentioned property for�ikecti n purposes.
.
Sig ture (Owner/Age' )""'" Date
4
PERMIT#
BUILDING PERMIT Y
DATE fk Rel VALUATION«' Qf LOT 47 TRACTJOB
SITE
ADDRESS W481 S};�i NW.11 BAN'
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
♦f 4!1 l ,L.AY
1".1V f�a�'L./. R,���i 6w\J
2 80 ��t'Ai�l�:i�,i-1��r 8.:lif�;-Ft.,.�, G1i.1 IVE i30
i�o8i/'�hrAI�t7EaC1�+ �'[T�!'�,1'r ?UfT, 150
l `f,)1fif.3l'+ A /71720
C:C,►li.C')N A C.'A. 91720
it>f3{)1""i4- {I;1ti i,1At 4 5701
USE OF PERMIT
CUSTOM ri:ou:y11TL )£'I'E N 3, z8'o 1 l r
I) C(M OF MNSTRUCTION
PERMIT FEE SUMMARY
CONS"i'#Cilc'"HON F-FIr. 1e1 -tam -4180" 51,2590)
P1, AN 0TE(7K .FFf-
ANZ11;H/',S3fMt.1'or3: V01' int --421-000 vV,.if1
Lti!~i3i 'i.1 4�'lle. I+t lo.1 4J00.i120.o00 SA)2,67
PLAfAfi8IN4r1F?±Y; 1014Ua.7 -14};9-000 x225+.7-5
3'iRt"3W4 MiaTR7,N FTY - RENrP )0100-7414, ) V7 6 i .
tJIGM).140 FEr.fit?i"f##1�3`a12. t?Qi(3 S<ft.00
AW 01AJOLIC �*1LAC'E* f�1::3i1: 7i)e. ( 4t + (1ti1) 19t►,t
I'xEVF...C:K:K I#vilnAt".0 t . SI,90um)
7.
r
tiir ti,-'TTJr,A1; VC N1.1;1`(CI,r' 7f0N AND P1,q"t+j
17 M
LESS
$0 00
t
RECEIPT fi
DATE
BY j�
DATE FIN
INSPECTOR
INSPECTION RECORD,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings Z
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Y
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath / 00
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Hacks
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
Pool Cover
Sewer Connection
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)
COMMENTS:
"
E^9113/2000 09 0& _.� 9092920499, ,y^ S(_,,HMID CONTRACTING
PAGES 04
�
s . 'INSULATION CERTIFICATE
h
This-is to certify that insulation has been installed in`conform'ance wit), , the -current ,energy regulatibr,
California Administrative Code, Title 24, State,of Califoniia, in the building at..
,
PGA• WEST I PHASE 1A I TRACT 2M60 I LA QUINTA ' r
LOT 47
-� CEIL'I'NGS: w
-
-TYPE:.Fiberglass BATTS MANUFACTURER: OwenslCorning THICKNESS:. R-.38 12" BLOW
•
..'"�.
..
.WALLS:
TYPE:-Fiberglass Batts MANUFACTURER: Cwens/Corning THICKNES&R,-13 3 112"
4
.,
GENERAL CONTRACTOR:' CENTEX HOMES, 4LICENSE: =
BY:.TITLE: ,
$CHMlD INSULATIrJN RACTORS, INC: ; - LICENSE 42.21517.' 'C-1
/C
r
BY: TITLE:. PRODUCTION MANAGER DATE: 08130J00 '
INSULATION CERTIFICATE
This isVto certify that insulation has been installed !n conformarce'with the current energy regulation,,'
California Administrative Coae, Title 24, State of Califomia, in the`building.located,at
-'
PGA WEST/ PHASE 1A !.TRACT 289601 L-A QUINTA CA
.. LOT 47 -..
- - - . r ,
�.,
� ,.
-
`s - r.,
•CEILINGS: � �
. .
{ TYPE: Fiberglass BATTS �vANUFACTURER: Owen's/Corning THICKNESS: R-38 12" BLOW
t � .
r .•
.... - - :
-
a
WALLS' ,, - �
t,
TYPE; Fiberglass'Batts MANUFACTURER: OwenslCorning THICKNESS: R-13 3 112".
GENERAL CONTRACTOR: CENTEX HOMES' ' ,LICENSE # r
x.
.TITLE:
- 4 -
SCHMID INSULATIOC ONTRACTORS, INC. LICENSE #221,517.. C=2
'
V
TITLE: PRODUCTION,MANAGER DATE: 08/30/00
X45
FAX NO. :u 1. 27 2000 10 :.31 AM P?
JU l tiLL�i 11V1N �� 1 !r'IL ATE (P��l of 7) CF -SR
An installation certificate is required to be posted at the building site or made available for all appropriate iaspeaio me
information provided on this form is required; however, use of this form to.,provide the informafm is optional) Atter
completion of final inspection, a copy must be provided to the building departssient (upon request) and the building owner at
occupancy, per Section 10-103(b).
QAC SYST)cMS_
Hearing Equipment
Equip. Y of Efficiency Dues Duet or Heatig Hcasatg
Type (pkg. CEC Certified Mfr Name Identical (AFUE etc.)' Lotadon Piping lead Cspsakv
heat txtetp) and Model Number switms W IR value) (aerie, etc) R -value (Daft) .(BAY110
Cooling Equipment
8quip• CEC Certiried Comped mr g of Efl3eieaey Duct Cooling Cooling
T'pa (pkE• Unit Mrf Name and ideralcal (EEEt. ata.)I Locstim Duet Load CaFse*
heat ) Model N F -IR v s) ate.) R -*slut (6uMtr) (IIttsllsrl
1. > rtads greater Than or equal to
1. the undersigned. verify that equipment listed above is: 1) is the acetal equipment installed. 2) equivalcnz to or mere
efficient than that specified in the certificate of compl-mince (Form CF -1R) submitted for. eotripliance with the FjW-W-
Ffrctencv Srondardr for residential buildings, and 3) equipment that meets or exceeds tine appropriate requirement's for
manufactured devices (from the Appltanm Efliciency Regulations or Part 6), where applicable.
ignature, Date
WATER HEATING SYSTEMS -
Distribution
Hater CEC Ccriiflcd Mfr Type (std.
_Type Name do Modci Number Point of-U&a
s ung u aaetar (Co.Name)
OR General Contractor (Co. Nasse) OR Owner
if Rectr-
a of Rands Tank
Em-
External
cvlation.
Identical Input (kW Volume
ciencyr Stss;tdbys
!molation
)nvol TYPO
SYtntrrn or Bb/hr) (gallons)
W, RE) Loss Ow
R. -value'
MG y`7
5 K
2 For malt gas storage (rand input oricss than or equal to 71,000 BtWhr). electric resWance and beat pump Water heatera. itu Energy Faomr.
For large gas storage wattr hearers (rartd input of Seater dsart 75.000 BUAW. Ila. Rvwvay Ef'ficiettey, Standby Lou and Rated Input.
For ipstaataacous gas water beaters. Ilse Racovwy Efficiency and Rated Input,
3. R-12 external insul.-don is mandatory for uwapa u%w heaun with an energy fieeot of leas than 048,
Faucets & Shower Heads: '
All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section I 11.
1. dee undersigned, verify time equipment listed above my sipature is: 1) tete actual equipment installed; 2) equivalent to
or more efficicni than that specified in the certificate of compliance (Form CF -IR). submitted for compliance with the
EnerV Ffficiency &andar,ds fbr residential buildings; and 3) equipment that mesu or exceeds the appropriate
requirements for rnanufactured deviccs (from the Appliance Effk ancy Regulations or past 61 where applicable.
JD Mechanical, Inc.
Signanuc, Datc Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPY TO: Bui!,J:ng Department
HERS Provider (if applicable)
Budding Ownerat Occupancy
_ July 1. 1999
t
c: y SEP713-00 09:46 Am HEATING AND AIR 714 $21 2187 P.02
Installation Certificate; Residential CF -6R y=
Use of thla,lor'nt to satloty the raquiremsnts of the Adminlstrstive God■ la optiontl, bit the InfarmsiWn frivol be provided and posted,
LO'i Q� BC �S'� ;ra,Y LAN I
1
Site Address , Permit Number
An Installailon cenAfcate.is recurred to be posted at the building 0..e pror 1•5 the asuanCe of the occupancy permit, This form
may be used to meet this a-requiremer.ts. All. appliance categories listed below are the actual ecvipment installed. Note that ,
the editiencry and type of the appliance installed must be eauwaient or trotter than the appliance specified an the Certificate ol" �
Compliance (CF -IS). Tt..is certifica'e for ns equivalent) shalt be propared and signed by Ino porson(s) assuming overall
responsibility for the appliance installatlon.
I, the undersigned, verity that the equipment listed in the. Category above my signature is the atrial equipment Imnalled and
that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards, In addition; I have verified that
the equipment is equivalent to, or more. efficient than the equipment specified on the Certificate of Compliance scbmIned to
demonstrate compliance whh the Energy Efficiency Standards. for residential buildings,
HVAC SYSTEMS
Note: Hydronic boiler informatien is entered here, Other nydronic orccmbined hydmnie equipment'is listed under`
Water Heating Systems,
HoaUng Equip.. CEC CartRiod Actuals Distribution . Duct or sHeisting Load Heating . y
Type (furnace, Manuf. Make S Etticlency Type and Pip Ing Before Over. ; Equlprrtent .
heat um etc, Model Number AFUE: etc.l Locatlon R•Vslus Sizing (i3tuh)) caoact (Utuh)
DtJC,T I U7
IL
a tar -1
CEC Certified r
Cooling Equip. Compressor Unit Actual, Otsuibutlon Duct or
Type (slr-cond,, Manuf,'Make A Efficiency Type and Pipping
heat PUMP: etc: Model Number SEER Locaticn A%lue
. .� o
cT
I^ t`
T e bu ding d ign hes; I ss and danign heat gain rate have been deterrnined using a rush (N ; staec�lled in Seam 150th) c!
.:
o En gy E! envy 5 r+dards, and are two of the criteria usea !o: equipmert srzins and saIw.x,n. :
- signs ra !l LC-;lAP10E- r�F1J-'A�i I� •s� ��y—/�,[., ;t � � /� �•
�/. Oats HVA; Subontracw tCc. Name) cr Gerera: Contrac=r or Avner
WATE� HEATING SYSTEMS i
• - Eger '
Water HasIInG CE's CartHledRated' Tank Faccr or E qtr nal
System Type Manu!. Make b Input (kW Capacity Recovery Standby' insulation
:«
(storage gas, etc.)Model NumCe or Btuh)• (a_lonal EF!Iciency Loss ;I% 1 R•V&Iuo
' i. For small,go$ storage (sated inpvt S %C (00 Swhr), aisciric raalatsnca ane hast pump water haters. lis: Energy F=zr.
For large gas storage water heatom (rated Input >7$,0r0 Ctt7` r), list Fates :rout, nAc: yat,/ E!fic:enc! enc S!anety Lcsa.
_ For MNantansous gas wares hut'
or, list Rates Ineut and Reccvery
For Inatantaneoua oiectrfo water heatefa. list Rat9c;ngul.
FAUCETS $ SHOWE4 HEALS
Ali lancets and 5h0werneacs .r.,t::lad o'y .teras .r:`e C^rrrr:gsion's "irG�crj•ct Cartiied Fa_cots a% S"cwt?".ead5,
pursuant tc Title 2e. Par, c S•�DA'fapler 2. Sec: or 1 J
. '5igrcari'e` _. Cats Plun ,n^ c :
o , -vbc,x irarLr ICC. Narset cr venerai Cor:-ac:ar or Cw•r7r
r19vltpl Januar/ : Y41, .- .
"3 � ��,..- . ._.. w+.Ma'.^'•n w�..:, .},+T+' ti ..4f + - ��� .�:Y: x: �'.'%��G.�.r+"�S?„F�n- 'r • ,f �-•�-'."�. y,.^'i.."..
` ii. •r 1 Fes. T kyr f:(xr f�{' .�!' , f� .. � . �, `f
-0
rd a 3 odcu. 1C
P 0, -Y-*
Ci
low -tif uinfa r
Ba�Ving,a'- nd.,;-S fety-Debar'Unent
- ._ • •..rte . .. �^'..
This Certificate issued pursuant toyhe;regOone ents of. Section` 109'.of the Uniform Building Code,
certifying that, at the time of issuance, this structure' was in coA706nce with the various ordinances F
of the City regulating bui%ding construction or use. For -the following: ;
BUILDING ADDRESS:` ~T' =r' 80 -481 -SPAN ISH,BAY
Use Classification: SINGLE, FAMILY,DWELLING,_ Bldg. --Permnit No.: 9908-052
Occupancy Group: R-1 Type 'of Construction: WN �Larid,Use Zone: RL
Owner of Building: CENTEX HOMES- Address: ,229O.WARDLOW CIRCLE, STE 150
'.City:. CORONA, CA., 91720
By: • .DANIEL P. ,CRAWFORD JR.
2000
Date: 9/14/'
- r -
Building Official T'� ' ". - .
=r .z; r ".
z ,`POST IN A CONSPICUOUS PLACE