9908-049 (SFD)m 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 es#2� Lic. Class Exp. Date
s �aie Signature of Contractor ;y
OWNER -BUILDER DECLARATION " n
I hereby affirm under penalty of perjury. that. I'am exempt fromthe Contractor's
License Law for the following reason:.
( ;) I, as owner of the property, reason:
my employees with wages as their, sole
compensation, will do the work, and the structure isnot intended. or offered for
Sale (Sec. 7044, Business &Professionals Code).
(,) . 1, as owner of the property, am. exclusively contracting' with. I'icensed
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 herebyaffirm 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.
(�1 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:
Caner;Policy No. "
.A+1+tC+€2r..�vLTTA.fd.6U1T.�`h"$ • .. UN(`" 322'43{i�02
(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 •tof the workers' compensation prgvi'sionsfof Section 3700 of the'Labor
Code;' , al forthwith comply with those provisions,.
Date` APPllcanp" �.`
Warning: Failure to secure Workers'.Compensation overag .Is unlawful and
shall subject an employer to criminal penalties•and�civi -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 applicator.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.authWizerepreser} tatives of this City to4terupon,,,
the ove-mentioned property for,, inspectibFf purposes.Signature (Owner/Ag 't)'"` k r•Date
PERMIT#�- __ .
BUILDING PERMIT
DATE W1611 -"VALUATION ;2.64,439 . LOT TRACT 28960
JOB SITE i l�••��XQ VIY►�b. �:`�
ADDRESS
APN
OWNER 1
CONTRACTOR / DESIGNER / ENGINEER
CEN EX 140MUS
C )rNTEX iiOMES
22��, WA.R..DLOWV.CJRCLL-', .5Urf-E- lai3' .
p p.
228D WAP,01i3OXV CIRC] E, St.TA �1F 1.50 '
G:ORONA CA 91'x20..
CORONA CA 91'770
CBL
USE OF PERMIT
SLNGLE .FAMILY DWELLING
8f;0- 1"F29,- 29; PLAN 4, ft --A 1-I' IRS NOT IN`t.':LUDH 01 -OM QIVALL.OR
FAL.
CUSTOM Ct'bW3TRVL.Y10_N 3, WZ06 V
>K l
PORRCH/PA TO 4:1+00 W
/
GAi AJOEICA. PORT 688,00 SF
ESTIMATED CSS, OF COMMUCTION '
264;284.80.
PtN;'RNIff 'FEE SUMMARY
CO BSTIZUCTION FFE .101-000-4.18-000
;PLA:14 CHECK FE -9
NfECi€ANTCAL Mi.0i-f3€3t1~ 1-atK2 2:00
i R'f.G,4L 'E7r.I's m l -w0-420-000 3. �
PLz.Jiv; H40 FEI 't , : i(1l 4680- :i.9 3Q(D $199.7s
STRONG MOTION PEE -RESID 10t-000-24100 e25.43
_
GRADINGM E.Qt-ii i-�23•fi X23.40
.
ART ilii P4. nic.PL.,kms - R mr. '/vi-O(�255•QOt9 $�II0:73
I77EVEE OPEZ IRIP.!§.CT.FEE $1,907.00
;j
b1 ..
1 STAO`OTAL CONSTRUC'nGN,AND PLAN CHECK..
$5,066.17
..r LESS PRE-P,i M.VEES
SO.00
i.�01'r$Q.. YiIM-1 i 1H"ET', S D�:Ti�+ ;f O* . ...
�;�sE��6.��
RECEIPT
DATE
BY l'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE I
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
j
Underground Ducts
Forms & Footings
Ducts
Slab Grade
9
Return Air
Steel
_
Combustion Air
Roof Deck
/ /
Exhaust Fans
O.K. to Wrap
/ p
i F.A.U.
Framing
Q _ i
Compressor
Insulation
g
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPR VALS
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
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)
SEP -13-00 08:45 AM HEATING AND AIR 714 921 2187 P.03
Installation Certificate; Residential .
CF.6R :.
Use of this corm to setlafy the requlrentsnta of the •dntlnlltrstive Codo Is optional, but the Inlormatlon must be proWded and posted.
Lar -sr-
911e Address
Permit Umber ^i-f•—
An Instal!atlon c0nrticale is -'squired to be posted at the building site prior to the !ss,ance of the occupancy permit. This form
may be used to most these regOrements- AI. appliance cats90ries listed belCw Br6 tha'aClual'equipment Installed. Nath that
the efficiency and type Of :he appliance installed must be etaurvalent or bet+et :han the appliance specified on the Certitk ate of
Compliance (CF. I Fi)..This certdicate (or hs equivalent) shalt be prey areC and sigr.ea by the persons) Specified
on the overall
responsibility for the appliance installation.
1, the undersigned, verify that the equipment listed in ;he category above my signature ie the acual equiprtient lnsfailgd and
that he equequipment
a meets t 0 of m s the tequirements of the Appliance Viciancy Standards. In addition, I have verdled that
the equipment is equivalent to or mora efficient than the equipment specified on th
demonstrate compliance with the Energy Efficiency Standards for residentiale Certificate of Compliance submitted to
;A thugs.
HVAC SYSTEMS
Note: Hydronic boiler information is entered here. Other hydronic or comoined hyomnip
Water Meeting Systema, equipment is listed under
Meting Equip. CEC Candled Actual Dlstributlon Duct or Healing Load Heating
Typ® (furnace, 'Manu-'. Make E Efficiency Type and piping Before Over= Equlpmont
heat purrip. arc.) Modal Number 1AF U1: etc. Location R• alu• sizing Stuh Ca scfty (Btuh)
II—•-_�1
—tl(_„� UT
:7kIC --.•�-.^�
C>EC Cartifled
Cooling Equip. Compressor Unit Actual Distributlon Duct or
Type (air Cond.; lrlanuf:.Maka EHlClvncy Type and PI ng
heat pump, etc.) Mcdal Number _ (SEER) Loca.lon R-Yalt:e
(..ill t Jl :r � � � v / � .__ •
VdIng he t ices end design heatgan re:e have been determine- cslrg as rethcd 1CGC.1lsd In Secbrt igp(h) ct
c/ anca.da, and are two cf the criteria used fol eeuiomsr:t s,z!r1q and aelec cnen�1Nr;f
Oa`te rVAC Subonp'Qror ; o. Hamel cr General _ontw',Cr pr O,vr»r G
WATER HEATING SYSTEMS
Water Heating CEC Certtfled
System Typo Manuf. Maka +4
(astoregs gas. etc.) Model Number
Rated'
Tank
Factoryor
Input (kW
or Stun)
Capacity,
Recovery
anocal
t`s'flclenc
Emtnal '
Tank
Standby-' Insulatlon
— i- 1 n ,r_. . .
------------
�.
1 For small gas storage input 5 75.000 aralhr), electric fsslstance anc hast
For large ypump wst•r hoatws. list Energy Facer. �ygagetoraga castor healers {tared Input ,75 Opo Stuhr), .isi Rates :naut, FaccwrJ Etficienc, a7c Sla�cby :csr.•
For InsUntanevua yes water hostas. list Rated input ane Recovery Elfic;eery..
For instantaneous electric wstee h"tws, lis; Rats; Input. 4
FAUCE'S & EHCWER HEADS
Alllrfaucsts dle icwerheacs .nstaked are . s:ao in . he Co.Tmrssccn s Sire:,cry a •:a^cried Fa Ars and Shcwar^egos,
p TitPar: 5. S�ochao,er Sec:ron t 11,
Stgnar4re --- �-
Date rlu no,nt SvDcytCdC.Cr (Go, Narrer cr Genera
Cor.; asci or Carer
FAX NO.
uta t AJLILA 11V1V i„W11 11�'1UA1'E
,
qui. 27 �V- W 10:.31w P2
(PO -1 of 7) CF -6R
An installation certificate is required to be posted at the building site or mads available for all appropriate Wspecdolm (The
information provided on this form is required; however, use of this form to provide the information is optioosl.) Ager
completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at
occupancy, per Section 10-103(b).
QAC ,T= _MS_
Aeming Equip~nr
Equip. Y of Efficiency Duo Duct orF{eaaftg Heating
Type (pkv. CEC Cenif led Mfr Nano Identical (AFt1F, ox X Locatloa Pipet= Load Caw*
Heat ► and Mo cl Numbcr svi mule, etc.) Rwal
ug
Cooling Equipment
Equip. CEC Certified Compttswr 0 of Ef is k uy Dtux Cooling Cooling
TypetpkX. Unit Mfr Name and ldeattca! (SEER.ets.)t Location Duet Load Capwft,
her CUMV14 Model Ntirrtbtr DLCF-IR VAIVVI Wdcr etc.) RwWue 1
I . ? reads Veater rhan or equal la
1, the undersigned, verify that equipmeru listed above is: 1) is the actual egtipmeat installed. 2) equivalent to or more
efficient than that spccified in the certificate of compliance (Form CF -IR) submitted for. compliance with cite EneW-
4ftrenev Srandordr for residential buildings, and 3) equipment that meets or exceeds rite appropriate requirements for
manufactured devices (from the Appltanm E, iciairy Regularfau or Part 6), where applicable.
tgnature. Date InMing SubC4=VRCMf (Co. arae)
OR General Contractor (Co. Name) OR Owner
WATER HEATING SYSTEMS;
Distribution If Recir- sof Rated( Tank Effi-
Hcxw CEC Certified Mfr Type (Std. cvlarion. Identical Input (kW Volutne cieney, SutrAW
Exus,ial
!:relation
Type Name & Model Number Poirtaof--Use) ConuolType Sysum or Bayhr) (aliotts) (EF. RE) Loss OW
R -value'
2 For small gas storage (rated ingm orlesa than or equal to 71.000 Bru/hr). electric re idanes anti beat pomp .rater haters Itu Energy Favor.
For large gas storage water hamn (rated input of geaxr (but 75.000 SbAw). Ila( Rcwvetr Etticiwxy. Standby Lan end Rated Input.
For ittstaataccous gas water heaters. Iles Recovery Efficiency and Rand Input.
3. R-12 external insul;.lon is mandatory for:tangs wutm hearts with as energy fietot of las than O.Si.
FeIICeti & Shower Heads. '
All faucets and Showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111.
I. the undersigned, verify dw equipment listed above my siztature Is: 1) the actual equipment installed, 2) equivalent to
or more efficicni than that specified in the certificate of compliance (Form CF -1R) sub niacd for compliance with the
Energy Ffficlency &andards fbr residential bu:i dings; and 3) equipment that meeu or exceeds the appropriate
requiremen4 for manufactured devices (front the Appliar=a Effkk ncY Regulaaiaru or Pett 6� where applicable.
ooJD Mechanical, Inc.
Signature, Dace Installing Subcontractor (Co. Name) OR
COPY TO: Bui!J:ng Departinrnt General Contractor (Co. Name) OR Owner
HERS Provider (if applicable)
Building Ownerat Occupancy
_ July 1. 1999
8/30/2000 9092929499 SCHMID CONTRACTING �. PAG'E.103F
`14:39.
.
INSULATION CERTIFICATE c
This is to certify that insulation has been installed in conformance with the current energy, regulation,
'' r
ti alifornia,Administrative Cod�`Title 24, State otCalifornia; in tlie,building.at
,C
' PGA WEST 1 PHASE 1131 TRACT 28960 VILA QUINTA .
`
-`. LOT 29'
CEILINGS:
.
TYPE: Fiberglass BATTS . MANUFACTURER: Owens/Corning, THICKNESS: R-38,12'; BLOW
•,
�r
`
•
�k
� WALLS:, • +..� !
TYPE: i=iberglass'Batts MANUFACTURER: OwenslCorriing. THICKNESS:R-13 3 1/2"
-
GENERAL CONTRACTOR.' CENTEX HOMES P LICENSE: ti
BY: -TITLE:
SCHMID.INSULATION COQ ACTORS, INC. LICENSE #221517, :C-2-
By: TITLE: PRODUCTION MANAGER . DATE: 08/30/00
r }•} r a
,•
ho- , - ,T -
,.. ' .. , - _ '_ ... ;
•w � e - •� ,
" �,' INSULATION CERTIFICATE .
a
This is to certify that insulation has been insla'llk in conformance with the'current energy regulation,'
"
California Administrative Code; Title 24' State of California, in the building located at .°
- ' PGA WEST 1 PHASE 1B l TRACT 28960, 11A QUINTA-CA
LOT 27 r
CEILINGS:.. v 4.
TYPE: Fiberglass BATTS MANUFACTURER. Owens/Corning THICKNESS: R 38 12" BLOW
.. '
.
• TYPE: Fiberglass Batts MANUFACTURER: Owen slCorning THICKNES,S:`R=13 31 /2"
r
GENERAL CONTRACTOR:, CENTEX.HOMES LICENSE
.'
t3Y. � � TITLE:
- SCHmib CONTRACTORS, INC. `' v ' , LICENSE#221517 C-2
By. _ TITLE: PRODUCTION MANAGER' -DATE:08/30/00
F4
�e rV e",,are ..o I
ci
ty ofiL'- a in
Building and Safetk Departnie'n't
This Certificate issued pursuant'to t e requirements of Section' )09 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: 80-490 SPANISH BAY
Use Classification: SINGLE FAMILY6WELLING Brig.. Kermit No.: 9908-049
Occupancy Group: R-3 . Type of. Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES " Address: 2280 WARDLOW CIRCLE, STE 150
City: CORONA, CA., 91720
By: DANIEL P. CRAWFORD JR.
Date: 9/14/2000
Building Official
POST IN A CONSPICUOUS PLACE