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9909-277 (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 Date '�' Signature of Contractor -.Y x; 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. 704.4, 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. (�,) , 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. WME . GUAM= (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 pro visions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions'., D,atet `�) a �� Applicant KWarning. Failure to secure Workers' Compensation coverage Is unlawful and shall subject an employer to criminal penalties and civil fines up�tb $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 representatives of this City to enter upon the above-mentioned property for Inspection purposes. Signature (OwnedAgent) - ^x - Date w •b PERMIT # BUILDING PERMIT DATE _1 J�Jf q/I"VALUATION S1 .3.75 2() LOT 419 TRACTJOB SITE ADDRESS LD - Z7 7 VAIN rsA 34 APN OWNER CONTRACTOR / DESIGNER / ENGINEER 2.,n' ) W��ABBtt.�>1.,4,!W CIRCLE, LE, Si.3�'�`1.�; 136 2.+'t��ijj iRA��AR,LW.,i.i�k C.:1R4.,U.{,S��f f2 IJV qq 11 1,T)Itf_)NA ("A 91141 (2 4.�)50.��, A ���'t. 40,N) !"i ° 14-4ma `»1'6111 USE OF PERMIT �71,��J lr'ii l�lll'�li.�•1� 1,i PY lF:Caf.�f S�.�.f �&Tte LtA 49� t%t jVv iC. its' fadt4xf' 0t)E; i Wr4U.OR POOL o:, SAME', TALA ' TY1% fSHKA1,11;D T If `cXININ1` RUCTION,, 4173;731.12 PERMIT V401.1104WAP►.0 t t i►v ;'f €�iJt 7'lt�N �`k 10t 40 1141,"(R) �i1.�1i1.`fff 417. AW (1IF('K V M (M-4 11q_1 i R t ry i5 a to I *(* A21 • �V100 � i U-.QTA tC,At. $< Wi��:t a -4A -W 1 31A 1i ti:i k"k�Gfh [f>5f39��:F;" lCli �1tiaD w� 41� S09.75 STR0NO %1f,'Y[ T0N 14,* �« .. dim.. 3 l3 5557 •-t �f} )gji�.{1t jfty '.*,7 ;-� t itil?liS:i i:1;3; ti �5} ix� E't;ti�a!af ART .1141 #0J1iA L,* i'% AOS w xi Lt: rEj S,^7 - k-i#(9i� 3-1,..i • . . YWYM(WER MCIA 411' H -A Sit,�fll l,i3t/ SflR-'YrAf.CTbelrs'TYtX710N.Ahft�7,'Sraf,A�fyy,,°�yt't:C`C q . 1XIS 1IRE L A tM .FIEFAS, • P ,A RECEIPT DATE BY Y DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings // _ Ducts Slab Grade Retum Air _ Steel Roof Deck Combustion Air Exhaust Fans O.K to Wrap 3 Framing F.A.U. Compressor Insulation SdD Vents Fireplace L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath /Zp Drywall - Int. Lath � ed Final Final POOLS - SPAS BLOCKWALL APPROVX S steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Waste Lines Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection QU Encapsulation Gas Piping _ Gas Test b� 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) ' t6V 3/,2©ob r 99:06. 5092920159 SCHMID.CONTRACTING.z +`'PAGE , 02 16 j' i' 'INSULATION CERTIFICATE"i" : `• _ . This is to certify that insulation has been installed in conformance with—the' current energy regulation, ' . { California Ad"ministrative:Code: Title 24, State of California, in the, building at , PGA WEST I PHASE 1B I TRACT 289607 LA QUINTA, . LOT ,49 r �.. ^ CEILINGS- TYPE:; Fiberglass BATTS MAN UFACTURER.OwenslCorning THICKNESS: •R-38 12" TYPE: Fiberglass'BATTS MANUFACTURER: OwensiCorning THICKNESS: R-38 12'-'.131_0W WALLS; TYPE: 'Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-1 3 3 1l2:' . GENERAL CONTRACTOR: ,;CENTEX HOMES" - LICENSE: BY: ..' TITLE: a . ' SCHMID INSULATION C RACTORS, INC ' LIC PJ�E #221517 :G-2 ' + BY:. TITLE:PRODUCTION MANAGER, DATE: 09113/00 - ` INSULATION CERTIFICATE . This is,to certify that insulation has been installed in conformance with the current energy regulation, ' California Administratiye Code, Title 24. State of Califomia, in the building located at r - PGA WEST I PHASE 1 B /,TRACT 28.9601 LA QUIINTAT -LOT 49 J CEILINGS: '. • TYPE: Fiberglass BATTS MANUFACTURER: Owens/.Coming 'THICKNESS: R-38 12" ;• .. TYPE: Fiberglass'BATTS MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW ' WALLS: ' R • f TYPE: Fiberglass BattsMANUFACTURER: Owens/Corning .j` JHICKNESS:'RA331/2" '' r GENERAL CONTRACTOR` i,CENTEX HOMES LICENSE ' SY: TITLE: M ' �C-2 SCHMIp INSULATION. NTRACTORS, INC;. LICENSE#221517 �. BY: TITLE; PRODUCTION MANAGER DATE: 09/13100 + . , -. �' • ,., ' In, . . : ',r j'' t .]tip .Y' • • �' :- j , . •I• }'„' +• . ti 1= 01'1 .? FAX NO. tet, -4110 t ALLA I IVlr l,l+,<<i 1MUATE y�6 Address cal. �7 _� 10:31WI P_' WaWl of 7) CF -6R An installation certificate is required to be posted at the building site or made available for all appropriate iaspecdoas. Mae information provided on this form is required: however, use of this form to„provide the information is optional.) Ager completion of final inspection, a copy must be provided to the building department (upon request) and the building owner al occupancy, per Section 10-103(b). HVAC SYSTEMS: External Volume chancy' Standby' !asuladoo Heating Egsrlpmenr Leos (S�6j`� Rn-Wall�ucc'- .� Equip. No( E1Ttciewy Duo Duct or HoainY Hieasing Type (pkC• CEC Ccaificd Mfr Name Identical (AFUE etc.) tocaalOn pip n Load C40161%• hearprtp) and Model Number svottrns WIF-IRvaluel (ade, etc.) R -value (Bttt/hr) ( adw Cooling Equipment Equip. CEC C'mnificd Compressor 0 of Eftideacy Duca Cooling Cooling Type (pkg. Unl[ MN Name and Identical ls� au.)' Location Cues Load Capacity her oumai Model Number Stnerru RCF -IR valve) Letitia et4) R -value Mtwhr) (Bmvhn 1. > reads greater than or equal ra 1. the undersigned. verify that equipmaru listed above is: 1) is the actual equipment installed. 2) equivalent to or mom efficient than that spmlfled in the certificate of compl-(anco (Form CF -1R) aubmimed for. compliance wtih the EnerV- Eiciencv Stondordt for residential buildings, and 3) equipment that mecca or. exreeda die appropriate requirements for manufactured devices (from the Appllartm Efliciency Regularions or Part 6), where applicable. lgnaturc, Date Installing Subcontractor (Co. arae) OR General Contractor (Co. Name) OR Owner WATER HEATMG, SYSTEMS - Distribution If mcdr- sof Rated' Hcsmr CEC Certified Mfr Type (Std. eularlort. Identical Input (kW Type Nauru & Maki Number Point.of-Use) Control Type Syitenn or Btuthr) Tank Em- External Volume chancy' Standby' !asuladoo .gallons) (EF, RAE) Leos (S�6j`� Rn-Wall�ucc'- .� 2 For small gas storage (rated inM orless chart or equal to 75.000 BtWhr). electric reAssance and best pump water heaters list Energy Faoaor. For large gas stnrage wartr hastM (rand input of peaty than 75,000 Budlu). H" Roeovwy Efriciency, Standby Lon and Rated Input. For lastaat"cous ras wager beatcm Ilse Rscovery Efficiency and Rated input. 3. R-12 external iruul : •.! :n is mandatory ror storaya w%w heaters With an energy faetor of las than 0.$$. Faucets & Shower Heade. All faucets and sl,ow•erheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section I 11. 1, the undcnignzd, verify dw equipment listed above my sigutrue is: 1) the actual equipment installed; 2) equivalent to OT more etfici-.:!r titan that specified in the certificate of compliance (Form CF -1R) submiud for compliance with tau Energ), E,$reie;;cy 55randar& fbr residential btdUngs; and 3) equipment that meets or euceeds the appropriate requiremenrl fc r manufactured devi= (from the Appliance Effx ancy Regrtladons or Put 6), whole applicable. 001,z;���,L'� JD Mechanical, Inc. Signanuc, D;�- Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner COPY TO: Bui!_:ng Department HEI'.: Provider (if applicable) Bui!.::ng Owner at Occupancy July 1. 1999 08/30/00 10.56 FAX 7149211631 Alliance Z04 y Installation Certificate: Residential CF,6R Use of this lams to satlafy the requirements of this Adminlatrailve Godo is optional, but the information must be provided and posted. LOT W 1210-E&PLAN #I Bits, A nese PermitNumber An Installation candicate s required to be posted at the building she prior tc 1he issuance of the oc--upancr per, This form may be used to meet these requirements, All apoflanca categories listed below are the actuate equipment installed, Note that the efflcienry and typo of the appliance installed must be equivalent or better than the appliance soecifiod on the Cartiflcate of Compliance (CF•1R). This certificate (or its sQuivelent) shall be prepared and Signed by the parson(s) assuming overall responsibility for the appliance installation. 1, the undersigned, verity that the equipment listed In the category above my signature is the actual equipment Installed and that the equipment most$ or axcesds the requirements of the Appliance Efficiency Standards. In addhion, 1 have verilled that the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. HVAC SYSTEMS Note: Hydmnic boiler information is entered here. Other hydronic or combined hydronic equipment Is elated under Water Heating Symarrta. Hosting Equip. CEC Certified Actual Distribution Duet cr Heating Load Heating Type (fumaea, Manul. Make A Efitcleney typo and Pipping Before aver• Equipment heat um ate, Model Number AFUE.etc. Location Revalue Sizing Stith) Caoac Stuh) —Quvr/ OUT • zPLO 2-1' FW -..S Q ---m--- --- --•�- PUT 0 CQ A 0 CEC Coni led Cooling Equip. Compressor Unit Actual Distribution duct or Type (air cond., Manus. Make a Efficiency Typo and Ptpping heat um etc. Model Number SEER Location R•Yaiue Irr U ;1i 59 4 110- t r PW uildln gy9� tl aa�ss and design heat gain rate have been determined using a method st0ecdisd in Seton 150(h) of She E r i� ic' n St` ndards, and are tNa of the criteria used for equipment sizing and aelec;on. Data HVAC Subonvacmr (Cc, Naas) or General Contractcr or Cwner WATER HEATING SYSTEMS Water Heating CEC Certified Rated' Tank Factor or Tank ns,! System Type Manuf. Make a Input (kW Capacity Recovery Stanobyi ;neuklatlon store o ss, etc.) Model Number or Of..6 alicna) Eiflclenc Lasa by R• Mato 1, for orna11 gas slorago (rated input S 7:,000 Btu/hr), eleetrle reslatance and heat For pump water pasters. Ilst E^e;gy Fac or. Y r WOO osis atorsgs water pasters (rated input >75,1)eC 6tufir), list Rated Input, Recovery Efioiencf ata Stancoy Loss. For Instantsnoous gas water heaters, list Rated Input and Recovery Efficiency For Instantaneous electric waist heaters. list Rated Input. FAUCETS a SHOWER HEADS All faucets and showerheacs installed are listed in the Ccmmission's Dimc ory of Ca vfied Fauca;s ano Scow•erheaes, pursuant to Title 24 Pan S. Subchapter 2, Seaton i 11. S gnarure Date Plumb!nq Subcontractor (Co. Narret or Ganem, Contactor or Comer °Vi_oa JAnuery 199 xOccupancy a� � o o� Cityof Quinta La Buildinig and Safety Department oF- This Certificate issued pursuant to the requirements of Section 909 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: 80-517 SPANISH BAY Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-277 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., 9.1720 By: DANIEL P. CRAWFORD JR.• Date: 2/20/01 Building Official POST IN A CONSPICUOUS PLACE L