9909-276 (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
734094 el it ` F� t1N"W20f
Date'J° Signature of Contractor kj,�
V .
OWNER -BUILDER DECLARATION p�
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).
() 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.
(), 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' compensatiori insurance carrier & policy no. are:
Carrier Policy No.
(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-prov slons,,;f Section 3700 of the Labor
Code • I shall orthwith comply with those pr � visioris: I
, eDate Applicant
V
Warnink Failure to secure Workers' Compensation coverage 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 'representatives of this City to enter upon
the above-mentioned property -for inspection purposes.
gnature (Owner/Agent]'Dates 1 n
PERMIT #
BUILDING PERMIT 1;11M11
6)
DATE fO/J)J/J' VALUATION '+ w �1�. LOT ? 4 TRACTJOB
SITE
ADDRESS �v:.�t F L�J >� s 4k� i1
APN AQJ•
OWNER
CONTRACTOR/DESIGNER/ENGINEER
fl! ENrrIV.I .H "INIE1.
22.90 WA72iJLOW CIRCLE, SUM' IA ..
2.281) W AinDLOW CIRCLE, SilT.IE LW
14<s �l�.l 3F A CA 91 20
{.'OR.01N , CA 9 t'720
USE OF PERMIT
S1NG,U 3�A44'W, ! 1� 1 1�i.t.117ii
z;j lam W1 Z, .1 L,%14 3. Y!6,1"T 11R4:9 'ilio f N,f,:1..RJbLi iiLC.AX 'Vb.At'.!.
.4"(.11.>[.. 75�oltc;f;tLt+:1`lL+N t,�1� A�.iW t.:t�I�c. ���: (.+lt �19�SL'3'fI�'%,1;:1� �t?�.Ah:S'�•
CW SAM& KAAN TYPE.
Ct)iNi7.`Rra( C,14 11053.00 37
13t11zt'HAVV '.f0 563.001
6800 SF
;'4=�� ,t `l�'�.➢tt¢ flP CM OXF i. V. iNSTRUC, ION
2w3iYpGni1211)
ab.�!.7xY.L�ii �•�• �� i_a9'i :T'4J l�'�lNiQ�1�[ it
l"IONI `FXUtl 710N FEE WIAW-41kt- OU ss1,i",1+.2 _w
6+'i AQlt":�F?f
�vlYsc:�ti,'11•diC,'�1�1. ;•�� 11}1 •ttil�'•�a1���}61 ai lu �at�
1�t,Tlivfl313v1tF€rfs lOf 4}1}€1^Sit°" `1d?i.`sY1
4°#CiY�friito'yti:
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ART 414.PUTALk: RL.- ii: 7{}14kJ{}a255-00
gr Ifl-'f°J Xf't'a.1, i"'C3A1Sl li''t V`fig{ N 4N 1� S.,A1pp_N 06'i,.�"K
(��1T ((
1:'1'MP f,FRIFS.1
Wli
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
j Underground Ducts
Forms & Footings
6
t Ducts
Slab Grade
9
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Dr Il - Int. Lath
Final
Final
BLOCKWALL APPROV LS
POOLS - SPAS
Steel
Set Backs
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
Water Piping
�� 5��9
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�f�
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)
C �/
a -SPANISH AY QPGA WEST
September 19, 2000``
CITY OF LA QUINTA
;
78-495 Calle Tampico
b`
La Quinta, CA. 92253 -
To Whom It May Concem
•
This letter is to verify that.all of the O'Hagin Ventilation System vents for clay tile applications are
installed correctly and within all manufacturer's `recommended specifications.
Number of O'Hagin Vents 'Installed
Lot#
w '-
' �.• •., ' .
' - •, '�
+3
• PlanAI
.
.�
Phase #>
' Tract # 28960
Sincerely,
S•4 •
f t
j'I
' Pat Leffard
Sr.,Field Manager''
• a
'F i •
y ;< ../ y
'fit ' •
08,1.31/2000 N08:47 ' , 9092920499 SCHM11) CON TRKiJTING < PAGE
0:3
INSULATION CERTIFICATE
This is to certify that insulation has been instalied in conformance`witrr the current energy regulation,
Cbliforriia Administrative Code, Title'24; State of California, -!n the buildi;ig at
x PGA WEST / PHASE 1E / TRACT -28960 I LA QUINTA
,
LOT 27
CEILINGS:
TYPE: Fiberglass,BATTS MANUFACTURER; Owens/Corning 'THICKNESS: A-38 12" BL01N'' }
� , f a .� - -,
., ',y W ,
WALLS. •• . .y -
Y
' TYPE: 'Fibergla'ssBatts MANUFACTURER:OwenslCorring •'•':THICKNESS:R-1331/2" 'w
.'► �'
GENERAL CONTRACTOR•,tiCENTEX HOMES
LICENSE: r-
BY:'TITLE:
SCHMQ !.NSULATION CO ACTORS; INC'.. :.LICENSE #221517 ' C-2 '
IA
BY: = T1TE E: PRODUCTION MANAGER DATE: 08/30/00 `
,INSl1LATI N.CERTIFiCATE
' This i$ t0`0ertrfy that insulation has been in in conformance withthecurrent energyreguleticn,
California Administrative Code, Title 24, State of California, in the•building located at
f
;
PGA WEST'! PHASE 16 / TRACT 28960
I LA QUINTA CA
LOT 27
CEILINGS; - -
;TYPE: Fiberglass BATES MANUFACTURER:,;OwensICorning' THICkNESS. R-38 12" BLOW
�• ' J ,.' WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS' -R-13 3 112"
"
GENERAL CONTRACTOR CENTF_X-HWES ." LICENSE
k r
,BY,_ TITLE:
SCHMID CONTRACTORS,•.INC.- LICENSE #221517 C 2 Y•
` - BY: ` -- '¢ - ` TiTLE:j ;PRODUCTION MANAGER . DATE: 03/36!00
FROM . FNx NO. ;ul. 27 21W 10:.31HM P2
Lill, IL 11VIN l.hsll 11`1UA E (Pa i Of 7) CF -6R
nss
MEN Number
An installation certificate is required to be posted at the building site or mach available for an approprim inspections. (The
information provided on this form is required: however, use of this form to,.pnovide the informafm is opdoosl.) After
completion of final inspection. a copy must be provided to the building department (upon request) and the building owner at
oceupancy.per Section 10-103(b).
HVAC SYBT _MG_
Hsating Equipment
Equip• It of ElTiciewy Dun Duct or FkainE Heating
Typo (pkg. CPC Certified Mfr Name identical (AFUE, ere.)' IoeaBDo pw" Load Capsaty
haat ) and Mo cl Nurnbcr sys attic, cc;.) R�vai
Cooling Equlpntenr
Equip. CEC Ccnirred Compressor a of Efficiency Duct Cooling Cooling
Type tpkg• Unit Mtr Name and identical (SEEK 40104' I.vicetion Duct Load heat t Model N CAP=*
ale(9042, of—)
R-Valu; (&olltr) (BN/br)
1. > reads greater rhan or equal to
1. the undersigned. verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalenz to or more
efficient than that specified in the certificate of compliance (Form CF -1R) submitmd for. eampliance with the EsserV-
gtWcienev Srandards for residential buildings, and 3) equipment that meets or exceeds die appropriate requirements for
manufactured devices (from the Appllance Ericiency Regltlarlons or Part 6), where applicable.
tgnature. Date s img Subcantraaw (Co. ame)
OR General Contractor (Co. Name) OR Owner
WATER HEATING SYSTEMS-
Distribution If Reeir- a of Ratedr Tank E!R-
Heater CEC Certified Mrr Type (Std. wlarion. Identical Input (kW Volume ciency2 Standby'
Externd
!m1ation
TY Nana & Model Number Poincof--Use) Control SYstarts or Bnyht) ( allons) W, RE) Loss OW
P -value'
yds .�s 97
2 For small gas storage (rated inM orless than or equal to 73.000 BtWbr). electric resWanes and beat pump water heaters. ltst Energy Factor.
For large gas storage watt/ hearers (rand input of g eaW than 75.000 Bnaft), titin Recovery Efficierwy, Standby Lon and Rased Input.
For ittstaataocous gas water heaters. Ila Recovery Efficiency and Rated Input.
3. R-12 external insul orlon is mandatory for storage wbtar heaven with an energy factor of las than o.St.
Faucets & Shower Heads.
All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111.
1. the undersigned, verify riot equipment listed above my sigtaamre is: 1) the actual equipment installed; 2) equivalent to
or more efficient ulran that specified in the certificatti of compliance (Form CF -1R) submitted for compliance with the
EnefV Efficiency Standards for residenrial btrildingg and 3) equipment than onsets or a)tteeds the approptinte
requirernenq for manufactured devices (from the Appliance Effkiency Regtdadorts or Part 61 where applicable.
JD Mechanical, Inc.
Signator,, DZ Installing Subcontrmetor (Co. Name) OR
COPY TO: Btti!d:ng Departrnrnt General Contractor (Co. Name) OR Owner
HERS Provider (if applicable)
B u i I c ;ng Owner at Occupancy
_ July 1. 1999
Cedificat&,�,O`f �..�
City of La Quinta
_ Building --.and - Safet Department Y OFA F.
This -Certificate issued pursuant to the'requirements of Section 109 of the. Uniform BuildingCode,
certifying,that, at the time of issuance, this structure was 'in compliance with the variousordinances
M of the City regulating building construction or use. For the following., x
BUILDING`ADDRESS: 80-526 SPANISH BAY'
Use Classification: SINGLE FAMILY DWELLING 4 Bldg. Permit No.: 9909-276, _
�- ;
Occupancy Group: 'R-3 Type of 'Construction:' 'VN Land U. Zone:" RL-
Owner.
L Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150
i - City: CORONA,�CA.,,91.720 '.
By: DANIEL P. CRAWFORD JR.
Date: 10/19/2000 _ y
Building Official r '
r
POST IN A CONSPICUOUS PLACE
a