9909-275 (SFD)-LICENSED CONTRACTOR DECLARATION
I hereby affirm under, penalty of perjury, that ,l am licensed:under provisions of
.Chapter 4 (commencing with Section 7060) of Division 3 of the Business and
Professionals Code; and.my License is in full force and effect.
License #. Lic. Class Exp. Date
_94 01. 11204
Date ;"' f ' y' -Signature of Contractor
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: 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. perjury) one of the following decfarations:
O I have and will:inaintain a certificate of consent to self -insure. for workers'
compensatidn,' 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 r� ��y(yy ��1��,)j'7[ Policy No..
MEZ. llUARPLt�t 9 L:Er5 i L6t51711�V,G
(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 ibis -permit is issued,
I shall not employ any. person in any manner so as to become"subject to the
workers' compensation laws of California,•'andjagree-that if I should Become
subject to tF�e workers' comoi n alai n provislo's of; Section 3700 of the Labor
Code • I shat orthwlth comply with thoserove lots `
Date Applicant
Warning:.
allure to secure. Workers' Compensatib I coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to�$1.00,000; 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 ion his
application:
1. Each person upon whose behalf this application is made & each -person at
whose request and for whose benefit• work is.' erformed under.'dr pursuant -to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
A hold. harmless the `City of La Quinta;" its officers, agents Iand employees.
2. Any permit issued as a result of this application becomes.null'and void if
work is not commenced within 190 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 in
specfon purposes i
Signature :(Owner/Agent)"- 4� "' ` `Dated1111
„
BUILDING PERMIT PERMIT"
DATE "VALUATION $2,64;Z84,t10 LOT1!-"-""� TRACT 9
i���,.•
JOB SITEO
ADDRESS lr�`:Sl►.i�{.�n'�iAl.
APN
��►`-��:S:Ja-��
OWNER _
CONTRACTOR/DESIGNER/ENGINEER
T290 WARDLOW, CIRC d E, Z 19 A 8:.1,56 F :.
MOvAiDLOW CIRCLE, SUITE t.
c6R.6NA. CA' 917M
CORONA 9,029
( ),2, 794 ! CWJtf .. 5761
USE OF PERMIT
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IMn-
RECEIPT
DATE
BY i}.'
DATEFINALED.
INSPECTOR
7 1f
,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
d �
Underground Ducts
; Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_J&j1e4
pi
= F.A.U.
Framing
Compressor
Insulation Mi7ktis
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
DZTII - Int. Lath
lEv_G3.a/ i
Final
Final / _
BLOCKWALL APPROVA S
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
d
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
A
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 —� —pa
Utility Notice (Perm)
COMMENTS:
~
! SPANISHBAY FPGA WEST
CENTEXHOMES
� September 11, 2000
'CITY OF LA QUINTA'
78-495 Calle Tampico
;
La Quinta, CA: 92253
,r
To Whom It May ConcemM 4
This letter is to'.Verify that all'of the O'Hagin,.Ventilation'. System vents for'clay tile.'a 'plications are
Y
' installed correctly and within all;manufacturer's recommended specifications.
'
Number of O'Hagin Vents Installed_ -
Lot'#
Plan #". �f
;•
,
- Tract # 28960
- � �
..- t • �;,
' + M l.♦
' Sincerely, a
Y V
.. -Pat Leffard i t •+:
I • .�.
Sr. Field:.
Manager
08/30/2000 14:39 0092920499 SCHMID CONTRACTING.,, FADE ,'02
INSULATION CERTIFICATE?
This is to certify that insulation has been installed in conformance with the current energy regulation,
California Administrative Code;
FfZ6`11 :� FAX NO. ;u1. 27 4" 10:.31PN P2
L110 2
AJULA i WIN lr•lc-ATE 1 Of %) Ck*-6R
`X rasa Permit Number
An installation certificate is required to be posted at the buildin; site or made available for all appropdate iaspecdom (The
information provided on this form is required; however, use of this form te..provide the mfortnasioel is opdowl.) After
completion of final inspection. a copy roust be provided to the building department (upon request) and the building owner at
occupancy, per Section 10-103(b).
ffVAC cLMEMc_
Hewing £qulpment
Fquip• t+ of Efficiency Duct Dun or Hoaai HR g
Type (pkg. CPC Certified Mfr Name Identical (AFUE etc,)' Lecadoa low" Load Cap�ty
heat ) and Model Num Svs ntk, stc.) R-Vw )
Cooling Equipment
Equip. CEC Ccnlrlcd Colnp(essor al of Efficiency Duct Cooling Cooling
Type (pkg• Unit Mur Name and )deralcal (SEER, ars.)' Location Duct Load Capack,
hear oumo) Model Number RCF -IR value) igr* eta) R-Vwuc
1. > reads greater than or equal ra.
1. the undersigned_ verify that equipment listed above is: 1) is the actual egnipmeat installed. 3) equivalent to of morn
efficient than aunt spccifted in the certificate of eompl"imco (Form CF -11) submitted for. compliance win die F.,nerV-
Efclenev Standards for residential buildings, and 3) equipment that meet: or exceeds due appropriate requimaenta for
manufactured devices (from the Appllanm Eflicigncy )Zegalartons or part 6), where applicable.
rgnature, Date
Installing
Subcontriaor (Co. Nmej
OR General Contractor (Co. Name) OR Owner
WATER HEATING SYSTEMS:
Heater CEC Ccrtiflcd Mfr
Disvibution If Reelr- 00
Type (Std. cvlation. Identical
Ratedt Tank
Input (kW Volume
Em-
cianoy' Standby'
External
%oulation
Type Nauru & Modci Number
Point of-Uss) Comm] TYps Systems
or MAO ( 311010)
(PF, RE) loss ow
P -value
2 For small gas storage (rated input ofless dun or equal to 71.000 BtWhr). ekctrie resistance and beat pump Water beatera. it" F-ncre Feeuor.
For large gas storage water hssren (ta=d input of grater than 75.000 Budiv). IW& RcWvwy Efficiency, Standby Lass and Rated Input.
For )astaataacous gas water beaters. Ila Racovery Efficiency and Recd Input,
3. R-12 extcmal insul:;lon is mandatory for storage %+cuter heaara with an energy factor of las than 0.51,
Faneets & Shower Heads: ',,
All faucets and showerhmas installed are certified to the Commission. pursuant to Title 24, Part 6, Section 111
I, the undersigned, verify stmt equipment listed above my sigtamm is: 1) due actual equipment installed; 2) equivalent to
or more ef1•iciazr duan that specified in the certificate of compliance (Form CF -IR) subtniucd for compliance with the
Ena V Fifficlency Standards fbr residential btn1dings; and 3) equipment that meets or acceeds the appropriate
reguiremenq for manufactured deviocs (from rhe Appliarrca Efficiency Regulcrrtons or Pati 6X where applicable.
JD Mechanical, Inc.
Signatur"�.D at Installing Subcontractor (Co. Name) OR
COPY TO: Building Deparunrnt General Contractor (Co. Name) OR Owner
HENS Provider (if applicable)
Building Owner at Occupancy
_ July 1. 1999
WCer ti -of 0
ccqpa.ncy. T
r : �
Citk- of La. Q.finta
IWO
8.6ilding.and Safety Department
OF��
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 -544 -SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-275
Occupancy Group: R-3 -'Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTER: HOMES -Address: 2280 WARDLOW CIR, 'STE4150
City: CORONA, CA., 91720
. > r
By: DANIEL P: CRAWFORD JR'
l _ &-t-t '
Date: 11 /6/2000 }
Building Official
POST IN A CONSPICUOUS PLACE a p�
r