9909-279 (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 ir�full force and:effect.
License # ' Lic. Class E* Date
x.9J, .aid}r' t°C} id 9ll.40i
Date j Signature of Contractor'
OWNER-BUILDER"DECLARATION
I hereby.affirm under penalty.of perjury that 1 -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).
( ).
['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. ..
have and will' maintain workers' compensation. insurance, as -required by
Seotion 3700 of the Labor.Code,'for. the performance of the work forwhich this
permit is' issued. 'My workers' compensation insurance carrier-& policy -no. are:
Cartier. `Policy No. M
A T, diTb r t N.Tb n 1:1et'�A fa " " . tis diraYYF9!� Lhd�
.'�: `•C!:¢b�.j;�. �lJ/'11.1...fOd48f b?. it'1-U,lar. eJ?t� / .-. •
(This section need not be completed if the permit valuation is for, $100.00 6 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 tor become subject'td'the
workers' compensation laws of California, and agree that if I should (become
subject to theiworkers',comp@nsationprovisip s df_Sectlori'3700.of the Labor
Code, I'sh"II forthwith complyfwith those pr�isio S. '
Date: t"� �°� Applicant'
NoVarning: Failure to secure Worker's' Compensal on coverage is unlawful and
shall, subject an employer to criminal penalties and civil fines up'to OO,OOo, in
addition to the cost of compensation, damages as provided for in ectioh 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 Quinti, its officers, agents and employees.
2. Any. permit issued as a resu'It 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 cancejlation.
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'
Sig 'ature ' (Owner/A� " ent)-- r- "9f!^4 -:
Y
g Date 4�
PERMIT #
BUILDING PERMIT«.:.
DATE.t t�f�6tVALUATION� ariy�t�)« LOT! _ Q TRACT°dt
�E JOB SITE ww�
tYQd-:9n9
APN.
ADDRESS avY �IlXd►.4l
OWNER - -
CONTRACTOR %DESIGNER%ENGINEER
i 2SUeY�ieif. l�ie6#1��:�14. �1eCy.��i�Ji "jr3i
ZjR04di 7«hOut £)1%~e.�e�b�1�'i�: u�li
i ►k2j.>�,r, CA, -9i 1 t3
Cs tiNA-1.,.;Cfx- 91.720
iy13+�1�•7aa �didt)d� �,��d: � :� �6�
USE OF PERMIT
SINGLE". PAMUS it i:!"U:1440..
L i iT, ifJ,.,f�.iV2. 11. li9.%W4S N;dT Lei.rt7M ALt)CK WALL "13I
YOUL. '15°i kBOUC PION GO PLAN. C EEKAWe OYi.'i',✓d'OLIV'Y.t Ilk 1 S1$1 tK1A.N1CK
OF Sfi1WS PL-AN'T'Y F'
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d+ ,UAdW1 G le tf13 tddlf l t:t-t3�JE3 3 � f w 115.
... £ �'
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ART IN Tt.;;l3irtc f'"3 Aeo- OS - R alb, 701A011-2551-000,
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 9
Slab Grade //_��`%�j
Steel f �-�
Ducts
Return Air
Combustion Air
Roof Deck
Exhaust Fans
Orap 3
F.A.U.
Framing Ire
Compressor
!
Id ion ,�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath e_
D II - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
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 !
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 10
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)
08/30/00 .10:56 FAX 7149211631
Installation Certificate: Residential
a111ance
Q09
CF -6 R
Use of this form to aaasty tits requirements a( the Administrative Cede Is epttanal, but the Inle mat>gn must be provided and pontes.
LST '51
a►` PLA Pg
Site Address Pevm,t Nbmoer
An Installation certificate is required to be posted at the builcing site prior to the issuance of the occupancy perms. This form
may be used to most these requirements. Ali appliance categories listed below are the actual sruipmeni installed. Note that
the e"Iciency and type of the appliance installed must be equivalent or butter than the appliance zoacified on the Certificate of
Compliance {CF -M. This cendicate (or its equivalent) shall be prepared and signed by the persen(g) assuming overall
responsibility for the appliance insta9ation.
I, the undersigned, verify that the equipment listed in the category above my signature is the gonial equiprnGrlt installed and
that the equipment meets ovexceWs the requirements at the Appliance Efficiency Standards. In addition, I have verified that
the equipment is equivalent to at more afticient than the equipment specified on the Certiliczale 0I ComOarics submi od to
demonstrate compliance with the Energy Efficiency Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronie boiler irdofmation is entered hare. Other hydrenic or combined hydroric equipmerr, is listed under
Water Heating Symems,
Heating Equip. CEC Certified . Actual Distribution oti ct or Heating Load Hesting
Type (furnace, Manuf. Mata A Efflclency Type and Pring Beier Over. Equipment
hetet oum eft:. Modal Plumber lAFUE. ate. Location R- %lura Stil;Btuh) Cab tty(stuhl
F'U R.T4- OUT PUT
�Ls —� P�is�►
CEC Cartif led
Cooling Equip, Compreasor Unit Actual Olatribution Oua:t or
Type (air cond., Manuf. Make A Efficiency Type and fsfpIn
heat pump, etc.) Model Number _(S@ER) Location R%nigue
A19- C0P4_ v
TheElergy)
desiq at to and design heat gain rate have been determined using a method sawclied In Se ,lion 150(h) e'
theilio, Sta dg, and are twc of its criteria used for equipment 9iYin:j sial saier.;on.
• t`...t'..-�fl•1`IC' � . l ► E��Y A.h r � a� Lie_. ht� ,
Signature Data HVAC Subontractar (Co, Name) pr Genera! Ccntra.= or Cwr*r
WATER HEATiNG.SYSTEMS
Energy' External
Water Hescrig CEC Certifled ' Rated' Tank Factcr or Tank
System Type Manuf, /Make a Input (kW Capacity Recovery Standby' Insulation
storage as stm) Model Number or 6tuh (gallons) Efficient Loss ( R•Velue
For small pas storage (rated input S 75.000 Stunt.), electric resistance and hest pump water ha&tety. lilt Energy Facmr.
For iargegae attarege water heaters (rated input 3,75,000 Btvhr), list AaEK ,nput, Recovery Eftienv arc Stancby Losa.
For Instantaneous gas water hest". list Aated Input enc Recovery Elfcency,
For Instantaneous siectric water heaters, list Rateo input.
FAUCETS & SHOWER HEADS
Ali lauceis and showerit..eads installad are listed in the Corr,r,ssicn's Directory of Candied Favcs;s arc 5hnw'erneacs.
cursuant tc Tilla 24. Par, 6. Subchawar 2. Section t It i.
CigLa:�fe �a;9
F'4V°ase J&MUvy .9V7
P!umb,rq Subcontractor (Cc. Name, cr Gar era, Contractor or CxA-'
NE r
ice}
08/31'/2.000 "08: 47 9092920499 SCHMID CONTRACTING",
PAGE '07
4 °.
+., INSULATION CERTIFICATE
This is to certify that insulation has been installed in'conformance with the current energy regulaiion,.
California Adrninistrdtive Code; Title 24, 8tate''of
California; in, the building at r
PGA WEST I PHASE' 2A
[TRACT 28960! !.A QUINT,4"{
LOT 51
CEI! .INGS: ' ` i'.
TYPE: Fiberglass BAITS MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BL.OW
�.•
WALLS:
TYPE:.Fiberglass Batts MANUFACTURER:Owens/Corning T.HICKNESS:R-13 1/2 -
GENERAL CONTRACTOR: CENTEX HOMES LICENSE::.
TITLE:
SCHMID INSULATION NTRACTORS, INC. ^LICENSE #221517, ''C-2
1. BY r !/ TITLE: PRODUCTION MANAGER ' DATE: 08/Z
0/00
INSULATION CERTIFICATE
This is to;
TE
r
CEN , E HOME � SPANISHBAY (FPGA WEST
September 11, 2000!
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA. -92253
To Whom It May. Concern
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'Hagln Vents Installed '2 21
Lot #
Plan # • 3 /L4,9—
Phase
y,Phase # 2
Tract# 28960
f O'ccupancy,rt�ficato oCe
C
it •of L -a Quinta. f
"Idin and Safet •. Department Buy g y"�°F'
•
` This 'Certificate issued pursuant to the requirements of .Section 109 of the Uniform Bui/ding+Code,
certifying that, at the time of issuance, this structure was in compliance` with the various- ordinances.
of the City .regulating. bui/ding construction or, use. _ For the fol%wing:..
BUILDING ADDRESS: 80-555 SPANISH BAY
Use Classification: " SINGLE FAMILY DWELLING Bldg:, Permit No.: 9909-279
Occupancy Group: 'CENTEX Type.of Construction: -3. Land Use Zone: VN '
HOMES
.1 Owner of`Building: RL w Address.: '2280 WARDLOW CIR, STE 150
City: CORONA, CA., 91720
By: DANIEL P. CRAWFORD JR.
Date: 12/5/2000
Building Official -
POST IN A CONSPICUOUS PLACE