9909-274 (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
V31) 41
734094
tD,ate I�j f ,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).
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
p rformance'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.
(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' com pen sation 'laws of California, and 'agree that if I should become
subject toPthe workers' compensation-pl California,
, ;6f• Sdc ion 3700 of the labor
Code, � shall forthwith coniply-vQth those• ovisiQ s( "
Date t� Applicant �f y►��-"�`'`�
\,*arnirig: F ilure to secure Workers' Co �nsat
peio`A coverage I,s unlawful and
shall subject an employer to criminal penalties and civil,fines Info $100,000'; iri
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 Cluinta, 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 i spection purposes.
Signature (Owner/Agent) Date
.� �.
PERMIT #
BUILDING PERMIT f W2..74 w '
DATE I(6I'i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footinga_fftA,
Slab Grade
//g117
Ducts
I Return Air
SteelCombustion
Air
Roof Deck
/
j Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace Ff.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
# Condensate Lines
Party Wall Firewall
Exterior Lath
D II - Int Lathf�
1
Final
Final74213�
POOLS - SPAS
BLOCKWALL
APPROV LS
Steel
Set Hacks
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
S
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:
FinaliV—
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
s 08/31/2000 09: 47 .9092920499 " ' j Sc HI�IID GONTRAG'TING j , FAGE. 06' .
IN
• ',; � `,+son
b.
•; ti y`a INSI.iLATI -
QIVI CE TIFlCe4T�
This is to .certify. that insulation'has bean Installed in conformance with the current energy regulation,
California Administrative Code, Title 24, State of Califomia,'in the building at +'
PGA WAST IPHASEr2A 7 TRACT 289601 LA Ql91NTi4+
} , LOT 25
•CEILINGS , .r: `. �,. �. + - �{ • :�' , s. �,., '
TYPE,:' -Fiberglass BATTS MANUFACTURER:Owens/Coming THICKNESS: R-313 12" BLOW
WALLS: '
TYPE: .Fiberglass Batts MANUFACTURER:;Owens/Cornin
g : , THICKNESS:R-13
1 GENERAL CONTRACTOR: CENTEX HOMES LICENSE:
BY:,TITLE:
SCHMID INSULATION CONTRACTORS, INC'. -
LICENSE 4221517C -2
BY.
TITLE: PRODUCTION MANAGER GATE: 08/30/OG
`� INSdJLATIOIV CERTIFICATE r
' This i� to certify that insulation has been installed In conformance'with the current energy regulation}
California AdministrativetCode, Title 24, State of California- in the building located at
PGA WEST l PHASE 2A/ TRACT 2896P I LA QUINTA ' CA t
SLOT 25 .
CEILINGS: y
TYPE. Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-33.12" BLOW
,`...
WALLS: .
TYPE: Fiberglass Batts MANUFACTURER: Owens/Cerning THICKNESS: R-13 3 112" t
k
GENERAL CONTRACTOR: CENTEX HOMES ' . LICENSE?#
EY;. TITLE, `
. ' —�
SCHMID INSULATION NTRACTORS, INC. LICENSE #221517. C-2
BY: TITLE:PRODUCTION MANAGER• DATE: 08/30/00
s.
Am
08/30/00 10:56 FAX 7149211631
Alliance
•
�08
Installation Certificate, Residential CF•6Fj
Use of this corm to eiiit0aly tho requlremanta of the Adminletretive Code Is optional, but the Inlormadon must b° provided and posted.
Liar.
Site rAddrosa
Permit Number
An Installation cendicate is required to be pealed at the building site prior to the issuance of the occupancy perms. This form
may be used to meat these requirements. All appliance categories listed below are the actual equipmen¢ installed. Note that
the eHlclencf and type of the appliance installed must be equivalent or better than the appliance uiPm led on the CeNote th of
Compliance (CF -1R), This cendicate (or its equivalent) shall be prepared and Signed by cite porion(s) assuming overall
responsibility for the appliance installaWn.
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment lnstdod and
that the equipment meets of exceeds the requirements of the Appliance Elficzency Standards. In addition, I have verRled that
tac
the equipment is equivalent to or more efficient than the equipment spedied on the Certificate of Compliance ve V
demonstrate compliance h the Energy Efficiency Slandards for residential buildings, submitted to
HVAC SYSTEMS
Note: Hydronic boiler information is entered here. Other hydronic or combined hydronic aquontgrit IS listed under
Water Heating Systeme.
Heating Equip. CEC C4nlffad Actual Distribution Duct or Heating Load Pleating
Type (Iurneee, Manuf. Make & Efficiency Type and
heat pump, ate.) Model Num
PIpins Before Over. Equipment
ber (AFUE etc, Location R. Blue Elzin Btuhl Goac (Btu 0.1
t-- _tet
CEC Certffled
Cooling Equip, Compressor unit Actual Distrlbutlon Duct or
Type (air cond., Manuf, Make & Efficiency Type and PI I
heat pump, etc. Model Number tgF!Pn% t .,....,__ .. P.ng
Alm co01 v
-moi ( x.,
41he
— T"� t f
esign atlas tend design heat gain rate have been dwarm;ned 'using a method soecced in Secton 150(h) of
ict Sia . rds, and are t a of the criteria used for equipment sizing and aelecaon.
� f r11
(?ate HVAC SubonTacoe (Co. Name) or General Contractor or Owner
WATER HEATING SYSTEMS
Water Meeting CEC Can mled Rated Ener t
System 'Type ittenuf. McKe & t Tank Factor or Tank nal
store ® as etc.) Model Number Input (kW Capacity Recovery Standbys Insulation
or 6tuh allor,al Efticfenc Loaa ('41 A -Value
t Fer Antaga
ll s stoiage (rated input S 75,000 Sh Atr), etsctrle resistance ano heat pump water tea, list Energy Facmr,
For large gas storage water heaters (rated Input 3,73,000 Btu/hr), list paten Input, Recova c
For Inalantaneaus gas water heaters, list Patent lnput and Recovery Efficiency, rY "'0nry enc Standby Cosa.
For Instantaneous siegtrlc water heaters, list Rated Input.
FAUCETS & SHOWER HEADS
All faucets and srowerheacs installed are listed in the Commission s Oirec:Cry of Candied Fauce;s a,,^o S! owenc�acs,
pursuant to Title 2c. Pan 6, S�bcnawor 2, Section t 1 t .
Signa, re
Cate
•F.m,ieecJanunry 11 V2
PlumUeng S'.oeontractor %Co. Name i or Ga -ler -al Ccntraewr or Owner
i M FAX NO. 27
(Pa:b,. f7) 1a:311irt `k• -6R
uRa i tiLLli 1 t V lv L Jr:� r'!l.'A'
w Fess Permit Number
yQ5
An installation certificate is required to be posted at the building site or made available for all appropriate WV*c ions. (The
information provided on this form is required: however, use of this form to..provide the information is opdowlL) Afta
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).
LMAC OM _Mc-
Hearing Equipment
"°ip• r of , Effickncy _ Dna Duct or Roaring Heating
TYPe (Pkg• CEC Ccnificd Mfr Nam: Identical (AFUB, ea.)' Loeaxion Piping ldad Capacil�v
hear 22m) and Model Number SWstays IZCF-IR valuel In k. ate.) R -value (Batt (gpvlut
CooQnrg Equ/pnacrtt
Equip. CEC Certified Compressor g of Effict aey Dun Cooling Cooling
Type (pkS. Unit Mtr Name and ldcrAcw (SEER sta.)' 1.0080011 Duct Load
hen t Model Numbcr RCF -IR valva) - (gr* eta) R -value (swam ()dtt7/!)r)
1. > reads g caxr rhan or equal ra
1. the undersigned. verify that equipment listed above is: 1) is the actual equipment installed. 2) equivalent to or more
efficient than that spccifted in rhe certfficate of compl-nano (Form CF -1R) submitted for. compliance with the Energf-
Efflcfenev Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (from tate Appliance E,riciaancy Regulations or parr 6), where applicable.
1gn3cure, Date
WATER IJEATTNG SYSi'EM4-
Muribuuion If Rccir-
Heater CEC Ccrtiflcd Mfr Type (Std. eularion.
TYpc Name & Modcl Numbs Point -*f --Use) Control TV
mg Subcontriew (Co.Name)
OR Geamil Contractor (Co. Name) OR Owner
SO Ratedt Tank Em- Exumal
Identical Input (kW Volume cienay, Standby' Waladon
systeve or BaYhr) (gallons) (EF. RE) Loss (K` R-vdue'
Z For small gas storage (rated input of less dutn or equal to 75,000 BrWhr). electric reAziaaes rand beat pomp aster heatcm list Energy rawer.
For large gas storage wooer heaters (tared input of gteaper than 75.000 Buov), list RotaveryEfrciattry, SniMby Lass and Ratsd [nput.
For iastaIIlancous ca water bes cm list Recovery Efficiency and Rated Input.
3. R-12 external Inwl;clon is mandatory for usage ureter heater!{ with en energy factor of las than 0.$i.
Faneets & Shower Heads- ',,
All fauces and showerheads installed are certified to the Commission. pursuant to Title 24, Pan 6, Section 11 I.
I. the undersigned, verify that equipment listed above my sigrtamm is: 1) the actual equipment installed; 2) equivalent to
or more eff)civnr than that specified in the certificate of Compliance (Form CF -IR) submiud for compliance with the
EnrerV Fffciency SYandmds for residential bunUngs; and 3) equipment that meets or rxceeds the appropriate
requtremen4 for manu&=xrtd devices (from the.lpplianm EffKi&�YRegutatiors or Pan 61 where applicable.
6v JD Mechanical, Inc.
Signanuc, Daic Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPYTO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
_ July 1. 1999
Certificate of Occupancy
City of La Quinta
Building -and Sa'-fet' Depailme-"t Y`� 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._fo/%wing:
BUILDING ADDRESS:. 80-562 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-274
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:. 12/12/2000
Building.. Official
POST IN A CONSPICUOUS PLACE
I