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9909-280 (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 �441 ' fp'Md t l Signature of Contractors l OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt.from the Contractor's License Law for the following reason_ , ( ) 1, 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). ( ) 1, 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.0 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 Se tion 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 RR Policy No. �yvl� .Yi1YE1'`A.tl.. 4 Utf'1f.1/YL t 1GY <s44. (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 pthat if I should become subject to+the workers' compensation prvlsions of Section 3700 of the Labor Code al fo�,rt,I� with comply with those brovi�s ons. Date:1 E Applicant�`. `Warnin : Failure to secure Workers' Co pen• ationKoverage,, is�5 lawful and shall subject an"employer to criminal penalties and civil fines up to.. 10.0,000, 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 Isubject 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-author,�e[[repres ntatives of this City to enter upon the above-mentioned property for 1 spectio purposes: Signature (Owner/Agent) Date PERMIT# BUILDING PERMIT DATE�,/05/1"VALUATION S27,1.111..,� „LOT TRACT lDf� i1 JOB SITE ADDRESS �If� -Ji% a egl t3 �ft LII l .. APN 769-04-005 OWNER CONTRACTOR? DESIGNER / ENGINEER , �h •fir q p� L,�?�i t ��,�.€�L..���ra e-i'i a�+�- Yt''�y y �,.�7:'i4F,.�s �,i,'�l1ai�•i �'� . '.I'M � til t1ARAE.ri i �h' ;—lit�ia6, ,^i�Jr 3'lP..l Yaf 1. 4' 4�:'F .. /f. r,. :�-2. 0 bpi",l�4 ii is �lieil �b ll 9.LS y:UL, SUI FE IA CA 41--120 001H.ONA. (141,0 5764 USE OF PERMIT A:t�.( 5%, .1;�s�Fr 11J,. l 1t,►F i 41.E loL 41A9 1f t%i .K %r'h13,:�.'f R vwL. 7wo 0iV .t?3..A N CHECK MU i'WiX OF SAiv'It! PLAN T YPEL CLy?'TO� I C0 6,lrA'1'?rZU(; i 1.0N x;:320.00 8r 188.00 31 • i.?i�f��.t1t+��'a'iA.�,tyt33i"L' 6i'S:+l.!�i �.T•" .��•• .yy•��f,,SRay,'$: >r!,'�Vi'f.)4+4A�/_*4 aJ , Bst.F15 Y�.1 ti6.+',4 J•'41'1�t d�i� g'I.N.LL, k99 qq ��jj-y�;,� ��••rr A�,���+6 A' INt+a4la kT Lt_'trl'S�Yii ,3�LS .R• - '0NS- TRWf10*fF8H IN-41LO-418-WY T, T .. -tf0ffD0()~-4N�Aw11.-f�t0PR/? aY r. H��•�1^;FTry •-- iY:'ll :!`rl,ltltarl.'.rtl. i• 'tw R116110�i t.f I.c�t '{w, t`► ~ l�y1 ,� / i � � F� .f.;k.:�:�ii'F6<A�il'4a.i'A'4iK�' . �:�.tAi W,\P�4,M4i"Wk+W 3i't�l.�hi !".r� 1'f.43,f+F£4rNu FEE, $199.75 i F-•• ?t'rt20rlr1 rub sl1r31v FAxR . t2F9 37 Ma w n �('� ♦ {" (may +f� ('� -`,{25 - 000 '.1' IN Pf<I133.WXPLl�1. IiiIi -RMA; ; 769-tem2sa-01W l:��vf�,C"�IWlwt� t�t��c.�a• � � � t,fxa'rc�r, ; 4Idf1 YiTAi'.t':�"",�Jf g'RI.IC;itE7'+tid f11ti3F'6i�1,;%Ni"ftv X RECEIPT DATE BY t j DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Return Air Steel Combustion Air Roof Deck jeW,C 4 Exhaust Fans O.K. to Wrap / pa 7 F.A.U. Framing Compressor Insulation , _ Vents Fireplace .L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath DrMall - Int. Lath pb Final Final BLOCKWALL APPROVALS 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 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 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 04 Utility Notice (Perm) COMMENTS: Vii• oi)/ VU +. V: JV 1 AAL I Iq'I .1V -J,L A.L.J. iZWL instaiiation Certifica. Residential CF -6R Use of this least 10 aatisty the requirements of the Admanletrative Cads Is optional. but the Intgri»stlon must be provided and posted. LOT* �� -s� .� ;�►.i S�� t `c'P�A� � � 9 �©9 - z-(? Site Addrew Peanut Nuttiest An installation candicats is required to be postoo at he building she prior to !f,G ;ssuance Of the 0CCJp2ncy permit, This form may be used to moot these requirements. All appliance categories list" below are IhO actual ecuipment installed. Note that the efficiency and typo of the appliance installed must be equivalent or cotter than the apoliance specifloc on the Certificate at Compliance (CF -t R). This certdicato (or hs equivalent) shall be prepares ar:d signed by the persons) assuming overall responsibility for the appliance instaasoon. I, the undersigned, verity that the equipment listed in the category abova my signature is the actual egt;ipmern Installed and that the equipment meets or 0tce0ods the requirements of the Appliance Efficiency Standards. addition, I have verdled that ds. I 1110 equipment is equivalent to or more shicient than the equipment speChied on the Unificate of Compliance submitted to demcn$irate Compliance with ;he Energy Efficiency Standards for residential buildings. HVAC SYSTEMS Note:' Hydrunic boiler information is entered hero. (:?ther hydronk or corntined hydranic equipmsrtt is listed under Water Heating Syllgma. Keating Equip. CEC Carttfled Amai Distribution Cunt or He0¢tng Load HeatlnQ . Typo (fumac0, Monuf. Macke i Etilcleney Type and Piipirtg Before Over. Equipment heat urtt . otc. Model Plumber AFUF_ etc.) Location A• al se Stzln etuh) Caoac Stuh1 CEC CartMlad Cooling Equip. Compressor Unit Actual Distribution Duct or Type (air cond., Manuf. Make & Efflclency Type and piping heat pump, isle,) model Number (SEER} Locatlon Fi-Value �1�7 "goL129 --a - u -- 4 !Z•u t! 4. Wie! at loss and design haat gain rata have been determined using a mt r.i*e s¢ec:fisd in Sac: ta30(h) of I1"arda, anrd are two of thecr;teria used fo equipmem sizing and aaiec;;en, Oats HVAC S -0o ttrar or (Co. Name) or Genesi Contracccr or oww WATER HEATING SYSTEMS Water Heating CEC Certyie,i E-rtsyr t Rated' Tank Facto nor TankExtarnat System Type Msnuf. Make & Input (kW Capacr*.y Rac:overy Standby, insulation (storage gas, etc.1 Model Numberor etch (sl;ona) Ef!lcfency foes t l Ft•Vaiva t, Far small gas storage (rated input S 75.000 e;uihr), slottria resiatanee and feat pump wafer hreaters. !iSl Energy ;ac=t. For targe gas atarago water heaters (rated input>75.000 atwhri, list Rated input, F;VQ cry E.7atiat;ncr arc Slarcby _csa. For Instantaneous gas water hestera. list Aatvd Input and Recovery Elfic:rrrcy, Far Insuntaneoua slsctric wstsr healers. list Fated input. FAUCETS & SHOWER HEADS All faucets anc showerheacs installed are listed in ine Comms51cn's Oirertcry of Ca.hified Fauc;ots are Showemeaas pursuant :o Two 24, pan 6. Suixhaptor 2. Section i 1 i. Signarure 01,1 to Ptumolrg Subcontractor (Cc. Names or Can era; Cortractcr or t Omer •�.Qorl : ,.. Fax NO. 27 2� >_a: 31HM R2 L ut.7 l AJ J- i 11V1N l.t'�'��le 11:A E (P%,.gkf %) CF -6R w rens elm r Number An installation certificate is required to be posted at the building site or made available for all approprsare iaspecdons. Cne information provided on this form is required; however, use of this form to,.provide the inform ban is opdoosl.) After 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). QAC JW _M�- Hearing Equipment Equip• it of Efficiency Dara Duct or Hmn Heating Type (pkg. CEC Certified Mfr Name Identical (AFUF- cc,)' PW" 1adheat ) Model s atc,capackv etc.) R-val s Cooling Equipr»ent Equip. CEC Certified Compressor 0 of Ef6deaeq Dtxt Cooling Cooling Type tpkS. Unit Mrt Name and Identical (SEES. WW.)1 Irocattion Duct Land heat 't Model Nurnbrr Strwms Ptcr-IR VOW etc.) Rwal t Mayhn l . > reads greater than or equal ra 1. the undersigned. verify that equipment listed above is: 1) is rhe kcaval equipment installed, 2) cqutvalcat to or more efficient than that specified in the certificate of eompl-iance (Form CF -1R) submitted for. compliance whh the EnerV- E,fcienev Siondards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (from the Appltanae Efficiency Regularions or Part 6), where applicable. Ignature, Date s mg subcMiriaw (Co. Na=j WATER HIcATiT\'G SYSTEMS- OR General Contractor (Co. Name) OR Owner Distribution If Rcclr- r of Rageds Tank EfR- External Hma CEC Ccrtiflcd Mfr Typc (Std. cvlation. Identical Input (kW Volume ciency., Standby' !asulatlon Type Name & Modci Number Point *f-Uss) Conuoi Systerru or Bayhr) (gallons) (PF, RE) Loss (!c' R -value' 2 For small gas storage (rated inptn oricss than or equal to 75.000 BnWhr). electric ruwance and beat pump -awr hesuera. Itu Energy Factor. For large gas storage warn hearers (rated input of greatar than 75.000 Stothr). Ilse Rowvery EfGciarsey, Standby ion and Rated Input. For Iusraataacoas gas wager heatem list Racovery Efficiency and Rued input. 3. R-12 external insultdon is mandatory for storage %+weer heaara with an entry (amor of leas than 0.S3. Faneets & Shower Heads -- All faucets and ahowerheads installed are certified to the COMYn scion. pursuant to Title 24, Pan 6, Section 11 I. 1. the undersigned, verify time equipment listed above my signature is: 1) tate actual equipment installed; 2) equivalent to or more effic"'r than that specified in the certificate of compliance (Form CF -1R) submiucd for compliance with the Energy FffJclency &andards fbr residential btnUngs; and 3) equipment that meets or exceeds the approprim requtremen4 for manuf =zvd devices (from rice Appll vwe Ejzxi4 n Regttlaatons orPact 6X where applicable. g' JD Mechanical, Inc. Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner COPY TO: Bui!d:ng Department HER.5 Provider (if applicable) Building Owner at Occupancy _ July 1. 1999 ficate of Occupa'-np-y-.: Cit of La wuinra. Building and Safety Department OF�ti i fix. • • • • , J. This Certificate issued pursuant to the requirements,ofSection 109 *of .the Uniform. Building Code, certifying that, at the time of issuance, this structure was in co MP with the various ordinances of the. City regu%ad6g building construction or use. For the following: BUILDING ADDRESS: 80-571 SPANISH BAY Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-280 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: 12/11/2000 Building Official POST IN'A CONSPICUOUS PLACE r