9909-273 (SFD)LICENSED CONTRACTOR DECLARATION.,
h ` -h re.by affirm under penalty of.perjury that I am licensed underprovisions.of
Chapter 9 (commencingwith Section 7000) of .Division 3 of the Business and
Professionals,Code, and my License'is in full force and effect.
Y) License # Lic. Class + . Exp. Date .
'134 4 ABI rj , d � U3r311201
.. r.. 1f
Signature of•Contrac o -
p 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).
( ). „1, as owner of the property„am exclusively contracting with, licensed
contractors to construct the. project (Seca 7044, Business & Professiorials
Code).
O I am exempt under Section B&P.C. for this reason
Q Date Signature of Owner
L _ WORKER'S,COMPENSATION:DECLARATIOfU
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
.J performance of the work for which this permit is issued.
l have and will maintain workers' compensation insurance, as' required by
S ction 3700 of the ,Labor Code, for the,performance of the work for which this
permit is issued. -My, workers' compensation Insurance carrier 8 policy no. are:
'- Carrier/ Policy No: ”
r1, F[:#t: Criq'c�3+�aiTirifiE ' VI'C,83271rrl "21
'(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 t6 become subject to the
workers' compensation, laws of California,:aiid agree •that if l should become
subject to the workers' compensation"provisiops of Section 3700 of the Labor'
Code' I shall forthwith comply with those • rovl tons
Dafe')• �+ Applicant Z% L
ff
V11Varnin ailure' 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 t6 the Director of Building and Safety
for a permit subject Ao the ' conditions and. restrictions seta forth on "his
application:.
4. Each, person upon whose behalf this application is made & each person ;at
whose request and•for'whose.-benefit work is performed under.or..pursuantto
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.iif
work is not commenced within .180, daysfrom 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.' 1 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 linspection`purposes.
Ignature, (Owner/Agent)- + ""� - Date
"
BUILDING PERMIT PERMIT #
DATE )VALUATION 1,%-243,3,$6J0 WT r24 O . TRACT 128960
JOB ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
carrm.X Jimms ,
•;.56
rFN� EX H"M S.
22190 IWArakow C-IRt"I :, Ka" `a £ ..
2290 Al%Ak6LOW Catcu, A�i" )" I%
QA .919720
t'ti'O.itOd+A - _ . .:L:!A 91720
r 9)zµ�a-area: s>BL19 761
USE OF PERMIT '
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
V
OU' i_ Al R7
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
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
Drywall - Int. Lath
z,4�
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS,
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
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/ 31/2000 `08:47 x092920499 `" SCHMID CONTRACTING PAGE 00
" INSUL.ATIQN:ACEPTIFICATE ?.wr, ;
This is to certify that insulation has been instaliecl1n conformance with the`currenf energy regulation,'
California Administrative Code-, Title 24, State of California, in ttie building at
PGA WEST PHASE 2A /':TRACT 289601LA QUINTA •;
3 • { LOT 24 ;
'CEILINGS:`
TYPE: Fiberglass BATES MANUFACTURER: Owens/Coming THICKNESS: R -3a 12" BLOW
�
` 'TYPE; Fiberglass Batts MANUFACTURER:'Owens/Corning THICKNESS:R-13 3 1(2
GENERAL CONTRACTOR. CENTEXf#011AES= 's LICENSE;
SY: ,TITLE:
+ SCHMID INSULATION C TRACTORS INC.�� c ' LICENSE #221517 G2
BY TITLE: PRODUCTION MANAGER. DATE: 08i30100
�• =
INSULATION, CERTIFIC ,
This is to certify that insulation has been`installed in conformance with the current energy regulation;' ; t
California Administratwe'Cod e,'Title 24, State of California, in the building located it "
.t
PGA WE$T !'PHASE 2A 1, TRACT 28960! LPA QUIN"TAj {GA.
�. LOT 24 %.
CEILINGS:
TYPE, F iberglss5 BATTS MANUFACTURER: Owens/Cetning' THICKNESS:' R-38 12" SLOW
WALLS.
TYPE: -Fiberglass Batts; . 141ANUFACTURER:. Owens/Corning THICKNESS: R-13 3 112" -
GENERAL CONTRACTOR CENTER HOMES k LICENSE'#
BY: �. TITLE:' , *�
SCHMID INSULATION Cq RACTORS,'INC, LICENSE:#
22- 517 C,-.2
gY - JITLE:PR4DUCTION MANAGER DATE: 08/3G100
r
Y � s.. � �' " •`.i� - A yT r. is , _ • ! ♦ �.
,_ �� •} i r . '* " Y •' as d J
03/30;00 10:56 FAX 7149211631 A111ance
Installation Certificate: Residential CF,6R
Use et thla form to satisfy the r4quirenwnts of the Adminlatrallve Code is optlonat, but the Information must be provtdod and posted,
- �° ddre�aa q
Permit Number
An Inataftatlon certificate is required to be posted at the building site prior to the issuance of the occupancy perms. Thfs form
may be used to most these requirements. All appliance categories listed below are the annual equipment installed. Note that
the eHlciency and type of the appliance installed must be equivalent or better than the appliance soecilied on the Certificate of
Compliance (CF -t R). This canilicate for its equivalent) shall be prepared and signed by the persons) assuming overall
responsibility for the appliance inslailailon.
1, the undersigned, verity that the equipment listed In the category above my slg nature is the actual equipment Installed and
that the equipment meet$ or sxcesds the requirements of the Appliance Efficiency Standards. In addhion, l have verified that
the equipment is equivalent to or more efficient than the equipment specifled an the Certificate of Compliance submitted to
demonstrate compliance with the Energy Efficlency Standards tot residential buildings.
HVAC SYSTEMS
Note: Hydronic boiler Information Is entered here. Qther hydropic or combined hydr0nie equipment is listed under
Water Heating Systems.
Heating Equip.
Type (turnacs,
CEO Cat•tilled
Manut. Make &
Actual
EHIclency
Distribution
Type and
Duet or Hsating Load
F�Ipping Befare over.
Heating
Equipment
heat purnp, QW4
Model Number
iAFUE. etc.
Location
R -value SW Btuh)
Caesc' 8tuh)
gt,P.� b'l til %r'1
U 7
(gallons)
E+41clencY
Lcsa ia.) R -Value
�••��
-----
a
^�
�_C•Cy
CEO Certlf led
Cooling Equip,
Comproeieor Unit
Actual
Distributlon
Duct or
Type (air pond.,
haat
Manut. Make &
IEffielency
Type and
RI Ing
pump, etc.)
Model Number
(SEED)
Location
R -Yalu®
Pts' & COPi ._--_�- 0 — 721 v
12 . v _ 4T:L S�
The 4m4lnq d®sign host teas and design heat gain rate have been determined using a method aneciied In Section 150(1.1) of
the .rte y c+ n lat?dards, and a two of the criteria used for equipment sizing and selection.
r4E�FTiNC Ahn A1C
Signatu Cate HVAC Suoonracix (Co. Name) or Genual Contrac_r or Cwner
WATER HEATING SYSTEMS
Water Heating
CEC Cart ifled
Ratedt
Tank
Ener s
Factor cr
�ekmal
System Type
(storage a$ eco.
Manus. Make &
Modal Number
Input (kW
or Stuh)
Capacity
Recover(
Standbys Insulation
(gallons)
E+41clencY
Lcsa ia.) R -Value
For small pea atoisge (rated input S 75,000 f dhr), electric resistsnes and heat pump water heaters, list Energy Factor.
For largte 9ss storage water heaters (rated input ),75,000 etwnt), list Rates :r,Fut, Recovery wf scienry arc otancoy Loss.
for instantaneous gas water heaters, list Rated Input and t?eeovery Efficiency,
For Insuntanecus electric Wolof heaters, list Rated Input.
FAUCETS & SHCWE;; HEADS
All faucets and shcwerheads installed are listed in the CO^.7.ISSIOn's Direr.Cry of Cen6ied Faucats zrto Showerheacs,
Pursuant to Title 24. Part 6, Subehaolor 2. Section t 11.
Signatre
4 Cava P—IUMO nq SubContractx (Co. Narr.el c., Ganerat Contraczr or Jwrer
94v,eeaJanuary 1072
FRG I I '. -FAX NO. : lu 1. 27 211" 10:31W P?
z LIRJ t rsiLii I WIN l.l;�c'1 W1LATE (Yatvi of 7) Cir' -6R
yds
%d3ress MEN Number
An installation csitificate is required to be posted at the building site or made available for all appropriate inspections. Me
information provided on this form is requited: however, use of this form to„provide the information is optioaaQ 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).
HVAC MM .MS_
Mewing Equipment
Equip. 9 of Efficiency Duo Duct or ('loaanii HmWj
Type 1pkg. CEC Certified Mfr Na= Identical (AFUE, etc.)' Location plpn+t Load Caplickv
hear Mmol and Modcl Numbcr Svsttms rKT-IR value) (artk, etc) -R-Val ue (Btu) Mullrt
C001hog Equipment
Equip. CPC Certified CoMp wr of Efi3deney Dtut Cooling Cooling
Type tpkj. Unl[ Mrr Name and Idearlcal (S Eat, ON.) t 1,9008011 putt LOW
heat. otrmali Model Number Systems ICF -IR va1Vs) (actio, eta) R-Vwue ftOwl (ISt>sThr)
1. > reads greater than or equal to
1, the undersigned, verify that equipment listed above is: 1) is the acmtal equipment installed, 2) equivalent to or more
efficient than that specified in the certificate of compl'inca (Form CF -1R) submitted for. compliance with the Fnew-
Efcfency Standards for residential buildings, and 3) equipment that meets or exceeds tate appropriate requirements for
manufacttmed devices (from the Appltanae Eggciairy Regulartons or Part 6), where applicable.
tpamre. Date
Installing
u tractor (Co.
amt)
OR General Contactor (Co. Name) OR Owner
WATER HEATING SYSTEMS
Distribution !f Rccir- a of
Ratedl Tank
Eflii- External
Heaton CEC Certified Mfr
'type (Sid. eularion. Identical
Input(kW Volume
ciemey' Standby' !rtsuladon
Type Nama & Mo&i Number `
Point -of -Use) Convol Type Systems
or f3ttVbr) (gallons)
(EF. RE) Loss (W R-41-3
2 For small W storage (rated input oflcss than or equal to 77.000 B1whr). ekctrie redstance and beat pump Weser haters Itu Energy Fames.
For large gas storage watt/ hearts (razed input of greaw than 75.000 Bugiv). Ilse Raovmy Effieiwwy, and Lou sod RatW Input.
For instaatsacous gas water beaten. Ila Recovery Efficiency and Rued Input,
3. R-12 ememal insul;i!on is mandatory for storage %vutar hevAn with an energy factor of las than 0.53,
Faucets & Shower Heads:
All faucets and ahowerheads installed are certified to the Commission. pursuant to Title 24, Part 6, Section 111.
1. the undersigned, verify tbw equipment listed above my sips MM is: 1) the actual equipment installed; 2) equivalent to
or more eff)cicnr thm that specified in the certificate of compliance (Form CF -1R) submiucd for compliance with the
Entergy Fftcleacy &andards for rebidential buildings; and 3) equipment that meets or exceeds the appropriate
requirernen4 for manufactumd devices (from the Appllar=e fffxiancy Regukatons or Pact 6� where applicable.
/W� I
IIJ14-0
JD Mechanical, Inc.
Signarurc. Dart Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPY TO: l3ui!d:ng DeparanrnT
HERS Provider (if applicable)
Building Owner at Occupancy
_ July 1, 1999
to of O'cupanccCer ti caY a
Cit
of.La'- Quanta
Buildin and Safety Department.
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: 80,580 SPANISH BAY. -�-
Use Classification: SINGLE FAMILY DWELLING r j Bldg. Permit No.: 9909-273
• r
Occupancy Group: R-3 Type of Construction:, VN Land' Use -Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR. STE 150 A
w City: CORONA, CA., 91720
By: DANIEL P. CRAWFORD JR.
Date:" 12/27/2000
Building Official - T
POST IN A CONSPICUOUS PLACE
Certificateof.occuponcy..
Cit of La,Quinta
BuildW and Safety Depa-Mtent ^SOF
This Certificate: issued pursuant to the requirements of . Section :109 of . the Uniform -Bui/digg :Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City.regu/ating bui/ding--construction'or use. For.the following: -
BUILDING ADDRESS: 80-580 SPANISH BAY .
Use Classification: SINGLE FAMILY DWELLING. Bldg. Permit No.: .9909-273
Occupancy Group: R-3 Type of Construction: VN Land Use *Zone: RL .
Owner of Building: CENTEX HOMES ':Address: 2280 WARDLOW CIR. STE 150
City: CORONA,. CA.; 91720 .
B DANIEL P. CR