9908-044 (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
7210).4
ate 'Ignature of Contractor- '�"'�
OWNER=BUILDERDECLARATION
I hereby affirm under penalty of perjurythat I'am exempt from'. the Contractor's
License Law for the following reason:
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, Busine§s & Professionals Code).'
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' °
WORKERS -COMPENSATION DECLARATI6N:
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
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.
f4`vaFY�.. CsRiA,,^ A� ^t1 - :02
(This section need not be completed if the permit valuation is for $100:O0.or less).
O I eertifyahat 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-Galifornia, and agree thatif I should become
subject to'the,�vorkers_' compensation 0r.tjslons of Section 3700 of the Labor
Code, d s' all f rthwith comply�withI ose 1ovision�?
D/ater at , ��Appl.ii nt• '�',\ ; . '... ,
arnin : Failure to secure Workers'.Compe �stio co grage is unlawful and
shall subject an employer to criminal penalties,and civil finesup-
-Jct 600;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 subject permit to cancellation.
I certify.that I have read this application and state that the above information is
correct. I agree Ab comply ,with,all,City, and State laws relating to the building
construction, and hereby authorize representatives of this City. to enterupon a
the/a'bove-mentioned,propeity for.inspeeon purposes.
Signature (Owner/A`gent).••ti�•� "* Date
PERMIT#
BUILDING. PERMIT ' , , RDATE
j) VALUAITION 52737LOT �� � - TRACT
JOB SITE —tegr �]-1t 1
ADDRESS �. 5 �1�A3 tYCYiA .t7 F� $f1
APN
7694M••00
OWNER
CONTRACTOR / DESIGNER / ENGINEER
2280 'W,, R.V1.0 CMC. LU, SUITE -1:V
2280 WARDLOW t'';IRCIF, SUVE x V
C%R4�KA CA, 9! VO,
COROMA, CA 91720
CBLN 5761
USE OF PERMIT
ai!4jCii.l, �.r1.1i�.`�'
'
j1.i1)V�7:'.lj,{�.j.S�_�♦i� •� fj' •511 �7':�, 'j�j �'{�1'^y (i� ( ,•���'j
Molt,
CUMNI CONS'i'RUC.'r1ow 3.32dt.f)L; Sk
!'s�RG'�•fll1�A:.�7*a lb3£f tt3 .S.F'
273,731.20
KNOUT FEE WMAUCRY
C C?:EvS t.42Ci0 .'ii }t VEL l0I••ii(N; •4W-000
KA.N G"FCYC: ETH s t del,98
LEC,UUCAL l� iti .. 1.0f QE?t 421NOOO b205.56.
tri;+•3�S�ItJ4,} 1";fid•:, f �R •�4'}'{i„� � 4�-Z}i�3 � 1�9 ?S
`fit! (Ot10 MO"!' ON AMY - .0i.R' R.YD .1014311) 4 g -ANN)
rel: `i' Ii�f a�[iLUf Fa:;fi3.t � s t :tE=70f-000-255-000
EWMEiat°R R %Mt%r C'T ('U&i
, F �
6'JB°/yam t �'�J-F.:�d� /P
?R(30'_K47Y'1, U(3*rKY 9.A.tYX.Y P4AN- 1 CHECIK
TOTAL PERMIT FRO DUENOW
;5,175,39
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 10
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck A
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Z4 zfm
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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
Utility Notice (Perm)
COMMENTS:
CENTEX X f' OMES SPANISHBAY ®PGA WEST
September 1.1, 2000:.
CITY OF LA QUINTA,
78-495 Calle Tampico ..
s
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:
1 Number of.0'Hagin Vents Installed
Lot#� ...
Plan
Phase #_
,
Tract # 28960
'.Sincerely,
Pat Leffard
Sr. Field Manager
a8/3112000 28:47 9092920499 a SCHMID• cbNTRACTING PAGE
�.
INSULA�'10MCE iIFtCATE
This is to certify that insulation has been installed -in conformance with the currenf energy regulation,.
California Administrative Code, Title 24, State of -California; in thebuilding at
PGA WEST I PHASE AA 1 TRACT 28960. / LA QUINTA
LOT 26'
• j-.
``'CEILINGS:
TYPE: Fiberglass BA
TTS' MANUFACTURER: Owens -/Corning. THICKNESS: 'R=38 1'2" BLOW
r
'WAhLS:
' TYPE: Fib"erglass"Batts MANUFACTURER: Owens/Corning ' THICKNESS:R-13 3 112" '
GENERAL CONTRACTOR: CENTEX HOMES LICENSE: .
BY: t TITLE:' ,< .
SCHMID INSUIATION CONTRACTORS, INC,t.' . ^*
LICENSE,#221517 C-2 '
BY: TITLE: PRODUCTION MANAGER': DATE: 08/30/00 -
INS )LATIQN CERTIFICATE
- This is to certify that insulation has been installed.in.conformance with the current energy'regulation, • '
California Administrative Code, Title 24, State of California, in the building"located at -
PGA WEST t PHASE 1A I TRACT 28960,1 L.A QUINTA CA l
t j LOT 28
CEILINGS;
TYPE: Fiberglass"BAITS. MANUFACTURER: Owens/Corrin'. > "1'HICKNE$S:-R-38 12" BLOVic.
WALLS: }
`TYFE:.Fiberglass Batts, - MANUFACTIJRER;Owens/Corning THICKNESS .R-13 3 1/2
'GENENAL CONTRACTOR: CENTEX HOMES LICENSE #
TITLE:
SCHMID iNSUCAT10N CO' . AtTORS, INC.. LICENSE �221547 C-2
TITLE; PRODUCTION MANAGER DATE: 08/30/00
FRfir1. 'u�, t t�1LLEi 11V1V l-l�sc'11!' I A E Wagv,l of 7) ia: 31r -r, (F -6k
Xddteff MEN Number
An installation certificate is required to be posted at the building site or made available for all appropriate iospecdoas. Cme
information provided on this form is required: however, use of this form to..provide the information is opdoaal.) Atter
completion of final inspection, a copy must be provided to the building department (upon request) and the building owrrer at
occupancy, per Section 10-103(b).
HVAC MMEMSe '
Hearing Equlprrwrrt
Equip' M of Efficiency D" Dui or H090111; Beating
Type (pkr,. CEC Certified Mfr Name Identical (AFUE ext.)' Lotadon piping Load CSP ikv
heat ) and Mo cl Number Svs aerie, etc.) it -Val
Cooling Equlppmenr
Equip. CEC CartiGcd Compressor 0 of Ef6detuy Duct Cooling Cooling
Typo Loks. Unle Mit Name and identical (SEER. eta.)e Locaaioa ower Load CapazO
hest otrmei Model Number S5gWTn# P&CFARVOY91 eta) R.valve (Bettlhr► (DMIW
1. > reads greater Than or equal to
1, the undersigned, verify that equipmttru listed above is: 1) is cite actual egtzipmeat installed, 2) equivalent to or more
efficient than (hat specified in the certificate of compliance (Form CF -IR) submitted for. compliance with the Ener.
Mkienev Siondards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (from the Appilarwe Ericierry ReguLarions or part 6), where applicable.
Iparure, Date Installing Subcontractor (Co. -Name)
OR General Contractor (Co. Name) OR Owner
WA IJEATiNG SYMMS-
Distribution If Reelr- 0 of Rateds Tank Efri-
Heateu CBC Ccrtiflcd Mfr Type (3rd. c elation. Identical Input (kW Volume ciertayr . Stotdbr'
bmanal
!ruolulon
Type Name & Model Number Point.of-Uses) Convol systerro of Btu hr) (gallons) W, RE) Lost 0A%
R -value'
yd5 ss
2 For small tW storage (rated inm ofless than or equal to 73.000 BrWhr). ek irie resistance and beat pomp -awr baterL Itu Energy Factor.
For large gas storage wattr heawn (rated input of peaxr than 75.000 Stuft). list Recovery Efrieieamy, Standby Los= and Rand input.
For Itsstantaaoous gas water haters. list Racxavery Efficiency cad Rated Input.
3. R-12 external insul a:lon is mandatory for storage wutar heves with an energy (acaor of lass than o.Si.
Faucets & Shower Heads- "
All faucets and showerheads installed are certified to the Commission, pursuant to Title 14, Part 6, Section I 11.
1, the undersigned, verify that equipment listed above my siplature is: 1) the actual equipment installed; 2) equivalent to
or more efficia-it than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the
EnerV FfIClency &ands for residential buildings; and 3) equipment that meets or CXteeds the appropriate,
;irwncntl for manufactured devices (from the Appllarrce Effxi,&r Reguladom or Past 6), where applicable.
JD Mechanical, Inc.
Signattuc, Dat: Installing Subcontractor (Co. Name) OR
COPY TO: Building pePz=rni General Contractor (Co. Name) OR Owner
HERS Provider (if applicable)
Building Owner at Occupancy
July 1. 1999
C.eftifipate a
City, --of La Quinto
.
Building and Safety Department,
M OF
This Certificate issued pursuant'to the " requirements of Section 109 of the Uniform ' Bui/ding Code, A
certifying that, at"the time of issuance, this structure was in compliance with the` various ordinances '
of the City. Yegu/ating building construction or use. ' For. the fo/%wing: •
BUILDING ADDRESS: 80-508 SPANISH BAYS +'
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No 9908-044
Occupancy Group: R_ j- Type of Construction: 'VN - Land Use Zone: RL
- Owner=of Building CENTEkHOMES ' Address: 2280 WARDLOV1l°CIRCLE, STE 150 .�
City:- CORONA, CA.;. 91720
:.•�-�dj�,` By: DANIEL P. CRAWFORD JR.
-� Date: 10/13/2000 i
Building Official `
POST IN A CONSPICUOUS PLACE