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LICENSED CONTRACTOR DECLARATION
1 1herebyaffirm 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
aN'
A, T3 k i?3J3�t2d3d
• ato Si nature of Contractor ` w
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).
( ) I, 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
performance of the work for which this permit is issued.
( �).jl 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.
ATM , V WARA 41`I~:`s
(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 that if I should become
subject to ,the' workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those protisions.
Date: � Applicant
,Warning: Failure to secure Workers' Compensation coverage iun; lawful 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 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 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 forYinsp ion purposes.
fie" y
�eSignature (Owner/Agent) Dat°' °
f
BUILDING PERMIT PERMIT#
DATE 10/0.5/"VALUATION LOT TRACTJOB
SITE
ADDRESS ��•.�c�a�i1�1�1G��t�
APN 1^t�-tJ.�94Ja:►
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CVI..,TCFX HOMES
C EN"W X 140M :,,S
7.290 AA'A.I UL.C?W-OWL.E. St31T1:7 150.. :
2280 WARDT. O%V CII(C tea SUITE, 1.50
W!R ilNA CA 911M
CORONA A C'.,A 91170
USE OF PERMIT
�k�t.ii<Jy .9r'.FeAll•4..?t' �.11fs+'ls'•1.T.,�t+9i.�
Sri),• LOT a s:JILAN 1i(�. PE t OT is( ,S i4W 13.?C) UL, !k(A k WALL Olt
POOL.
PoA:Ci;vpA.rro 168.00 S
0ARA.CWC1i12.P(aXT 043,04 SF'°
• A1.?�1l�.faL\rtf�TM l?3' i.�'�/i@��'T eM710„Yr
PERMIT FEE SUINIMAR
CON&CRDUVION FEE 101-0110-4194M $1,24836
rq ANC''(~1RIK F1~!!
fi.TF: CIIA1`+ I AL F'hM i 0 i • 900-421-00D 0D 311.50
alit.'MrCAL KE� 5205-
a
P1.ipawmf vr4i tCfl-tif3tA 415-4�tli) Sl!' �5
s)'R!�fui'� !1/�'C3'�jlyjJ i�r}:.. �dt~`;Sxp if3l•�#O��n41-f�� $91:9
._ -
GR.ft13INC FEE tG) fir!) -423 -WD
ART IN PUBLIC K.A.CES-MM, 701-000-255-000
MVELc>a�PR MIPAC117 .1111.1a�,���.fat►
S )WKYTA1,CONS4'RITCOT ONAT40lltANrJ11 GI
$,5,1175 40
. .C•6Yl..EJ4L. �.IIJ�I:Y�IPw ,S'R`1FSH'1 �''�f �s i'fY17W
��DA, �F�.�9Y
RECEIPT
DATE
BY 6
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 Air
_/
SteelCombustion Air
Roof Deck Exhaust Fans
_9
O.K. to Wrap F.A.U.
Framing Compressor
Insulation l [ Vents
Fireplace O.L. Grills
Fireplace T.O. i Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
DgFwall - Int. h A
is—
i
Final �
Final
POOLS -SPAS
BLOCKWALL APPROVA S
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 411
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)
r: .. � . ,. ... .."'fit`..»_ 'tS�l
' 9,8/31/2000 08:47 9092920499 SCHMIID CONTRACTING PAGE•" 0q.
a
1NSULAT10N Q RfjFICATE
This is't� certify that'insulation;has been installed in conformance with the current'energy regulation,
California Administrative Code, Title 24, State of Califomia in the building at.
. ` PGA WEST./ PHASE 2A l TRACT 289607 LA QUINTA
LOT 23, t
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: OWeris/Corning THICKNESS: R 38 12" BLOW 4
v 1NALLS: r -
TYPE: Fiberglass Batts MANUFACTURER: OWens/Corning THICKNESS:R-13 3,1/2
GENERAL CONTRACTOR: CENTEX HOMES; LICENSE:
BY. TITLE:
'SCHMID INSULATION CONTRACTORS, INC. LICENSE4221517 C-2'^.
BY: TITLE:'PRODUCTION.MANAGER DATE-.0813=b'
. .. ,- .. fit` ' • -
+ INStlLATIOtV � 71FICR�T '
This is to certify that insulation has been installed in conformance-with the current energy regulation;
:'California Administrative Code, Tille 24, State of California, in tile.buildino, located 6t,.;,,
.. .. .. Mia '. ..
PGA WEST! PHASE 2A,1 TRACT 289601 LA-QUINTA CA
LOT 23
CEILINGS:. •�• ,, ` •. _ � +
TYPE: Fiberglass 13ATTS MANUFACTURER:,Owens/Corning THICKNESS` R-3812 BLOW
WALLS C
TYPE; Fiberglass Batts .MANUFACTURER: Owens/Comin THICKNESS! SS: F2-13 3 112" •- ; ,,
GENERAL CONTRACTOR: CENTEX HOMES
LICENSE #
SCHMID INSULATION RNTRACTORS', INC: + t-LICENSE #221517 C-2
f3Y: ✓
TITLE.. JPRODUCTIdN MANAGER DATE: 08/3010Q
08/30/00 10:56 FAX 7149211631 Alliance
Z06
InStaliati®n Certificate: Residential CF -6R
Use of this term to $&Italy the requirements of the Adminl$iratly Code Is optlonal, but the Information frust be provided end posted.
LOT 2 91�yu 4 I/01 ANd l
Perron Nurnow
An Installation certificate is required to be polled at the building site prior to the issuance of the OC--upawf permit. This form
may be used to meet these requirements. All appliance categories listed below are the actual equipment instaiied. Nota that
the efficiency and type of the appliance installed must be equivalent or better than the appliance speeilied.on the Certiticate at
Complianca (CF-iR). This certificate (or hs equivalent) shall be prepared and signed by the parson(s) assuming overall
responsibility for the appliance installation.
I, the undersigned. verity that the equipment listad in the category above my signature is the actual equipment Installed and
that the equipment meets or exceed& the requirements of the Appliance Ediciency Standards. In addition, I have verifled that
the equipment is equivalent to or mare efficient than the equipment specified an the Ce11iflCate of Compliance submitted to
demonstrate compliance with the Energy Efficiancy Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronic boiler information is entered here. Other hydronlc or combined hydropic equipment is listed under
Water Herat ng Systema.
Heating Equip, CLEC Cartlfled Actual Distribution Duct or Heating Load Heating
Type (turnace, Manuf. Make A Efficiency Type and Pfpping Before Over- Equipment
heat um Ste.) Modal NumberAFUE, etc. Location R•Volue Slzln Btuht Gioacfty (f3tuh
t i —- — -
� �P�� ot�t t3t�J GZ % ► O C>v
CEC Cart If led
Cooling Equip. Compressor Unit Actual Distribution Duet or
-Type (air cond., Manut, Make & Ettleloney Type and PI Inc
heat pump, etc.) Modal Number SEER) Location Ralue
_Q_ I IrrL::.A
Wrgff,
ss and dasign heat gain rate have been determined using a method soeallot in Seaton 150(h; c(
dards, and aretyroofthe criteria used fo pment sizing and sale xn.
pate HVAC Subontmaor (Co. Name) or General Ccntrac :r or Owner
WATER HEATING SYSTEMS
Ener t
Water Heating CEC Certified Rated' Tank Factor or Tana!
System Type Manuf. Make A Input (kW Capacity Recovery Standby' Insulation
store o as, etc.) Model Number or Blum (gallons) Elf IcIancv Loss 1 :) R,Valua
1. For small gas storage (rated input 5 75.000 Eltumr), sloetrte resistance ano hast pump water heaters, li`t Energy Facer- .
For targe gas storage water heaters (rated input >75,000 Btu/hr). fist Rated Input, Recovery Etficiencr arc Slaneby ::ss.
For Instantaneous gas water hes tens, list Rates Input and Recovery Efficiency,
For Instantaneous etniric woier haters, lis; Fated Input,
FAUCETS & SHOWER HEADS
All faucets and showerheaas instailed are fisiea in Iha Commission s OireC:ory of Candied Favrxis aro Srowerc, acs,
p»rsuant to Title 24. Part E. Subchapter 2. Semon it i.
Signature
Gate
Raviaoo January 1991
Plumbing SubcantractOr (Co. Name{ or Conerai Con: attar or Owner
fiilUl :i'' FAX NO.
u14J l AJUJU i 11VIN 1YIUATE
yds
;u 1. 27 24" 10:.31 HI R2
1 of 7) CF -6R
w gess erm t Number
An installadon certificate is required to be posted at the building site or made available for all appropriate iaspeuioas. (The
information provided on this form is required, however, use of this form tn.,previde the infozmation, is opdoWL) Afton
completion of final inspection, a copy must be provided to the building deparunent (upon request) and the building owner at
oceupancy,per Section 10-103(b).
HVAC SYSTEMS;
Aearine Equipment
Equip• a of Efficiency Duct Duct or Hotairtg Hming
TYpa (pkG. CEC Certified Mfr Name Idential (AFUF, eu.)' Lotadoa Piping Load Capsogv
heat ) and Model Num S1rq ,ems) R-val
Cooling Equipment
Equip. CEC Certified Compre.uor g of F.fedeaey Duct Cooling Cooling
Type tpk8• Unit Mfr Name and Identical (SE P4 OUX Location Duct Load Cap=*heat oumDdel i MoNumber Swum, WF -IR valval lam; etc) R-vwue (l uft) (BMVW
l . > reads neater rhan or equal ro.
1, the undersigned, verify that equipmeru listed above is: 1) is the aetoal etgupmeat installed. 2) equivalem to or more
efficient than that specified in the certificate of compl'icice (Forth CF -1R) submitted for. eampllanc with the EneW-
Effwfenev Standards for residential buildings, and 3) equipment that meets or exceeds dee appropriate requirements for
manufactured devices (from the Appliance Egicigney )tegularlons or Parr 6), where applicable.
tgnauue, Date
GOing
Sugra it (Co.Name)
OR General Contractor (Co. Name) OR Owner
WATER HEATING SYSTEMS-
Hester CEC Ccrtiticd Mfr
Distribution If Radr•
Typc Md. evlatlon.
r of
Identical
Ratedr Tani:
Input (kW Volume
EfTi-
cieney., Standby'
E%uernal
!.-Mladon
T Nama & Modci Ntunber
Poirtt*f•Use) Control Type
system
or BnAr) (8 ons
(PF. RE) Loss (1w
Rrvaluc'
.5 Ig S
i f
r
Z For small gas storage (rated input ofless than or equal to 75.000 BtWhh. electric resistance and but pomp water heaters Itu Energy Factor.
For large gas srnroge warn heaters (rated input of greater than 75.000 Staft). Ila Rowvary Efl►cimtey, Standby lass end Rated Input.
For Ipstantsaeous Qts water bestus. tilt Rscovery Efficiency sad Rated 1".
3. R-12 external insul:.lon 4 rnsndawry Cor twig %+attar heauw with as enargy factor *fins than 0.$$,
F31Ieet5 & Shower Heads '::
All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111
1, the undersigned, verify Stmt equipment listed above my signamre is: 1) dee tutual equipment installed; 2) equivalent to
or more efcicnt than that specified in the certificate of compliance (Form CF -1R) submiued for compliance with Ebe
EnerV Efficiency Srandar& for residenrial bwldings; and 3) equipment that meeu or exceeds the ante
requtremenq for manufactured devices (from the Appliance Effxigji Regu4gdom or Put 6), when applicable.
JD Mechanical, Inc.
Signawc, Installing Subcoatmetor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPY TO: Building Deparuncni
HERS Provider (if applicable)
Building Owner at Occupancy
July 1, 1999
*Certificate of Occdpahcy
City of La", Quinta.
.
Buildingand 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 regu/ating.buiLding construction or use. -For the following' -
BUILDING ADDRESS: 80-598 SPANISH BAY -
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-272
y
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
�00%n 140404 By: DANIEL P. CRAWFORD JR.
Date: 2/21/01
Building -Official
.POST IN A CONSPICUOUS PLACE