0008-278 (SFD)s 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
734tR ._ A -b M
03/31/2(
Date ��f 'fly>�� 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 riot 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.
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 ZURICH -.AMERICAN Policy No.. WC633 st196-03
(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, h I fort with'
comply with ose provlsio s.
Date: �' �s F�Ya Applicant {
Warning: Failure to secure Workers' Compensation coverage,is 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 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 fyor�inspection purposes. /
Signature (Owner/Agent)' "r r9----> Date% :ICJ
BUILDING PERMIT PERMIT#
D TE Jy l:� VALUATION LOT 1.78 TRACT
` 1
, {J c �/6�a,�.0 j';�� 289601
JOB SITE
ADDRESS A.7 �+�p /��qy y
. 1 07'S.C�MJ.S_k13.rH]3A-1 J
APN ���
yy Hwy
/�-f 855,1d4*5
OWNER
CONTRACTOR /DESIGNER / EN INEER
2280 WAR,UL,OW CIRCIZ, 301 :1'50 •
2280 WARDLOW CIRC S, 9I.3;' 150
CORONA CA 9170 .
CORONA CA 91720
(309)219.4600 CBIN, 5761.
USE OF PERMIT
5' Ga- Fi WLY M.E,1,S1A1•(3•
, - LOT54 PLAN 4f3R P1PRMIT DOES NOT INCLUDE BLOCKWALL OR
POOL751A PLAN CHECK WE REDUCTION FOR MULTIPLE ISSUANCE OF
SAME PLAN TYPE
CUSTOM CONSTRUCTION 3,142.00 S>;
PORC"ATIO 454.00 SF
0ARA.tE/CARPORT (SP) 13,434.80
XS•XT.1V.i M COsi' OF CC9xVgmvcllos
2169,294,80
PEi3.INY7TFEE Sf31I+YMUtY
CONSTRUCTION FEE 101.0090.416.000 $1,217.90
PLAN CHECK FEF: 101.000-439-316 $349.39
MECHAWICALFRE 101.000.421X000 $97,00
cJ
ELECTRICAL l,F. C 102-000-420-000 $176.23
^.
PLUMBINOFEE 101.00"19.000 SI99.`73
i"�
STRONG MOTION FBI, - RESW 101-000.241.-000 $26.43
t1i �-'
c RADINO PRE 101.000.423-000 $20.00
INFRASTRUCTURE PRP, 225F000-4$3.34.2 $1,.907.00
ART IN PUSUC PLACES - RIESII 701.000.255.000 S164,7i
w
f"1"I .�
Ui
SITZTOTAL 00 IRUC"tION AM PIAR a=,,$4,047.01
ims PRU -PAI7' FM
5;0,00
TOTAL 19'341 i]PJI' YnS DUENOW
$4,047AI
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
4Y 4
OPERATION
DATE INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 6
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing p
Compressor
Insulation 4lT7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
DWwall - Int. Lath d/
Zsi
Final
Final / v
POOLS - SPAS
BLOCKWALL APPROV LS
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 /�, ,�
Sewer Connection /
Pool Cover
Encapsulation
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)
J
RPR 30 2001 3 40PM SCHM4 CONTRACTORS,, 3.47-1897._ P.1
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.' INSULATION CERTIFICATE .
n This is t certify that insulatlon has been installed; In conformance with the current energy
regulatic •i. Callfornla Administrative Code, Title 24, -State of Calfornia,"in the building at ,
A PGA WEST - PHASE 2113 — TRACT 28960
4 .+
LOT. 34
CEILING
TYPE: F 3.erglass BATTS MANUFACTURER: Owens/Cornin,g THICKNESS: R-38 12", ti
�'• TYPE: F )erglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW
FS•" WALLS:. , r'
TYPE: I berglass Batts ' ;MANUFACTURER: Owens/Corning' THICKNESS:R-13 3112"
4: ( ENERAL CONTRACTOR: CENTEX HOMES. LICENSE: y
f BY: TITLE:
SCHMIC INSULATION, CONTRACTORS, INC., LICENSE 4221517'. C-2
BY: TITLE: PRODUCTION MANAGER DATE: 04/30101 :
' YIY.4'1VL'VTu2GPWi:.N.'�' .N Y.9r�Jrm -I.,THC}ythryfJf113O.lLiilfWHKOtLO%tGG":RT.1fII:Ol�i//.Cl:(.tlryq/.f(F'iIJ�iYGfJR:(U'A'.d[dy. rY(RI( a1.54�AAC0:l�JIN�Alefy4%IIR¢(pl(R(lVyGfGpq.tCifSfi'{G%qW AE�.O�ptl{1;:P.:fJN}L
a �:f0iV4'Ri/M�AUi1. O.K.YiitY.R-/Si44tS,1 HN.fll%A%d.:INRf4�lniRl:iW1>i4'�!Y-1.d4WRiWi9/.i6LlY:f011GbYY4fH'Jl3iG'OiU)]9At'YOW.YMW�OOfA'/LS4Y1fQY6GIq.W.OPg6YI1 y�!10. �W.fiKEL:aKff:aRWNO�P e. fir' MfG'uWi..%M
' .• .. INSULATION CERTIFICATE
This is to ertlfy that insulation has been, Instal led inconform 6nce,rvith the current energy
regulatior• Callfomia Administrative Code; �ttle 24; State of California; in the ng.located at
' n PGA WEST — PHASE 2113 — TRACT 28960 - ,4
LOT 54' ,.
- � CEILING; a x .I •'r £ .,
TYPE: Fit-irglass BATTS MANUFACTURER: Owens/Corning - THICKNESS: R-38 12"
TYPE: Fit irglass BATTS MANUFACTURER: Owens/Corning i' THICKNESS:.,R-3812"'BLOW
WALLS: T
' TYPE: Fi • srglass Batts MANUFACTURER: Owens/Coming. w . THICKNESS: R-13 3 1/2"
GENERAI CONTRACTOR: CENTEX HOMES • - . LICENSE #
r BY: . TITLE: ...' .:.. ~
SCHMID I ISULATION CONTRACTORS, INC: •LICENSE #221517 C-2 j w
A —. � �a •. I � !. .. � h ..
BY: / '. TITLE: ,PRODUCTION MANAGER d DATE. 04/30/01 x
'd�sX.'n'..,:!�ACo^A':M.e;�A!4'b;b!fN,MY•d, -'.'.'�C.'NMtlA'.nMlA0.:ltb0'ObN•:4Y0%W isr64K.deiS4.XI*C.4u.O..V.1'/nW.O!:bt'Y�.erY,.R:Y.'A.V:O'OTGf<Vtl.'JYB.,:03V:TJ'af:%1.sf�illcO.:i,'!1.O�:A'.l.'YCd/,YnYOY.bt/,C�%Y�ery:4::ttyLL:iV:aiIY,IG ••,
_ Celrtificate,bf OV7 (j La.Quinta
Building. and,Safefy Depzirtment'.-
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: 807607 SPANISH BAY
Use Classff cation:- SINGLE FAMILY DWELLING V Bldg. Permit No.: - 0008-278
Occupancy Group:. R-3 Type, of Construction: VN Land Use Zone: RL,
Owner..of Building- -CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150
t -City: '.CORONA, CA., 91720
By: DANIEL P. CRAWFORD JR.
Date: 6/11/01.
Building Official
POST IN A CONSPICUOUS'PL'ACE