0008-277 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
iChapter 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
7�L(39d r_ P►$' �_>.....,r.^''_ 03112€
Date >r�� " Signature -of Contactor t -'-
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). ,
O 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
pert rmance of the work for which this permit is issued.
>1,Q1 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.
�i3i3iC�1 AA6F.It1C�i�a 'W'C✓�3;i2086�63
(This section need not be completed if the permit valuation is for $100.00 or less). _
( )-I certify that in the pew
performance of the ork 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 o�Sec on 3700 of the Labor
Code, I h 11 f rt1}with comply with those provisions.
Date: �)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
S`the above-mentioned property forinspection urposes.
Signature (Owner/A 11 Date ' '�'• f t7
BUILDING PERMIT PERMIT#
DAT VALUATION LOT, �^'L TRACT
.
.;.' �2 • �2a
28960
JOB SITE
ADDRESS @LtD%E1,Ei'PJ)OA
APN
:77&WZ-003
OWNER—_ - -' —
CONTRACTOR / DESIGNER / EN (NEER
CWM HOMES
CW= HO.W.g
2280 WMDLOW C1 tC1 , QCT E 150.
221RO WARDLOW CIRC, W:I'M 1:50
C&71: OKA .. CA 91120
CC3ROMA
CA
"91' 20
(909)279-4000 -
CI
BLA. 5'161
USE OF PERMIT
SN(3iY, YAN.Y DWMUX0
113n)" I.01fili PLM 4MI PERMIT f OMS NOT INCLUDE SLOCKWALI, OR
POOIA75% PLAN CHECK FEE REDUCTION FOR. MULTIPIX ISSUANCE OF
.
SAME PLAN VYPE
CUSTOM CONSTRUCTIUN 36142,00 8F
PORCWPATIO 454.00 SIS
CARA( ICARPORT (SP) 13,434A0 .
PSCY " 11R*WXA1"Y
CONfITRUC`1'ION IVILR . 101-W0418-000- — -SV1100..
PLAN CHECK FES $?I939
MECHANICAL Fir 101-000.421=000 $92.00
EUMUTRICAL IT9 101-000-420-000 $176.23
�+_'5
PLUMBING r11?F. 101.010.419.000
STRON'Q MOTION FEE a R W1D .101-000-241,.000
LIRADIN4 YB
INFRAS"1'RUCTUXEFEE 225-000-443-342 $1,807.00
4 E 11._1
ART IN PUBLIC PLACES - R.EME 741.000.255.000 $160:71
0"iSk3-TOTAL C014 UC TION. AVYI) PT—W C�XZCX
$4,047.41
LXV PRrR,-FAID FF -134
$0.00
IOTA -L FEWI TIMS DVENOW
$4.047.41
RECEIPT.
DATEBY
DATE FINALED •
INSPECTOR
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts '
Forms & Footings
p /
Ducts
Slab Grade
rrp
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
0/
F.A.U.
Framing
6
Compressor
Insulation RL
p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
EQf�S �
Final / 216
BLOCKWALL APPROVALS
Final
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
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
Q �/
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:
SER,, 14 2001 3: 59PM SCHMID-CONTRRCTORS. 760 3471897
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.
INSULATION CERTIFl��4TE
/
This Is to certify that insulation has been'installed in conformance with the current
energy
regulation, California Administrative'Code, Title 24, State of Callfo_ mia, in the building at
a
-
PGA WEST SPMIISH BAY. - PHASE 26 - TRACT 289130 �
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CEILINGS: � '' � - _ . � " f '"•
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TYPE, Fiberglass.BATTS; MANUFACTURER: Owens/Coming a THICKNESS: R-3812BLOW
WALLS t
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TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS:R=13 3 112"
F
GENE RACCCONTRACTOR: CEINTEX HOMES LICENSE.
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BY: TITLE:'f t'
SCHMID INSULATION CONTRACTORS, INC. - .;2 #22"517 C=2
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BY. TITLE: PRODUCTION MANAGER ' E;ATE:_'09/14/01-
' Wil:.0.YnY?4S'M6i1V"IW;ifNCf�:�FtiN!://f4tN/Y1.15fO.YAY.:t'iMiYCVHYG:JLIY+W.iwAI/.1/IYJt':.r.>%M50i t;1'�,NY.NL:SVNiII.ILDiIFOHf:O:GKY.TONIQfGO/xfY:,Y!WF/'/•12L MGkrbW,YO[llrN.[O%iN/Fi7N16Y:eIVI+P,;B/d/B>'ItSVMt�I'..W.YY�
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CERTIFICATE
tiINSULATION
This is to certify that insulation has been installed In conformance with the current energy
P
regulation, California Administrative Code, Title 24, State of California, In the building'Iocated at
.t
6
K,PGA WEST�SPANISH BAY --'PHASE 26 - TRACT 28980.
•`
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'
a
CEILINGS:
e
•
TYPE: Fiberglass BATTS MANUFACTURER: Cwens/Coming THICKNESS: R-3812" BLOW
WALLS;
8
TYPE:.Flberglass Batts MANUFACTURER: Owens/Coming "THICKNESS: R-13+31/2_" e
GENERAL CONTRACTOR:, CENTEX HOMES , LICENSE #_ .
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BY: F TITLE:
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.
SCHMID INSULATION CONTRACTORS, INC. LICENSE'#221517 C-2
BY: TITLE: .-PRODUCTION MANAGER-, DATE 09114/01'
ftwre twcusrr�+swctirramt�anuw:r+o>uv'.eun.<.mu,r:.v�a: :rrua;awo�sa►oxasa¢as. rwnxr.romazererFgawwrea:avrour'rn+au�asexm'/eacra.yaeistirelnvn!%eufine nauast;.►,oma>.rvenrans.�.vama•,4T . .
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Cityof.La--Quinta
Building
and -Safety De'partment4 N-
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 thevarious ordinances .
s'. of the City regu/sting bui/ding construction or use.., For _the :fo/%wing:
BUILDING ADDR.ESS:: 80-616 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008-277
Occupancy Group: R73 Type of Construction: VN - Land. Use Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150-
City:
50-City: CORONA, CA., 91720 r
I &4%oL. By: GARY HARTMAN
J.
Date: 11 %27/01
Building Official
POST IN A CONSPICUOUS PLACE '
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