0008-279 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cllapter 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
wq,
Date `— I Signature of Contract
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.
%aI_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.
ZURICH-AMI=.RIC.AN WC03.22096•,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, I hll fo hwith comply witb.th�se-provisions
Date: I �.� Appant .--►? ,..,.
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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 mehtioned-property or inspecti' p rposes.
Signature (Owner/Agent) s'�"" Date •rte +,T;
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$264,28420 28960
JOB SITE
ADDRESS
APN 3
OWNER - - V
CONTRACTOR / DESIGNER / EN (NEER
CSW ROW"Is
C :1IONSS
2280 WAftIDLOW CYMCLF, Mff-E,150.
22E0 WAw)1:,OW'C1 mum, UifsPJ, i. so
CORONA Cdr. 91720
CORONA. CA 91720
(909)279.4000 CFI. ' 5761
USE OF PERMIT
STMZ FKhOLY DWFWWO
SFD. LOT56 PW4 4CL PER1611 T DOES NOT INCLUDE BL OCT<'WALL. OR
POOL 15% PLAN CHECK FEE REDUCTION FOR MULTIPLE fSSUANCE Of?
SAME PLAN TYPE
CUSTOM CONSTRUCTIO14 3,142.00 SF
PORCHIPATIO 454.00 SF
CARAGVCARPORT (SF) 131404.80
11=&T.i "TED COST OF C:ON.TrXU7anox
264,U420
FEE 4''iibn& R -Y
C014SSRUCTION FPL{- 101-000.4.18-000 $1,217,00
"-
PLAN CHECK FEE 101-000.439-318 $24829
1 7 "1
NECPLOW ICAL }REFS 1.01.000A214,000 $92,00
ELECTIUCAAL MF 101000-420-000 $178.23
PLUMBING FEE 101.000-419.000 $149.75
STRONG NOTION FSE • RESID 101-000.241.000 $26.43
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GRADING FEE 101-000.423.000 520,00
171
INFPA aTRUCTURE ICK 225-000-443-342 $1,90.00
ARTTN PUBLIC PLACES - RESIE 701-000455.000 im,71
C�
13LH.3-WrAL CC323ST . t C:'rION AND PI" CRECK .
$4,047.41
WTI& -PiMPLIT DI -TE NOW
$4,047.41
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/D
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
/ D
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans &Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D II - Int. Lath
D
_
Final
Final
BLOCKWALL APPROVA S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING AP R PVA
Gas Test
Electric Final
Waste Lines
/ 0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral/
Sewer Connection
(06d'
Pool Cover
Encapsulation
Gas Piping
Gas Test
!! b
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:
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INSULATION. CERTI-- FICATE`
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:This is to ,ertify.that insulation hes been installed in conformance wltti the;current energy.:
regulator California.Administratlye Code,Tltle 24, State'of California, in the building at ..
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PGA WEST= -PHASE 3—TRACT•28980'
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CEILING
TYPE: FI s�/'(�7�ass BATTS: • MANUFACTURER: Owens/Corning . ,;tI HICKNESS: R �8: 12”
TYPE: Fi`erglass"BATTS MANUFACTURER: Owens/Corning THICKNESS: "R 38-12 B! OW
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WALLS
<Batts
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TYPE: F'ie, glass MANUFACTURER: Owens/Corning, THICKNESS.R`133»172"
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G :NERAL -CONTRACTOR: CENTEX HOMES _, -LICENSE: -
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SCH MID, VSULATION INC. - LICENSE 4221517. C-2 •
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BY �. f'W 1 'TITLE: PRODUCTION MAN
..AGE DATE: 04130101;:
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INSULATION CERTIFICATE ,
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This Is to i )rtify that Insulation has.been Installed in conformance with;the current*ene.rgy
regulation California Administrative Code„Title 24, State of California, In'the building located at
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POA WEST:-- PHASE 3— TRACT 28960
CEILINGS
TYPE: Fib :glass BATTS MANUFACTURER: Owens/Corning' • THICKNESS: R-38 12”
. TYPE: Fib, rgless BATTS MANUFACTURER: OwenslCorning ;, 'THICKNESS;.R-38.12" BLOW
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WALLS: ' ..
3 1!2"41
TYPE Fil :;rglas[[s Batts. AAANUFACTURER: Owens/Corning THICKNESS: R-13
GENERAI CONTRACTOR: CENTEX HOMES LICENSE #
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SCHMID l ISOLATION CONTRACTORS;'INC:.• LICENSE_ 4221617 C=2 - .l
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BY: �__ TITLEi PRODUCTION MANAGER .-DATE: 0.4130101
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Certificate ofOccupanc'y.
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City of La Quinta
Building and S06ty-Departmen—t ti9.
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: 80-643 SPANISH -BAY
Use Classification: SINGLE FAMILY DWELLING : Bldg, Permit No.: 0008=279
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
(d/�t By: DANIEL P. CRAWFORD JR.
Date: 9/27/01
Building Official
POST IN A CONSPICUOUS. PLACE