0008-281 (SFD)�. LICENSED CONTRACTOR DECLARATION
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
73409.4 AB 14IC;_ OV31 12(
Date f" fix" 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 not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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.
W, 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.
MIUCH-AMERICAN 97t``39'ti X09$-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 Sect•o_n 3700 of the Labor
Code, I shall orth 'th comply with those -provisions.
Dater f +^Applicant E;• +"�
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 for inspection,purposes.
^• .=
Signature. (Owner/Agent) ' :`t-,.,.»,L,� ' _ -_ Date •I , 0
BUILDLt G PERMIT PERMIT#
Visyr;
DAV,'/'1'AVALa* LOT TRACT
,,�.32Ylr 25960
JOB SITE
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CIEWM.1101
Cmwc HOWS
2280 WARDLOW M- CLU, SUM 150
22 80 WAPMLOW C?YR= WITE 15 0
Ci3E.0NA CA 917212
CORONA CA 91720
(9W)279,4000 (=X 3761
USE OF PERMIT
MN012 FA MY DVf1 LWG
SPD LT20 PLAN 28R-PER.M1T DOES NOT INCLUDE BLOCK WALL OR
POOL. 7S% PLAN CHECK ME REDUCTION FOR MULA IPLE IS.0UANCiE 0?
SAME PLA14 'TYPE
C'US'TOM C:0175"fRUC` ION 2,9".00 STe
POIL HIPATIO 900.00 SP'
MARAGMlCARPOR'T (S?) 12,159:60
IMMKM COW 02, CONS11R ICM ..O.Iq
249,346.30
g)Mwr FEE 91i314MARY
.
C0440TRUCTIO'N t`fr,E 101-000-418.000 $1,141.00
PLAN CHECK FEE 101-000-439-318
NiECHA 41CAL`1rER 101.000.421-000 SIM50
!
1 I,EC7`R1t"AG'N7;I 101 -OW -420-000 $ib9.°,r3
%Arj
P1.UM81NC3 FEE101.000.419,,000 $i4�,'ry3
11Y, fact
STRONO MOTION FEE • RE -SID 101-000-241-000 $34.83
� (7) s 3
GRADING FEE 101-000,423,400 $,10,00
114MAt1TRUCTWUFEE 225-000443-342 p,M.00
(�
ART 1N PUBLIC PLACES - IE 701.004-255-000
kA
SUP,TOT'AL CC)MMU CTI -M AND PIAN CHFM
$3,953.61
1 FX3 PR&PAID MSS
$0.00
#
RECEIPTDATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings p�y�
Ducts
Slab Grade T
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
p
F.A.U.
Framing
b
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
S
Final
Final
BLOCKWALL APPROVALS
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
Sewer Connection
Qsp/
Pool Cover
Encapsulation
Gas Piping
Gas Test
d
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) v!10
COMMENTS:
SEP 1.4
2001'3:5.7PM" SCHMID-CONTRACTORS " 760 34718.97
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'CERTIFICATE
INSULATI®N
This is to ceofy that insulation has been installed in conformance with the current energy
regulation, Callfornla Administrative Cade, Title 24, State of California, In the building at
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. LOT 20
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CEILINGS: ; • �_
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TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-3812" BLOW
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WALLS:
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TYPE; Fiberglass Batts MANUFACTURER: Owens/Corning' THICKNESS: R-13 3 92"
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GENERAL CONTRACTOR:. CENTER HOMES LICENSE:
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SCHMID INSULATION CONTRACTORS, INC. - LICENSE#2116'117 C-2
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BY: I rV TITLE: PRODUCTION MANAGER ;DATE 09114/01
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.
INSULATION CERTIFICATE
.
This is to certify that insulation has been installed in conformance with tha.cunrent energy r
regulation, California Administrative Code, Tittle 24, State of California, In the building located at
r
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= PGAWEST SPANISH BAY - PHASE 3 - TRACT 28960
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CEILINGS-,,
.
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning . THICKNESS: R-3812" BLOW
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WALLS. L
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TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-13 3 1/2"
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GENERAL, CONTRACTOR: CENTER HOMES:'% LICENSE.# `.
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BY. - TITLE:
HMID INSULATIOCONTRACTORS, INC. , LICENSE #221517 C-2'
SCN'
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BY: TITLE: PRODUCTION MANAGER • DATE: 09/14/01
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141
WCertificate
Occupanpy*
Cit of LaQuinta
Building and SafetyDepartment�oF
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, of the time of issuance, this structure was in compliance with the various ordinances
of the City regulating• bui/ding construction or use. For the following:
BUILDING ADDRESS: 80-652 SPANISH BAY
Use Classification: SINGLE FAMILY -DWELLING Bldg. Permit No.: 0008-281
Occupancy Group: R-3 Type of Construction: VN Land Use Zone:, RL
Owner of Building: CENTMHOMES Address: 2280 WARDLOW CIR, STE 150
City: CORONA, CA., 91720
By: DANIEL P. CRAWFORD JR.
Date: 9/26/01
Building Official
POST IN A'CONSPICLIOLIS PLACE
_.