0008-282 (SFD)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
Date rt lCt3 Signature of Contractor" 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).
() 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.
t% I have and will maintain workers' compensation insurance, as required by
Sectl5n-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.
UIiICFi-AMF1tICAAAi WW3220"_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 shall forthwith comply with those provisions
Date:)' to Applicant ft `"�� 7
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 ofLa 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, nd State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property -for inspection -purposes.
on `
Signature (Owner/Agent) _ ----=� Date
BUILDING PERMIT PERMITN
�'"�
DATIOA VALUATION LOT ; TRACT
28960 "s
JOB SITE
APN
3 2g "
ADDRESS
7%�MaFy� �a�i
OWNER>
CONTRACTOR / DESIGNER / EN INEER
CM4TJ~:� 1101M
C ' 3C HOI .
22 WAa1 1,flW C RCLT' M= 130
2T.80 WARf. LOiW CIRC -1Z, SUITE 150
CGRO A -' CA 91720
CORONA
CA
92720
(909)279-400(1
MIS
5761
USE OF PERMIT
91HOLE ITA2v1I"LY DVELLU4G
SFD L.OTS7 PLAN ZAR -PERMIT DOES NOT INCLUDE SLOCK WALL OR
POOL. 15% PIAN GRWK YEE IiE1 UCTlCjWFOR MULTIPLE ISSUANCE OF
SAIME PLAN TYPE
CUSTOM CONSTRUCTION 2,973.00 SF
PORC HIPATIO - 300.00 Si:'
GARA.WC?ARPORT (SF) . 12,759.60
EST&TAM COST OF COtIGMUCT.10K
249,346M
PRIZw F". SUMMARY.
CONSTRUCTION FEE 101.000.418.000 $1,161.00
PLAN CNF.It`. M 101-00"39-318 2 4.Og
3
MEC K"ICA.L FEE 101.000.421.000
EL81UTPLIC:.AZ. ME 101.006-420-000 $169.59
PLUMBP40 IEP 101-000-419.000 1199,75
S`I'RONO MOTION ME RESID 101-000.241.-000
OPLA :1INO t+`i+R 101.000423.000 g20.0.0
INFRASTRUCTURE FEE =.OW -443-342 $1,907.00
ART IN .PUDIAC PLACM - RI:SIC 701.000.255.000
M -TI CflNR`i'iniiC'I'3:09 AVID PLAIT' C11:f ZY,
$3,953.61
LESS PRE -FM IWO
$0,00
F(AAL PMMT YEVES 1<iIDE. NOW
�>9�►3.s��
RECEIPT -
DATE
BY
DATE FINALED
INSPECTOR
13
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings p
Ducts
Slab Grade D
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap / /
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall.- Int. Lath
!b S
f
Final
Final 0
BLOCKWALL APPROVALt
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 — , pa
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection z
Encapsulation
Gas Piping
Gas Test
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
Utility4 tice (Perm)
COMMENTS:
RPR 30 2001.3 42PM SCHMID CONTRACTORS
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347-1837 p.4
s;. ' INSULATION CERTIFICATE' ;
a This Is to :ertify that insulation has been Installed in conformance with the current energy
regulatlor California Administrative Code, Title 24, )tate of California, in the building at t
r:z PGA WEST = PHASE 3 -TRACT 28960
LOT 57
"CEILING
TYPE: Fi srglass BATTS MANUFACTURER: Owens/CorningTHICKNESS: R-38 12"
TYPE: Fi srg less BATTS MANUFACTURER: Owens/Corning THICKNESS: 'R-38 12" BLOW
WALLS: '
TYPE: F iergless Batts' AVIANUFACTURER, Owens/Corning' THICKNESS:R-1 331/2"
G '.NERAL'CONTRACTOR: CENTEX HOMES LICENSE:
By:. b.,Q�MMtk1� TITLE:
SCHMID NSULATION CONTRACTORS, INC. LICENSE #221517 C-2 ` 4
BY: TITLE: PRODUCTION MANAGER DATE: 04130/01
wiarrz�e:rsracar�vsvnr/m< �lKtl�l'/ID.'1%/,.:N/A,Y1?'F/C.t'AIYNS:FTYL�/IX•1N'i4/.CS9fI,N..',WiR%AJ"J.'N%!i'N% Yf..b:+Y'. � ..1.Wtli.�Z"C.FGIN}'.l?i:/�I+:":W5)Y.Ihi9.'OX:✓':1.�:iX.:.'Yf.:�N:J11%iN.YPIAYAlP%J.>NNY�I'
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INSULATION CERTIFICATE'"
This is to i artlfy that insulation has been installed In conformance with the current energy . c
regulation California Administrative Code, Title 24, State of Callfornia,.in the, building located at
e
PGA WEST — PHASE 3— TRACT 28960
LOT 57
CEILING,
'TYPE: Fib rglass BATTS ' MANUFACTURER: Owens/Corning THICKNESS: R=38 12"
TYPE: Fib rglass BATTS MAN VFACTURER:,Owens/Coming THICKNESS: R-38 12" BLOW
WALLS:
TYPE: Fil` )rglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-113 3 1/2" `
GENERAI CONTRACTOR: CENTER HOMES 'LICENSE #
"
'9.
hJJAA&TITLE: _ -
BY:
SCHMID I ISULATION CONTRACTORS, INC. LICENSE #221517 C-2.
.
<BY: 1 TITLE: - PRODUCTION MANAGER DATE: 04/30/01
4
is
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Certificate of Occupancy
City of La Quinta
Building and 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 regulating building construction or use. For the following:
.BUILDING ADDRESS: 80-661 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008-282
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: . CENTEX HOMES
Building Official
Address:
2280 WARDLOW CIRCLE, STE 150
City:
CORONA, CA., 91720
By:
DANIEL P. CRAWFORD JR.
Date:
5/3/01
POST IN A CONSPICUOUS PLACE