0008-273 (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
734014 AB IMC .. , ,,� 0313 2 /2(
Date ���E �� 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).
( ) 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:
( ) .1 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.
V, 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:
Carver ZURICH -AMERICAN Policy No. WC$.322096-03
(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 p, rovisions-of Section 3700 of the Labor
Code, I shall orthyv��ith comply,with"those provisions.
Date: �10 /12c App0&t t 4+�' •--
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as•a result of this applicaton agrees to, & shall, indemnify
& hold harmless the .City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for:in}sy'p�eetion purposes.
Signature (Owner/Agent)-�"� �'a^^-- Date'
BUILDING PERMIT PERMIT#
DATE �� r LUATION LOT `-;TRACT
JOB SITE
ADDRESS irW-6701RAMWDAY
APN
775 -Mi -019
OWNER
CONTRACTOR/DESIGNER/EN INEER
(r1�1T�C �U: S
G"k,A;k�C iiU
. 2260 WAltUI,OW CUI:ULY, SLTiT;E 150
U80 SNA- D:Ct W CIRC; E, s7UT.E 150
CORONA CA 91120
CORONA
Cwt.
91720
(909)279.4000
C13i
5761
USE OF PERMIT
81k:IGl',:L� T�A1VIl1:.�' 1�iNl�J..;�cTC�
SFDw WT 19 PLAN 4BR PLP,. IT DOM NOT INCt,UDC BLOCK•WALL OR.
POOL„ 7 % PLAN CHECK FTrE R DUCTION 1!OR MULTIPLE iSSUANCR OF
EMS PLA:H TYPE
CUSTOM C:ONMUCTIO'N 3,14'2.00 SF
POk?CIi/PATI(? 454.00 SI?
0ARA0FJCARPORT (SP) 13,484.80
E8J 37 COSH` OF CORMHUC'.i7.ON
''"_''
164,84M
�y��pp,
',']�7�$ �o FEELRY
CONSTRUCTION FEE 101.000-418.000 $1,21-7,00
PLAN C1: ECX FEE $748.28
MECHANICAL FIDE 101-000-421-000 392.00
~�
>
I;rLKCTR1CAL FEE 101-000-420=000 .$176.23
:rt`1 t�
PLUMBING FEE 101.000.419-000 $199,73
STPZONCY MOTION FFE • RES1D 101=000-2.41.-000 $26,43-
C1I1AD1110 FED 101.000.42,3-0(10 $20.00"-
INFR.AS•IMUCTURE PEE 225-000-443-342 $4907.00
1-0
ART IN PUBLIC PLACFX - RESfI 701-000-235-000 $160,71.
MB -TOTAL C40NS'1RLTC]0W .AND PT. AW CSR C%
;54,047.41
LESS PRE.- 'AID FM
$0.00
TOTAL PUM%ILT MIS VUE If OW
$ 4,047AI
.,
RECEIPT
DATE
BY ' ;
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
G
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
to
F.A.U.
Framing
Compressor
Insulation
o/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
j
D II -Int.
Va3 fJd
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
/ 7
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)
SEP 26 2001 8:32RM ''SCHMID-CONTRACTORS
760 3471897 ,p.5
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` INSULATION CERTIFICATE
is to certify that insulation has been Installed in conformance. with the current energy
,This
regulation, California Administrative Code, Title 24, State of California, in the building at
<
PGA WESTtSP_ANISH SAY - PHASE.3 - TRACT 28980
LOT 19
CEILINGS'
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Coming THICKNESS: R-38 1Z'. BLOW
s
e
TYPE: Fiberglass BATTS. MANUFACTURER:10wenslComing THICKNESS: R-38 12”
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS:R-13 3112"
-
GENERAL CONTRACTOR: CENTEX HOMES LICENSE:
e
BY: .TITLE;
9.
SCHMID, INSULATION CONTRACTORS, INC. • LICENSE 0221517 C-2
TITLE: PRODUCTION MANAGER DATE: 09128!01
BY: - •+
n
00
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t
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INSULATION CERTIFICATE
This Is to cer* that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, Siete of California, iri the building located at
PGA WEST1SPANIiSH BAY - PHASE 3 - TRACT 28960
LOT 19
ElUNG :, `
TYPE Fiberglass BATTS MANUFACTURER: Owens/Coming THICKNESS.,'R-3812'' BLOW
TYPE: Fiberglass BATTS •MANUFACTURER: OwenslCorning THICKNESS: R-3812" .
WALLS:
PE: Fiberglass Batts . 'MANUFACTURER: OwenslCorning THICKNESS; R-13 3 112"
TY
•GENERAL CONTRACTOR: CENTEX HOMES LICENSE # __
BY. TITLE:
SCHMID INSULATION CONTRACTORS, INC. LICENSE #22'1517 C-2
By : Y.f ' TITLE: PRODUCTION MANAGER DATE: 09126,01
��.,Y�'yt[iYJt'i1t!J?bG'ii6.SfM:3!;W.i/tani4"t?�:fiT.dY�9iNi:9:^if(3'KS^/!'<IN:'IfGu(^..'<e:µau'.aJ�i�NtC/niHWE:']t:'i�.K:ind%.Maw'sY.Ys✓IIS:vISt:�iAO✓!.•i/Cs�.✓,IV4`N.'IOGI%'.O::E:</HNY.krsJ•::Y'.;Si': v?PiI.:'Nxl� �!' :�'v.N'3'::J '•r.'t::N.
•r
08/30/00 10:56 FAX 714921.1631.
Alliance
Q15
Installation Certificate; Residential
CF -6R
Uu no
the Administrative Cods is optional, but the Infornmalwn must be provided and postoo.
Permit Number
An installation cartilicate is required ie be postee at the building site prior to the issuance c( V16 °(...Joanty perm 9. Tnls for,
may be used to meet these requirements. All appliance categories listed below are the actual equipment instailed. Note that
the of iency and pe of the appliance installed must be equivalent or better than the appliance specified on the Certificate of
Compliance (CF. IW) , This candicate (or As equivalent) small be prepared and signed by the persons) assuming overall
responsibility for the appliance lnstaliaWn.
I, the undersigned, verify that the equipment listed in the category above my signature is the mist equipmOm irs1"84 and
that the equipment meet$ or exCeeda the requirements of the Appliance Elf ic;ency Standards. In addition, I have verjI*d that
the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to
demonstrate compliance with the Energy Efficiency Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronic boiler information is cantered here. Other hydropic or combined hydronic equipment is listed under
Water Heating Syttem$.
Heating Equip, t:£C Certified Actual Distribution Duct or Heating Load Heating
Type (fumeee, Manuf, Make & Efficiency Type and PI ars
heat um etc.) Mod�1 Number AEU 9 Before Over. E
E ete. Location R•Value SizingStuh) GoactTy f
Btuhi
2ot,.► a. % I - --- ---_p PUT _
CoolingEquip, CECG rtfflad
q p, Com reaaor unit Actual Distribution Duct or
Type (air pond., Manu). Make & Efilclency type and Pi In ,.
heatpump,etc. Model Number SEER pp
Location R-
I 1%lus
Xac:jk3c, (0
' 12Q r1 t� 4 � -1 —G
Th InQ das n h
!1 a Qr:er Elfici� t I°aa nd design neat gain rete have been determined using a melhoo st:ecf;ed in Seaton 150(h) of
ar+d da, and era two of the critan'astsed for equipment siz;,iq and aelecgn.
•d � U
Siynaturs A/�
Oats HVAC 5uLontrac or (Co. Name) or General comae=r or Owner
WATER HEATING SYSTEMS
Water Heating CEC Certtiled Rated )Energy) External
System Type Manuf. Make a Tank Factor or Tank
'storage is atc.i Model Number orpw (. w Capactty Recovery Standby) Insulation
(ciallonaY EflIcianc Loss (%; R•Vaiue
1. For arntil pat atoiapti (rated input S 75.000 a urhr), aleculc realstance and heat pump water hNlats. fist E+4 F
For large 9aa alors9e water heaters (rated input >75.0oo alwhr), list Fated Input, fiecovery c
For Instantaneous gas water heaters. list Rated Inpvt and R r -fir stir,
Efficisnry arc..tarc_y toss.
For Instantaneous altCtric waler hatters, list Rated input very E.ficiency,
FAUCETS & SHOWER HEADS
All !s,ca;s and sncwarheaes installed are iis;ea in !l`6 Commissions Uirece.y of Candied F2;�;5 ;,�;� S'tcwerheacs,
Dursuant to Tata 26. Pan 6. Subc.iapter 2, Section i t t.
Signature - .
Date Plumornp Suocoriactor (CO.
Name) c..-atter or —I-Vnar
F11• 1-4Q JonuEry 1192
FROM FAX NO. uI. 27 _)'" 10: 31HVI P_'
JL110 t Al-,JUA I IV1r It"I 'A E (Ya. .-1 of 7) C1 -,'-6R
9_64-
A rosy — --r--- � -
yds
An installation certificate is required to be posted at the building site or made available for all appropriate inrpettioos. (The
information provided on this form is required: however, use of this forst to provide the information is optional.) Ager
completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at
occupancy, per Section 10-103(b),
HVAC SMEMS;
External
Identical Input (kW Volume cicnay' Standby'
%mladon
Systems or Blulhr) (gallons) (EF, RE) Loss (W
Hearing Equipment
�
Equip.
it of
Efficiency
Duet
Duct or Hosting Heating
Type (pkg. CEC Certified Mfr Name
Identical
(AME, etc.)'
LDatloa
P*" Load Cts•
hear pump) and Model Numbs
Svstems
rkCT.IR value]
(title. etc.)
R -value (Bttl/hr (Bttyltrt
Cooling Equlprrtenr
Equip. CEC Canirtcd Compressor
y of
Ef6c}auy
Dun
Cooling Cooling
Type (pkg. Unit Mfr Name and
Tdcnrlcal
(SEER, eta.)
Location
Duct Load Capaettr
heat Camel Model Number
SY�t
RCF -IR valve)
1attia eta)
R-valuc ( tuft) Mtsyhn
I . > reads nearer than or equal to.
1, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed. 2) equivalent to or mom
efficient than that specified in the certificate of compl"lance (Form CF -1R) submitted for.eompliaace with the Enerv-
Efrciencv Srondards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (from the Appllan= E,liciency Regalarions or Part 6), where applicable.
Signature, Date
HATER HEATING SYSTEMS:
Distribution ]f Rectr-
Heater CEC Certified Mfr 'type (std. culadon.
Typc Name & Model Number Pout-of--Usa) ComroJ TV
stalling subcantractw (Co.Name)
OR General Contractor (Co. Name) OR Owner
S of Ratedt Tank E1Tt-
External
Identical Input (kW Volume cicnay' Standby'
%mladon
Systems or Blulhr) (gallons) (EF, RE) Loss (W
R -value
�
2 For email gas storage (rated input orlas thart or equal to 77.000 Bruthr). electric regWanee and beat pump -aeon hcatera. Itu Energy Factor.
For large gas store -le wattr haters (rased input of &rtwr than 75.000 BbAv). Inst Rcwvery Efrtciermy, Standby l..aa and Ruud (W.
For ilutantswcous eas water beaters. Ila Recovery Efficiency and Rated Input.
3. R-12 external insul :•.!.n is mandatory for staags wu car hewAn with as enwV factor of las than 0.53,
Faneeis & Shower Heads- '
All faucets and sttt;w erheads installed are certified to the Commission, pursuant to Tide 24, Part 6, Section I 11.
1. the undcrsign.d, verify that equipment listed above my signature Is: 1) the actual equipment installed; 2) equrvaltrat to
or more etficic.:i: dean that specified in the certificate of compliance (Form CF -IR) suhmiacd for compliance with the
Enery 4 icic;,cy Srandards for residential bu khn;% and 3) equipment that meets or wmeeds the approprim
requiremcn4 fcr manufactured devices (from the Appliance Effxi ncyrRegularions or Pati 6� whole applicable.
zmg
COPY TO: Bui! _:rns Department
HET'. ; Provider (if applicable)
Bu1!_::ng Owner at Occupancy
JD Mechanical, Inc.
Installing Subccintractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
_ July 1, 1999
"° - Certificate. of Occupancy
City of La Quinta
Building.and Safety Department
This Certificate issued pursuant to the requirements of Section 909 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: 80-670 SPANISH BAY
Use Classification: SINGLE FAMILY .DWELLING Bldg. Permit No.: 0008-273
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner bf Building: CENTEX HOMES
Ta -k, /4n;eu7
Building Official
Address: 2280 WARDLOW CIR, STE-15
City: CORONA, CA., 91720
By: GARY HARTMAN
Date: 12/27/01
POST IN A CONSPICUOUS PLACE