0008-280 (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.
r License # Lic. Class Exp. Date
73 094 .AB MC, _ � O�i31/2(
DateA)Signature of Contra or
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
perf.oynance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
�S ction 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.
ZURICif3:AMERICAN WC sa209b-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's, all'fort with comply -with -those q vlsionsr'
Date:. Y) '� i �,('�(gpplicanf '"�+- �7� ( ,
r
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 inspecti np ru poses.
Signature (Owner/Agent) 1't'" ~;•:.----- Date'
r BUILDING PERMIT PERMIT#
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DATE f� VALUATION LOTTRACT
,• ,`►+
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28960
JOB SITEt
APN 3,20
ADDRESS ;iD� �T3S`773-s-?
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OWNER •
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CONTRACTOR/
- - _
22180 WAIMLOW MCU, =rg I th ,.
2280 WARD1,04) F CM=,-,- SUITE 150
CORONA CA 91720
C:ORORA CA 91720
(909)279-4000 CBLft 5761
USE OF PERMIT
SWOLE k:AIYMY DVMMING
SYD- LOT58 PIAN 4AL PERMIT VOF'. S WOT INCLUDE 8LaP301C'WALL OR
P0047S% PLAN CHECK FEE R'EDUC110W FOR MUIU'IPLEMSiJ.+<1NCk OF
SAME PLAN TYPE
CtISTI OM CONSTRUCT ION 3,142.00 OF
PORCHWAT1O 454.00 SF
OAXAGEIC.AMRT (Sl) DA`14M
NS'1MMOM COSI° OF COI+t:►MUC' M14
k_ 2",:104.90'
PTS7C AWPt.7r.+' SLIA+1`Q "Y
X. =7:
CONSTRUCTION IEE 101.000-418.000 $1,217.00
PWI CHECK IEE. 101.000.139-318 W8.29
MECHANICAL IEE 101-000.421.000 $92.00
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ELECTRICAL FRE 101.000-4.20-000
PLU.'MBWO kTIE 101.000.419.000
STRONG MOTION 1 - RE -SID 101-,0p0-231..000 $26.43
t'!T1
I
ORADMO FER 1,, 01-000-423.000 $20:00
ash =1
INI•RASTRUCTU63}?..1 225-000443-342 S1,9n.E10-
.ART IN PUBLIC 11LA.C:U - RE= 701 MOM
OUB-TOTAT, GC)NSTRUM01,1' ANDMAN C';I X
$4,047,41
IM3 PRE -PASO FFM
$0.00
RECEIPT
DATE
BYDATE
FIN ALED
INSPECTOR
r0-1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
17
Underground Ducts
Forms 8 Footings
ib A
Ducts
Slab Grade
0 A
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
p/
F.A.U.
Framing Ole, a 9A,/
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
Final
FinalYZ ,
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs' -S
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
Pool Cover
Encapsulation
Gas Piping
Gas Test
i !!
Appliances
,
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FBQures
Main Service
Sub Panels
Exterior -Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
RPR
30 2001,3 40PM SCHMID CONTRACTORS 347-1997
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INSULATION_ CERTIFICATE,
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This is t+ certify that insulation has been Installed In conformance with the current energy ..
regulatio , California Administrative Code, Title 24,'State of California, in the building at
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PGA WEST —PHASE 2B,— TRACT moo,
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LOT
65
CEILING is
TYPE: F' )erglass BATTS MANUFACTURER: OwenslCorning THICKNESS:-'R-38 :12"
TYPE: F >erglass BATTS MANUFACTURER: Owens/Corning- . THICKNESS: R-38 12" BLOW
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WALLS:
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TYPE: l bergless Batts' MANUFACTURER: Owens/Corning THICKNESS:R-13 3 112_'
CONTRACTOR:
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C _*NERAL CENTEX HOMES LICENSE:.
BY: TITLE: -
SCHMIIC INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
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BY: TITLE: PRODUCTION MANAGER DATE: 04/30101
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INSULATION CERTIFICATE
This is to .ertlfy that Insulation has been-installed in conformance with the current energyy
'regulation California Administrative Code, Title 24, Stare of California, in the building located at
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PGA WEST — PHASE 213 --.TRACT 28960
LOT 55
CEILING:
TYPE: Fit irglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R•38 12"
-
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TYPE: Fit irglass BATTS MANUFACTURER: OwenslCorning THICKNESS: R-38 12" BLOW
WALLS: -' -
'TYPE: Fi Batts :MANUFACTURER: Ow®nstoming THICKNESS: R-13 3 1/2"
,srglass
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GENERAI CONTRACTOR: CENTEX HOMES LICENSE #
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BY: TITLE:'
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SCHMID I ISULATION CONTRACTORS, INC. LICENSE #221517 C-t
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By, TITLE: PRODUCTION MANAGER DATE: 04130/01
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Cer iOfT
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..Cit of L
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Building and Safety Department of
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-regu/ating building. construction -or use. For the following;
BUILDING ADDRESS: µ 80-677 SPANISH -BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008=280
Occupancy Group: - R'3 Type of. Construction: VN Land Use Zone: RL
,Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE-1-50
City: CORONA, CA., 91720
By: RICHARD K. KIRKLAND
Date: 7/2/01
Building Official _
POST IN A CONSPICUOUS PLACE