0008-272 (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
734094 AB HXC-_____,__� / 03/31/2. (
Date �-
' l ignature of Contractors -
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.
N,4I 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 ZURICH-A.ER1CAN Policy No. WC93304096.03
(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 ;1 sha I rthw,ith comply-with-thosg provisions.
Date: 7'!s' eApplicant
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 applicator 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,forr inspe tion purposes.
Signature -(Ownerr/Ag t)c '� Date
BUILDING PERMIT PERMIT#
DATE LOT TRACT
/VALUATION q
JOB SITE
ADDRESS
APN
775-031-01*7
OWNER
-
CONTRACTOR / DESIGNER / EN (NEER -
-
C-MEY, HOWS
CaF.3`TTMC HOMES
2280 WARDLOW (M U 9L 150
2280 W.R1JLOW CJRCLF., 51JI7.L' 150
CORONA CA 91720
CORONA CA 91720
(909)Z794000 Cwt 8761
USE OF PERMIT
MOLE RAWLY DWELLING
VD-LICITIR PLAN 3.F R PERMIT DOES NOT JINC'.I..UDZ BLOCI:WAI,L OR POOL
CUSTOM CONSTRUCTION 36053,00 SF
PORCWPATIO 335.00 SF
GA.RAOWCARPORT (81) 13,328.00
RS; COST OF CONSMUC77ON
2MI272.20
CONSTRUCTION IEE 101-000.438-000 $1.195.00
PLAN ClieCIC 1099 101-000-439-318 $930.51
MECHANICAL F199 101-000.4.21-000 $118,00
IELO,CTRICAL FEE 901 -OW -420-000 X1'7 .98
F i r
PLUMBINO FEF 101.000.419.000 $136.50
5-1fROND MOTION FEE. - RESID 101-04(3-241-000 $35.83
QRAOIN0 FF.9 101.000.423.000 $20.00
134FRASTRUCTURE FZF- 2,29-000-143-34.2 $3,907.00
"" 3'a 7 C r i
.ART IN PUBLIC PLACIwa - RESIL 701.000.255-000 $145,68
81.M -TOTAL CONSTRiiMOK AND PL" CHECK
$4,752.48
LESS PRE-PAJD F =3
$0.00
TMAJ, FEERTO't't' MS DUB NOW
$4,752.48
RECEIPT
DATE
BYDATE
FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footing
4
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
6
F.A.U.
Framing
Compressor
Insulation_4
/(!
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
Z�_�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
O Z�
Pool Cover
Encapsulation
Gas Piping
Gas Test
6
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:
_SEP
26 200,1 B-31RM SCHMID-COhTRRCTOR:S 760 34.71897
p.4
, ��vsr�nurnrawrs'svr�as�ycxusuF:>r'asrra:erwr�ax::vinare^�c:�e:w:aaaarw,�»xarrcrosr,��a n.���cvmc;ciurs�.w•as�rru.scat�r<-*•.:'.•�.u:r:�:z•rwdxa.u+r,.rw-cs�.sa,r.:�av;v.::ne "eua�v imrai:.e:�-<alsu 4 • ,. .
INSULATION CERTIFICATE
G
This is to certify that insulation has been installed in conformance with the current. energy
a
G- regulation: California Administrative Code, Title. 24, State of Califomla, in th6'building at
+'
PGA WESTISPANISH BAY - PHASE 3 - TRACT 28880
.
e
LOT 1>s
P
-
�o
CEILINGS
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Coming. THICKNESS, R-38 12" BLOW
TYPE: Fiberglass BATTS . MANUFACTURER: Owens/Corning THICKNESS: R-38 12"
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS:R-13 3"112"
yGENERAL
- w •4.'
CONTRACTGR:' CENTEX HOMES. LICENSE:
.
TITLE:
"
SCHMID-INSULATION CONTRACTORS, INC. LICENSE #221517. C-2
a
f -
BY . % - TITLE: PRODUCTION MANAGER.DATE:.09/26/01
1
�/Y5:1•iN:ifiYlt/.lL9.Y,Lt!iD.:,9..W.aT/.T.:T,:A.d�:1ZV.`�."N.SP,[yA:�U:=rS-!.+)!INtAlxnnYv)kll»x'vF�Ht�.!'AaHtJ:'Lq`K:CVYC'l-�1:iD:GO'tl�?CIN ORfD:'Cf¢!:071Y.SX<M.SfFJ4Zf1V•L.6•ldX,lO�f.�IfH'.l�/.!Y'.CS:C3l,.V1NI�Y.'�aR:J.i�'S, 44I1::l.Y.O,WnISefYA?�1uY'.'iL ,
INSULATION CERTIFICATE
This is to certify that insulation has been installed In conformance with the current energy
regulation. California Administrative Code, Title 24, State of California, In the; building located at
PGA WEST/SPANISH SAY -PHASE 3 - TRACT 28864
LOT 18
y
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-3812" BLOW","*
TYPE: Fiberglass BATT3 MANUFACTURER: Owens/Corning THICKNESS:'R-38"12" -
WALLS.. - .w...
TYPE: Fiberglass Batts MANUFACTURER: Owens/Coming THICKNESS:. R=13 3112"
GENERAL CONTRACTOR: CENTEX HOMES LICENSE #
BY. TITLE:
SCHMID INSULATION CONTRACTORS, INC. = LICENSE 4221517 C-2
BY: -TITLE: PRODUCTION MANAGER DATE: 09/26101
`.r.,«....vasnzwsfr'racrsaw.vnvr.w++f�A,xwY.ex+6!lnsclrm!a4�a;uwz: m.r.Miie'rls:ro:h5aey
.. 08/30/00 10:56 FAX 714821.163.1. Alliance I�j.15
Installation Certificate: Residential
- CF -fig
U�ae—of�this fob
to eatl2fy th11 r"ulrgmenta of the Adrnlnlatrrative Cods !a aptlond, but the Infarmatton must be provided and po.too.
su e = P N(Sff /`tY 3.4R Ob0$ 272
Permit Numt»r'
An installation candicate is required tc be postea at the building site prior to the issuance cf the occuoancy perm. T'nis torm
may be used to meet t,heae requirements. All appliance categories listed below are the actual equipment instailod. Nota that
the efficiency and type of the appliance instailed must be equivalent or better than the appiianee spgetlied on the Ceniticate of
respna Compliance ury of thelappliance Ingtallatbn ate (or 9 �uivaiant) snetl ba prepared and signed try ;ha persons) assuming over 11
I, the undersigned. Verify that the equipment listed in the category above my signature is the actual equipment instaabod and
that the equipment meets or exceeds the requirements of the Applltttnee Efficiency Standards. In addition, I have verdled that
the equipment is equivalent to or more efficient than the equipment Specified on the Certificate of Compliance submitmtto
demonstrate comcilance with the Energy Efficiency Standards for residential buildings,
HVAC SYSTEMS
Note: Hydronic boiler 1Norm&Wn is enured here. Other hydronic or com
Water Heabitted hydropic equipment is listed under
ting Systema.
Heating Et;ulp, CLEC Certified Actual Distribution Duct or Heating Load HeatlnQ
Type (furnace, Manuf, Dake & Ef Iclency Type and PI In
h*at �ump, etc.) Modal Number (AFUE etc t t ��„t,,.. pig Bofors over• Equipment
t I .t R alus Sizing(Btuh) Cann,if-.104
ed
Cooling Equip, Campr@&wr Unit
Type (air pond., Manuf. /Rake &
heat Dumb. ern t
h)
Th Ing design h t loss nd design neat gain tate have be
a Ener Eltici on aerarmined using a ,nathoc scec.l:ed in Saaaof
th ar+d do, and are two of the criteda sed for
d � � equipment aiat,ig and aelec;gn. n 130{h}
Siynatur9 UfktyCF �"� ►� av r r7�ATrNr, �h /L
WATER
Oats HVAC Subontrac ar (Co. Name) or Ger.erai Con7actor or C>vner
WATER HEATING SYSTEMS
Water Hosting
System Type
CEC CertifiedRatadr
Manuf Maks 6
Tank
Energy)
Factor or
Actual
Efficiency
SEER
Distribution
Type and
Location
Duct or
Pippin
R•Vnlue
Th Ing design h t loss nd design neat gain tate have be
a Ener Eltici on aerarmined using a ,nathoc scec.l:ed in Saaaof
th ar+d do, and are two of the criteda sed for
d � � equipment aiat,ig and aelec;gn. n 130{h}
Siynatur9 UfktyCF �"� ►� av r r7�ATrNr, �h /L
WATER
Oats HVAC Subontrac ar (Co. Name) or Ger.erai Con7actor or C>vner
WATER HEATING SYSTEMS
Water Hosting
System Type
CEC CertifiedRatadr
Manuf Maks 6
Tank
Energy)
Factor or
External
'storage as etc.)
ModelNumbeir
or B 8tuh(kW
or
Capacity
Recovery
Standbys
lank
Insulation
allons)
Efllclsnc
La as 1..n, ,
R•Velu
a
I. For small gas attiiag* {rated inputs 75.000 B urhr), elee;rle realatance and d host pump wats� heatacs. lis! E�em,Y Fe ;or.
For large yes atorsge waver heaters (farad input >7S,00o 8tttrhr), list Fated Input, Recovery �c
For Inetanansoue yea water hasten, list Rated Input and Recovery Elficienry, Efficterxy arc _wcn ,y toss.
For Instantaneous siecvic water hostas, list Rated Input
FAUCETS a SHOWER HEADS
All la ca;s and ShCwerheoGs installed are iis:sd in !h.e Commission s UireCcry of Candied Fa:cs; c' cwetneacs,
0ursuant to Titla 26. Pan 6, Subtlapter 2. Seect:on I t I.
a a;
1
SiSnaure
nate Plumorng Suocor.Taytor (
` Co. Names ..::.:r. -actor or Windt
F,r soc !onutry 19n
Kci? t FAX NO. - u 1. �_'7 _OW 10: 31W F2
110 l tiLLA I JLVIN k_L-_A 11"I LATE (Yag..'1 of 7) C -6R
M
1—
.! -Address afro t Number
yds
An installation certificate is required to be posted at the bading site or made available for all appropriate iaspecdoas• CThe
information provided on this form is required; however, use of this farm ia.pnovidc the information is opdoaaL) After
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).
JiVAC SYSTEMS:
Heating Egutpmerr7
Equip. do( Efficiency Do= Dun or Howns Kcasatg
Typa (pkg. CEC Ccrtificd Mfr Name Identical (AFUE, etc•)' Locadoes Piping l.Oad Cspa=r
heat pS11") and MOdcl NumW SvsI mf_ RGf•IRY91ue1 (aesle. etc.) R -Yalu.; (Htu/hr1 (E uhr1
Cooling Equiplrsent
Equip. CEC Ccrtificd Compressor y of Ef6cicacy Duu Cooling Cooling
Type (Dk3. Unit ,'vifr Name and Idcnrlcal . (SEEFZ an J' Location Duct Load Capwit•
heal pymc)i Model Number�r_u RCF -IR Valve) (900. etc-! Rw-aluc 0�s ) (BUM
1. > reads greater than or equal to
1. the undersigned, verify that equipmesu listed above is: 1) is the actual equipment installed, 2) equivalent to or more
efficient than 4't3t specified in the certificate of compliance (Form CF -1R) subtnimed for, compliance wfth the Enerv-
Efficienev Stondardr for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (from the Appliance E,lrciatry Regulations or Part 6), where applicable. -
Ignature, Date
WATER FiEATMG SYSTEMS:
Distribution 1f Ractr-
Hcrner CEC Ccrtificd Mfr Type (Std. cvlarlort.
Type Namu & Model Number Point -of --Ute) Control TY
Installing Sub=mczw (Co.Name)
OR General Contractor (Co. Name) OR Owner
sof Raul' Tank EM-
Extomal
Identical Input (kW Volume ciancy' , Standby'
:;Lwlation
Sysu" or Bmlhr) (allons) W, RE) Los/s.I16`
R-Waluc'
..'Z C5 m
2 For small gas storage (rated inpm orlcss than or equal to 75,000 Bnghr). ekcuie reAstatsee and beat pomp .•ager haters` I)u Energy Faczor.
For large gas storage wattr heartrs (razed input of peaw than 75.000 BbAv). Ilu Recovery Encianey, Standby Ion and Ruud Input.
For Irutahmacvus �,3s water heaters. tilt Racovery Efficiency sod Rated Input.
3. R-12 external insul : ,icn is mandatory for storage wrmer heatars with an asugy fsezor of )as than
FUMS & Shower Heads-
All
eadsAll faucets and s}:„ w erheads installed are certified to the Commission, punuaat to TitJc 24, Part 6, Section l 11.
1, the undersitr:d, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to
or more efci-:t: dean that specified in the certificate of compliance (Form CF -IR) suWnimd for compliance with the
Energ), F,fici, ;cy SYandmds for residenrial buildings; and 3) equipment that meets or exceeds the apprvpmte
requiremen4 f manufactumd devices (from the Appllarn;e Effuiency Regulariorts or Patz 6), where applicable.
JD Mechanical, Inc.
Signamrc, Dz,. Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPY TO: Bui. ':ng Department
HEP. , Provider (if applicable)
Bui!.:: 1g Owner at Occupancy
_ July 1, 1999
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:
Use Classification: SINGLE FAMILY DWELLING
80-688 SPANISH BAY
Bldg. Permit No.: .0008-272
Occupancy Group: R-3 'Type of 'Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES
Tem
Building Official
Address: 2280 WARDLOW CIR, STE 15
City: CORONA, CA., 91720
By: GARY HARTMAN
Date: 12/27/01
POST IN A CONSPICUOUS PLACE