0010-080 (SFD)LICENSED CONTRACTOR DECLARATION
I, hereby affirm under penalty of perjury that I am licensed under provisions of
thapter 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
�V•`.�Q."�•� ,µ.ms_ �,
Date t�"" �t 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 & Professiorials
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.
I have and will maintain workers' compensation 'insurance, as required by
56 ion 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.
(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 f rthwith comply.with.those-provisions.
Date: • 1 Applicant—
Warning:
pplicant 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 %Ipsult of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Qiuinta; 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 (Owne5Agent) M � ^- Date d— t
•
BUILDING PERMIT ' PERMIT #
DATE VALUATION LOT f(j♦i TRACT
r' .. (" � .•�° i � \ $p'�1�'idS. a A':.�,$�3 G`� 1� �- if•'s�tfJ ..
_
JOB SITE`' .�
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
:MFIHdkO
CNMW HOWES
220 VIARMLOW O2ICAT X, 150
2280VAYPLOW M2V0 150
CA M20
CORONA : CA 51720
("9)2?9.4000 CDO 57611
USE OF PERMIT
MIME FAWLY l;iW: .UW(F
SiY'f_"Ja1.fff b`t PLAN MS,,sPERiP,tiiiT ;CJOES NOT 114CL 3DE
WA.W000OUAPPi'ctrACH D 91 ti,WA'Y - 75%1 IAN M ECK REDUCTfraH 110ft
V.1XL'k'I.Pl.1,13S0ANC1.OF SA -ME VI AN TYPE
CUSTOM CONSTIVOCTION 12M up OF
PORCH,fMV2.Ci 1935.00 SP
43ARA3WCARPORT
:�b"Ml.�d,�`Ft' COST or C°0RMUC Iffon
20,249,20
Ml£3'j`F UCTIOM FFA+ 101.000.418.000 11.,234,00
PLAN f.HWX FEE ` 101-WO•,439-318 $250.93
D11Izt'.11AWIC L "S 101.000.421.OW 3:113100.
aX.e. E "YRIC L PM 161 -WO -420-000 $.1?3.79
PLUIV11 RIO put 101-000-419-000 $198:30
°i I i3>*Iia Oi 1' �1tI 1PEF; n iC1I lig lot -00044141000 $13.61
ORA,DINO MR, 101-000-422-000 00-422.000 U0.00
]7n YR.Mi1`RUCTUR.,F": FEE 1.25-000-44.3-342 $1,W7.01
RT IN PUBLIC 1'LAM RI3>`Ht70'1-OW--2551,000 $165,37
STJWW1"s`•+J1 C.°C�IPT;►�MiTL`TIONi YJ3 PLAN' CREAM"
$4,0?4.20
IMS .PRE PAID IMS
$0.00
RECEIPT
DATE
BY 1!
DATE FINALED
INSPECTOR
V11
t.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs .
Forms & Footings
_
/!
Underground Ducts
Ducts
��
- /
Slab Grade
�
Return Air
Steel
-2
_
Combustion Air
Roof Deck
/�y��
Exhaust Fans
O.K. to Wrap,h/a'`
_
F.A.U.
Framing �,�,tsdl���/
Compressor
Insulation
6j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Dn+wa11- Int. Lath 0.1
Final
/%�7/�
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
/�be�
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure -
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
T. _
--Y
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
i
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)
RPR
30 2001
3 46PM
SCHMID CONTRACTORS
347-1897 ,p.8
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INSULATION CERTIFICATE
This Is to ertify that insulation hes been installed In conformance with the current energy 0
regulation Callfornla Administrative Code, Title 24, State of California, in the building at
y - PGA WEST — PHASE.4 = TRACT 28960
LOT, 61
CEILING:
TYPE: Fit :rglass BATTS MANUFACTURER: OwenslCorning THICKNESS: R-38 12 'a
a TYPE: Fit irglass BATTS MANUFACTURER: Owens/Corning . , THICKNESS: R-38 12" BLOW r
x WALLS:
a ` TYPE: Fi erglass Batts MANUFACTURER: Owens/Corning THiCKNESSA-'13 3 112'..
G!' NERAL CONTRACTOR: CENTEX HOMES L CENSE:
8Y: TITLE: 5 .
SCHMID +ISULATION CONTRACTORS, INC.- ' LICENSE #221517`•' C-2 a
gY�: TITLE: PRODUCTION, MANAGER {'DATE_: 04/30/01
+r.>W?Bag:'divzz�id.'4frf9.s3cvv:P�:uV@•.i:. amaxuOaPrs�.Y.w,O,gr.M"v�i:r �nen6aab»Jdiw,.cw:uxt➢".aftYorzXaGt(I.iD::xCtC.OI.w:a✓,cif+.,✓.'va¢a'Ir6,�6tN�nMert�G;rkwsw.macuma:rar:auww..'arsuavusas9xum0,�.,.FalriYe..a.: v;:,'J/.:eiaY,JG:�:
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' INSULATION CERTIFICATE
This is to c rtify that insulation has been installed In conformance with, the current energy
regulation, ',alifornla Administrative Code, Title 24, State of Califomia', in the building located'at
PGA WEST — PHASE 4 -- TRACT.28960
-LOT 61
a
b CEILINGS
TYPE: Fibi 'glass BAITS MANUFACTURER: Owens/Coming THICKNESS: R-3812"
TYPE: Fib 'glass BAITS . MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW
WALLS: m
TYPE: Fit rglass Batts MANUFACTURER:'Owens/Corning THICKNESS:R-13 31/2" y
GENERAL 33ONTRACTOR: CENTEX HOMES LICENSE # r: -
4 BY: TITLE: _
SCHMID II SULATION CONTRACTORS, INC. r. LICENSE #''6.21517 C-2. ,
B! - TITLE: PRODUCTION MANAGER DATE: 04130101. _
, �G.Y.a.:tv..!Cd•%•eA a'ls:[+,Y.rM:CW,'A'W:i4] Y,!1 �M •siV.NiP:Q�iO•YK'A!:M..OrN �'+fa�hlXr42!'i1t'.%rrN,•9WN•ri.;6`.t!LC>I.'fv1l..'llifni��:9ArYNiV7:1Y.1!!'Edi:�Ylv/•Y.i.:C•JY.tlti:aK:.T.:�Rb9Nl1I.-3AFOlN:l1.G� :fv.a•:N:�'..Lt�N'•.V+ YY.•?f,'G.O,d.4
lo
Certificate-*ofOccupancy'
a�-�
�
Cit ofQuinta.
La
Building.and Safety Department -oF ti
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: 80-733fSPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0010-080
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES
Building Offici
Address: 2280 WARDLOW CIRCLE, STE 150
City: CORONA, CA., 91720
By:` GARY HARTMAN
Date: 1117/01-
POST
1/7/01-
POST IN A CONSPICUOUS PLACE