0008-270 (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
754094 AP FRO _ � 03/.31/2(
aI
DateSignature 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 propdrty, 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 Signaturd, 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, 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
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:
Carter Policy No.
EURiC H-AMEJUCAN WC$321Q9 -B3
(This section need not be completed if the permit valuation is for $100.00 or less).
-- () I"certifythat 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 ssoall forthwith comply w. ith-those,provisions.
Date: a %• _11 - Applicant
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.
A
2. ny 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 pro a for.inspection.purposes.
Signature (Owner/Agent) " R - -- Date a- "?-t -(
BUILDING PERMIT, PERMIT#
DATE �, EVALUATION LOT,
TRACT
i lsllda"Ui689ft{3
JOBfSITE � - -
APN
ADDRESS
.755 -.X -O..
OWNER
CONTRACTOR/DESIGNER/EN INFER
C ATTER ROM
C I'EX HOS
2.280 WARDLOW CIRCIA BUHR 150
22-RCi WARDLM CWd7.&; BUDDE 150
CORONA CA 91720
CO€tONA,
C.A.
91720
(904)2794000
CPU
5761
USE OF PERMIT
M1GIY- l JO&L Y DVJMS:Or O
SIPD-IDT16 P1,.AN 2AL -PERMIT DOLS ]dOT.INC1..U09 BLOCKWALL OR
POOL,
CUSTOM CONSTRUCTION 2,9'73.00 3F
{
T?Ci'RCH7PA'. 10 340.00 SIS
CtARAC3FW ARPORT j;SPj 12,731>.dG
FMWATA f`OFr OF COIISMU='(. N
` `
s 24118,',3146.30'
CONST13"L101014 PEE 101-000.418.000 $1,161.00
PLAN CI' WK TEE 101--000-435E-318 $956.92
±�2
MEC1lANICAL FEE 101.000.421.-000 $111:30
ELP.0 'MICAL IEE 101-000-420-000 $169.58
PLUM1 INO FEE 101.000.419.000 $199,75
STRONG MOTION ffEE • REsib 101-000-241-000 $24.83
O RADrNO FEl? 101-000-4234000
t---..
IAiIrRA:;7 Rlldi`I1RLP 1+EL? 22S -00t? -443-3d2 $);907.00
� 9 j
ART .11H PUBLIC PLAO, - RESIE 701.000.255.000
Rd9
"•�
91118 SOTAL CWgrRUCI TION AND PLAN C1WFCK
34,6 i 0.85
eS PRr.-PAID FE
$:0,00
TOTAL PZ&HY TIM DUE NOW
S4,670AM
RECEIPT
DATE
BYDATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings `�
j$
Ducts
Slab Grade
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
DDwall - Int. Lath
p
Final
Final / — /� d
BLOC KWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
A
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:
i
SEP 26
2001.8:30AM SCHMID-CONTRACTORS 760 34,71897
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- 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 at
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PGA WEST/SPANISH BAY - PHASE 3 -TRACY 26960
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CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Coming THICKNESS: R-3812"•BLO,W
MANUFACTURER: Owens/Corning, THICKNESS:' R-38 12"
TYPE: Fiberglass BAITS M
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TYPE: Fiberglass Batts - MANUFACTURER: Owens/Corning THICKNESS:R-13 3 112"
LICENSE:
GENERAL CONTRACTOR:' CENTER HOMES � _
BY: _ TITLE'
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INC. LICENSE 0221517 C-2
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SCHiUIID'INSULATION•CONiRACTORS,
TITLE; PRODUCTION MANAGER DATE: 09;26/01
BY
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INSULATION CERTIFICATE Y
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This is to certify that insulation has been installed in conformance with the current energy
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regulation, California Adminlstrative Code, Title 24, State of California, in the building located at
PGA WEST/SPI1NISH BAY -PHASE 3 TRACT 26660 '
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LOT' 16
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TYPE: Fiberglass BAITS MANUFACTURER, Owens/corning, THICKNESS: R-3812" BLOW
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Fiberglass BATTS MANUFACTURER: Owens/Coming THICKNESS: R-38 1Z'
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s"TYPE:
.' WAL �•r
THICKNESS: R-13 8112"
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TYPE: Fiberglass Batts Owens1Goming .
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yMANUFA6TUR'ER:
NILkAL CONTRACTOR: HOMES LICENSE #
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GE ,CENTEX
BY: TITLE:
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SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
' ' r`y�" TITLE: PRODUCTION MANAGER DATE: 09126/01
BY: .
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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: 80-754 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008-270
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: BILL GORDON
Date: 1/25/02
POST IN A CONSPICUOUS PLACE