0010-082 (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
.;,:...
'
Date*�"- �•'-�� Signature of Contractor -41
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 exe7pt under•Section .��•°• - - , B&P.'C"'for thirreason- --",
Date 66 =cam z —Signature of Owner, `.,
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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
SONion 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.l.should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code; I shall forthwith comply;with�those�provisions'.•
Date: �t •"'N 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..Qresult of this applicaton agrees to, & ,shall, indemnity
& 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 inspection purposes. .
Signature' (Owner/Agent) Date
BUILDING PERMIT PERM T#
DATE VALUATION LOT �Q-�_k TRACT
$264 !. �� - 28960
JOB SITE '- v
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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2.260 WM.DLO W CIACAA X3.1`1:,150
1280 WARDMAV (ARCI I, 4%Trm 15F)
CORCi1. A CA 91720
. CORONA CA 91724
(909)F,794000 CR%,fid 5761
USE
�yyOppFPERMIT
-
WAI,,TAq1°OOIiAPPROACJ.x @)P.fV'k:WA,Y 71% FLAN CHECK REDUCTION POP,
MULTIPLE iSSU NCE Or? SA.MZ Y1.AX TYPIR
CUSTOM C0112TRUC1 ION %142.0 OF
PORCHP.A.TIO 434'AM EW
GARA-0EICARIFO ,T (01 13,434.20
dLAMf.Y•V6i.AED 4,06r OF CiJWYM:UMOX
2#4X4. .V
CONVT1' UC x ION P29 141.000.4113.000 si' ou
PLAIN CHECK IV"1 , 1101-000.439-318 $318,29
1 t t1 1�}1C Is 11P 101-000,421-000 $921.00
:K°'11rYCFla'., 101-000-420-00 $176.33
P1.11JURNO FUR, 101 -WO -419-01K) $199.73
STYU)NO MOTION Pr'}„jY ..RF—SID 101-000-241-000 $26..43
43RAD11` O VIF 101,d30t 423.000 $2.00
1•Sdf?'Ff,A'SMAUCx'UA17, S 2'.8".�t' -000-443-342 $1,907.00
ART IM PUBLIC PLACES - RRrJU 701.000-255.000 8160.71.
VUH= WTV, C0N3 � V(_v 10,14' A rt► PLAX C,'HWX
1.17,33Td�S6-PAM MM
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fOMM.-MIMMONDUR NOW
S4,029,41.
RECEIPT
DATEBY�
DATE FINALED
INSPECTOR
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
��/ v9 �
Return Air
Steel
_
Combustion Air
Roof Deck
/�1,si�()(A
Exhaust Fans
O.K. to Wrap
6(
F.A.U. .
Framing v ASuL
_f_3
q/ _ _
Compressor
Insulation�lw
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall _
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Exterior Lath
Drywall - Int. Lath
�7AP
2 ��
—/_Z_/%
Final
1
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
/��3
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/ —
Pool Cover
Sewer Connection
�vl ` 3 Aon _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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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)
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" RPR 30
2001 3 49PM, SGHMID,C0NTRRCT0RS 347-1897
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INSULATION CERTIFICATE
This Is to srtify that insulation has been installed In conformance with the current energy
regulation Dalifomia Administrative Code, Title 24, State of California, in,the building at
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PGA, WEST:T- PHASE 4 —TRACT 28960.
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LOT 63
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CEILING:
TYPE: Fit irglass BATTS' MANUFACTURER: Owens/Coming, THICKNESS: R-38 12"
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TYPE: -Fit' glass BATTS MANUFACTURER: Owens/Coming THICKNESS:.. R-38 12" BLOW
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WALLS:
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TYPE: FI erglass Batts. MANUFACTURER: Owens/Corning THICKNESS:R-13 3 1i2"
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GI VERAL CONTRACTOR; HOMES • LICENSE:
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BY: TITLE:
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SCHMID ISULATION CONTRACTORS, INC. LICENSE 9221517 C -2. -
BY: TITLE: PRODUCTION MANAGER DATE: 04/30101
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INSULATION CERTIFICATE
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This is to c rtify that insulation has been Installed -in conformance with the current energy
regulation, ;allfornla Administrative Code, Title 24, State of California, in the building located; at
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PGA WEST'- PHASE 4 - TRAIT 28960
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LOT 63'',..
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CEILINGS
TYPE: Fibi glass BATTS MANUFACTURER Owens/Corning THICKNESS: R-3812"
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TYPE: Flbo glass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-3812" BLOW
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WALLS:
TYPE: Fib, rglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-13 3112"
GENERAL ;ONTRACTOR: CENTEX HOMES LICENSE #
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BY: TITLE:
SCHMID It SULATION CONTRACTORS, INC. LICENSE #221517 C-2
by: TITLE: .PRODUCTION MANAGER DATE: 04/30141
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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 iBui/ding 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: 80-769 SPANISH BAY
Use Classification: 'SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTEX HOMES
Building Official
Bldg. Permit No.: 0010-082
VN Land Use Zone: RL
Address: 2280 WARDLOW CIRCLE, STE 150
City: CORONA, CA., 91720
By: BILL GORDON
Dater 2/20/02
POST IN A CONSPICUOUS PLACE