0010-084 (SFD)r,LICENSED CONTRACTOR DECLARATION
'.I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter'.9'(c6mmencing 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
f R es ?4 „ .,44. �x�.:., e ..�,,l�• X6/31/2(
Date !w' "` Signature of Contractor"j
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&RC. 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.
y I have and will maintain workers' compensation insurance, as required by
Se�tion 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 Secllob„3700 of the Labor
Code, I shall f rthwith comply: with -th'o'se provisions.`,
Date: 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 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.
Y
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 Drposes.
Si nature (Owner/Anent) " w Date'`•
h
BUILDING PERMIT PERMT#
DATE VALUATION' LOT CVS 104M4 TRACT
JOB SITE '
APN
ADDRESS
OWNER
CONCONTRACTORDESIGNER /ENGINEER
MIM ygq
MMYL Holm
2280idtYIMT);,,OW C9karA'M= 150
2280Wdlkl�t ,0V1 CmCLE, surm 150
C."ORiONA C.A. 91720
CORONA 917.20
(.`°IUB)2794000 Ca ', �,761-
USE OF PERMIT
Si?l;> 55 PLAN 4C1:*PMMIT WES 140T %flea UDE
WA.,3W00U.kVPR•0ACF1 0KNAY - 75041. PLAN CHl�.tX s'8EDUC:'!'3ON POR
1C.4tF1..,SPLY, iSS:4T.d+►LCE OF S&NIR PLAN TYPE
CTSTOM CONSTRUCTION TION 30412/00 0F.
lF ORCHUP.AM0 4$4,00 3F
0AIRAOFIC. PORT (OF) 1%4?x,80
MWATED CWT OF C0.'49IRMION
264,2
AITAI %i Fps suet'
CONSIRUCTION FUR It)]K0'gJ• 1 O(10 Sl,.�]7,�i1
MEC" HAN10AL P`ER 101-000-421-000 $92.00
,FJ,VC:'k"ilJ'r..A,L.F8F. 101-fJ�2s'J-d t2 -t df� $!'�6.u3
P1 ali �S. M-10 NU?, _ 101-1000,419-000 S I M
f2L3t Cf MOTION 8 'F', r Ffi:UL9 101.0.00-241-000 116.43
C1i3ATai 40 FF,.:` I01 -(MO -423-000 910.€ 0
Nkt'R.t9MLICT'f.HBtF.ppv.00
ART 114 PUBLIC PIJAWEX - RUN. 701.000.255.000 TOM
0
SMD-2'O:i:AL., CONWRTH MON AND FPLvWC.11 CIC
$4,047.41
1E W PR K -RAL) ;FEES
$0.00
TOT'S, PERM $rk7gr DW HOS'
��'?S(d IVI
RECEIPT
DATE
BY " V�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forme& Footings
_
/ .�-
Underground Ducts
Ducts
Slab Grade
_ _
/2 ���
Return Air
Steel
!
Combustion Air
Roof Deck
/Q�
Exhaust Fans i.
O.K. to Wrap/p�
Framing
_ _ _ _
I
?�� 9�pr
s
F.A.U.
Compressor
Insulation
_//3 p/ �oF
Vents
Fireplace P.L.
i
Grills
Fireplace T.O.
`
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
nt. Lath _ _
Alk/�� -i � f�!_ -
Final
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
r��3�tjf�—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
/a�3�(fjj
Encapsulation
Gas Piping
Gas Test
Appliances
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)
4
RPR ,30 2001_ 3 51PM SCHMID CONTRt3CTGR'S 347=1897 p.12
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INSULATI9N CERTIFICATE
This is b certify that insulation has been Installed in conformance with the current energy
reg ulatio ; California Administrative Code, Title 24, State of Callfomla, in the building, at
PGA WEST PHASE 4 — TRACT 28960
LOT 65.
CEILINC 3:
TYPE: F _)erglass BAITS MANUFACTURER: Owens/Coming THICKNESS: R-38 12
TYPE: F )erglass BATTS' MANUFACTURER: Owens/Coming THICKNESS: R-38 12" BLOW `
'WALLS:
TYPE: I berglass Batts MANUFACTURER: Owens/Corning ' . THICKNESS:R-13 3 112"
C =NERAL CONTRACTOR: CENTEX HOMES LICENSE:
BY: TITLE:
SCHMIC INSULATION CONTRACTORS; INC. LICENSE #221517 C-2
BY: TITLE: PRODUCTION MANAGER DATE: 04130101
ChIYItG%YYIiMIRYJiCi]i1'MiWfX!/ 4:N.�.MmSA�'NGd�:I.lYtln,li'.C//M1Y�M'✓12WW30Kfi/1XV.fAtL1GWMx(f'J/�.IFN.N/i0ib'A/44�2•�i"11.tW.4%'rX!(IAM.e:eN.,%AG•AtY�r•�".Al'20M'/l/fCY,TAUTYI�ONO.']!".//JCaibYRC
>:2H2. �.
�wY.14Y.1d]?41%QSI,49/m LSWG 4.Of CYdrfOtffW'STAY/•N.N"✓.i[41Gi0P.9ItIA1'MFS.faSVY�%W!t'I:SY•H`:ANC3IfVAG/CfiWS:ISprvAi:Ti-ti]Y.�.1YST�. n'Yhtrmr/sY..'r://sl9b'•elfvdYaYl.LTiSe;1/fWnT�.s'/NI.W.elti:i�'•ii:ufG]Y..'Y,?iT�USN✓✓. /•aL1
INSULATION CERTIFICATE
. �
I
This is to ertify that insulation has been installed in conformance with the current energy
regulation- Califomia Administrative Code, Title 24, State of California, in the building located at
PGA WEST = PHASE 4,— TRACT 28960,
LOT 65
CEI_ LING;
t
TYPE: Fit erglass BATTS MANUFACTURER: Owens/Corning . THICKNESS: R-38 12"
TYPE: Fit ;rglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-3312" BLOWN
WALL
TYPE: Fi ,erglass Batts MANUFACTURER: OwenslComing THICKNESS: R-13 3 1/2":
GENERAL CONTRACTOR: CENTEX HOMES LICENSE#
a
BY: TITLE:
SCHMID I `ISULATION CONTRACTORS, INC. LICENSE #221517 C-2
BY: TITLE: PRODUCTION MANAGER . 'DATE: 04/30/01
;i
...c:ws� riloer�.vsrevi.1: .uwce:s^iromw �wxl.v.-ri+r.,csa . rrr seowI.,auvius:Ivxa,salu�,.v rw�.vc:ia,ssrt�.rwrirwar.:airav_Y.rs�":a<+n,azvri..unw:�e�i .ernM•,as:v ra ir.•r..i,em+�+r.+ � '
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'regu/ating building construction or use. For the following:
BUILDING ADDRESS: 80-805 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No:': 0010-084
Occupancy Group: R-3 Type of Construction:- VN Land Use Zone: RL
Owner of Building: CENTEX HOMES
I
! d�
Building Official
Address: 2280 WARDLOW CIRCLE, STE 150
City: CORONA, CA., 91720
By: GARY HARTMAN
Date: 11/7/01
POST IN A CONSPICUOUS PLACE