0010-077 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm.under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing witfi 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
awl
Datei,'_Signature of Contractors�K{
�a»✓� .o, ....
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).
( ) .1 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
Sepetion 3700 of the Labor Code, for the performance of the work for which this
OW!it is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
.�'�IRi:�i�-a4��:F.iCdr�P3 i�t�S;12��3��•C+ii
(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 shaforthwith cornplywith`those provisions.,,/�M
Date: l` 1 f:' Applicant—
Warning:
pplicant ,� s> y
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, 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_ p,roperty..for_inspection,,purposes.
L
Signature (Owner/Agent) "' 3" r-•- Date"
BUILDING PERMIT PERM T#
DATE VALUATIONLOT ►�i �TY _ TRACT „
,? 29960
JOB SITE `
APN t
ADDRESS
T-604108 ffFAMX"AY
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'1`E-71. ie3 l S
ICY, 11"a'w Homa
220 wAP.Dww fM' cu, aurin? 1511
2280 NVARDLOW CIRCIA.?, 9KIMe 150
CORONA CAA 517.20
CORONA CA 91720
...
(909)279.4000 MI d? . 5761
USE OF PERMIT
:iVD401' 1.4 N.: f#.5�.3AR,->a.Ml I T DOES'N4 r rN CLULTE ..
1
CUSTOM CONSTRUCTION 3215.01 OF
PO11wCkdB&'!af1'!'1Ct 535.00 SW
AMICARi'ORT (OF) 9,5940
XeST01M C OIST C?.I:�' ("P.M..i1fILYC.'HOW
C01148TRUC,"1'iC0I pla 101 -OW -4 3 8.000 $1,224.00
PLAN CHIeC:K ME 101-00".39-31.9 s d, o?,.n
101-00 0-421-000 S118,00
BLEC. RIG AL FUT, 101-M-424-000
JPLUMBI'Mo FEF 101.000.419-000 S1 S.Sr3.
SM0140 i.110TION 'F'EE RMID 1101-/lt) ��tly.n4l3f
t-(p
�1p0-2ND moti1�'3
A'.RA! R10WIt: R4it.°6P cg "Obi7x141� A�V.yt�
"IN"MMUCTUTt3?.1' E 225-000-443-342 $i,�lU'1.f10
A.1 IN PUBLIC: PIACES - Rp.,g1, : 701 _G00.255_00f) W45 37
SUB- OTAL 'CON UC'T1CiW AND PL.AW CI^.DMK,
SP4,63-7.00
L + 3 MrPAM PM
sn CSU
RECEIPT
DATE
BYf�%��
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_
��/ �f _�
Ducts
Return Air
Steel
i
Combustion Air
Roof Deck�p
{ Exhaust Fans
O.K. to Wrap _ -X
_ �� '
F.A.U.
Framing ���
_ �y
. Compressor
Insulation
(o�Z _
t Vents
Fireplace P.L.
Grills
Fireplace T.O.
0,Fans
& Controls
Party Wall Insulation
; Condensate Lines
Party Wall Firewall
Exterior Lath
D all - Int. Lath
'
Final8
_
Final
POOLS - SPAS
BLOCKWALL APPROVAL=S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
j Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines&MOV-0
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Z�3
Pool Cover
Encapsulation
Gas Piping
Gas Test
�v/D/ q—Z
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
I
Final
Utility Notice (Perm)
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Q : INSULATION CERTIFICATE'
This Is.to certify that insulation has been installed In conformance with the current energy, a
regulation; California Administrative Code, Title 24, State of California, in the building -located at
PGA WEST @ SPANISH BAY.- PHASE 1 - TRACT 28960 , 3
r LOT 13 t e
CEILINGS:
,
TYPE:' Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-3812" BLOW
WALLS: m a
TYPE: Fiberglass Batts -MANUFACTURER: Owens/Corning' - THICKNESS: R-13 3 112 j
GENERAL CONTRACTOR: CENTER HDMES LICENSE !#
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SCHMID INSULATION CONTRACTORS; INC.' LICENSE#221517'
BY: r - TITLE: PRODUCTION MANAGER DATE: 09/21101 4- ?
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• INSULATION CERTIFICATE
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This to certify that insulation has been installed. ih conformance with the cunt energy
' regulation; California Administrative Code, Title 24, State of California, in the building at-
t
PGA
PGA WEST•A SPANISH BAY - PHASE 4'- TRACT 28960
LOT-111� y
CEILINGS: x
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R=3812" BLOW
h
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TYP,E;Fiberglass Batts •MANUFACTURER: Owens/Corning THICKNESS:R-13 3.112"
' GENERAL CONTRACTOR: C_ ENTEX HOME^ • LICENSE:
BY: TITLE:'
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SCHMID INSU LATION,CONTRACTORS, INC. LICENSE #221517 C-2
BY: TITLE: PRODUCTION MANAGER DATE: 03121/01
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Q : INSULATION CERTIFICATE'
This Is.to certify that insulation has been installed In conformance with the current energy, a
regulation; California Administrative Code, Title 24, State of California, in the building -located at
PGA WEST @ SPANISH BAY.- PHASE 1 - TRACT 28960 , 3
r LOT 13 t e
CEILINGS:
,
TYPE:' Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-3812" BLOW
WALLS: m a
TYPE: Fiberglass Batts -MANUFACTURER: Owens/Corning' - THICKNESS: R-13 3 112 j
GENERAL CONTRACTOR: CENTER HDMES LICENSE !#
e BY: TITLE: -
z `
SCHMID INSULATION CONTRACTORS; INC.' LICENSE#221517'
BY: r - TITLE: PRODUCTION MANAGER DATE: 09/21101 4- ?
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- . lv Certificto ofOccupanP- --�-
a y Od
City of La. Quinta
Building -and Safety Department
r 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: 80-808 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING - Bldg. Permit No.: 0010-077
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150
City: CORONA, CA., 91720
--�"d By: DANIEL P. CRAWFORD JR.
Date: 9/28/01
Building Official
POST IN -A CONSPICUOUS PLACE