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0105-056 (SFD)J w I— WJ Z 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 Y V;�; , YDate'F7�t , Signature of Contractor OWNER -BUILDER DECLARATION I Hereby-affirm•under penalty of perjury that I am exempt from the Contractor's flcense. Law for the following reason: , 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). co () I am exempt under Section , B&P.C. for this reason LO �! 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. (,S,)' 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:. Carrier ' Policy No. • XtIR1Y'9H AI~f RRIC"k)v WC23U606 (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 forthwith comply with those pyo ision Date:'I" AP G 0A Applicant. .n VWarning: Failure to secure, Workers' Compensation co ePage 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 Is application. 1. Each person upon whose behalf this application is made & each p whose request and for whose benefit work is performed under or pur t any permit issued as a result of this applicaton agrees to, & shall, in ni & hold harmless the City of La Quinta, its officers, agents and em ees 2. Any permit issued as a result of this application becomes null an void i work is not commenced within 180 days from date of issuance f such permit, or cessation of work for 180 days will subject permit to cant illation. I certify that I have read this application and state that the above inform ation 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/Agen )j' _ Z 2 t !x; rte Date `5 ! BUILDING PERMIT PERMIT f/ DATE VALUATION LOT TRACT JOB SITE ADDRESS APN d �,�/� �(yy��yyrr�� �y �1, BAY RJW-823 NSJCAMS11.�GY.ff+!'.i. OWNER CONTRACTOR / DESIGNER / EN (NEER CENM HOMES 22,80 WPAIID1,0,iW (7MC-LF, AMZ 150 2260 WARD1, W 150 Wit ONA CA 91,720 CORONA Chi 91720 (909)4479.4000 cst# 5742 USE OF PERMIT MNGL Ydf ,Pl?d7 C SPU a WT 66 P"N 301, - I'ZWI T DOMSNOTWCUIDE RLOt: K WALL. POOL OR Dft1V PWA,`' APPROACH, 7$% PIAN CH ECK. RED CTIOX POR .MiD1,TIPLLMSIVANCF, OF St1MF PLAN TYPF_ CUSTOM CONSTRUCTION 3,215.90 OF PORC I-YP TIO 515.M SF CAR.t1.OW.aA.'I3.POR 1' (20) 1.IBMU":3ED C;OS1' 01t CoOR vMY7C ITON 266,.1480) CONSTRUCTION M 101.0001-416.0601 $1,224,00 PLAN CHSCIi FL- E 101-000-419-318 MAPS M14;CIWITOMNI.,"a 101-,000-421-000 $11.2.60 lad ICTRJCAL fes;?, 101-000-420.000 �l73.'79 PLIUMD0.10 PEX 101-00,0419-000 $193, 30 S,T1Rc;NO NOTION FEE - WISID 101.000-241-000 8W.61 Gwi lxo FRIE 101-000-423.060 920,00 INIVRA 3TRUCT- URE F&I 22.9-O41 I443.342 11,90T'00 ART DT PUBLIC I'1,:s=4,ca - keolc 7011-000.253.000 $155,31 V001 -11T t, C0H3MUCf1'10hf AND PLAIT (51RCK $4,09410 MAY 10 2001 LEW -_.hw mm $0.00 W.LAL PE MAUT 1pus DUE NOW i 44*4 20 CITY OF LA OUINTA FINANCE DEPT RECEIPT DATE DATE FINALED INSPECTOR 144, b INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings! _17 Underground Ducts Ducts Slab Grade _ G �3��y ° Return Air Steel �� Combustion Air Roof Deck _ _ Exhaust Fans O.K. to Wrap _ g_ _ �/ / _ F.A.U. Framing / _ Compressor Insulation �� �� Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation ; Condensate Lines Party Wall Firewall Exterior LI ° Int. D 11 Lath Final, f1 Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Footings _ ����� l Electric Bond 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral /Pool Cover Sewer Connection �D!�©� 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 q p� (Perm) /���! INSULATION CERTIFICATE This is to certify that insulation has been, installed in conformance with the current energy regulation, California Administrative Coe, Title 24, State of California, in the building at PGA WEST, PHASE 5, TRACT 28960, LA QUINTA LOT 66 14 o CEILINGS: a TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW e _ WALLS: 01 TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS:R-13 3 1/2" 0 GENERAL CONTRACTOR: CENTEX HOMES LICENSE: o BY: TITLE: e SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2 'er p BY: TITLE: PRODUCTION MANAGER DATE: 02/12/2002 a 0 e +.i.�v�aric�vsrerrrririrrrririririrsesiririrsirisssairirirsiririririririsireiririaavisenireiriri_+.girrvsiririnvai.�irirriaiririririririririria..�viririsysie 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 located at PGA WEST, PHASE 5, TRACT 28960, LA QUINTA LOT 66 CEILINGS: TYPE: Fiberglass BATTS , MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW WALLS: TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-13 3 1/2" GENERAL CONTRACTOR: CENTEX HOMES LICENSE # BY: TITLE: SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2 BY: TITLE: PRODUCTION MANAGER DATE: 02/12/2002 rrriririririoiw� w riri�rrrrirriori�iririsrisi�rrirrririririririr rir rrrmivwwriri�vrsridiirorrrsrrrrirrdriiirrririri�crriwir•irirrris�irisiririrvrs 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: 80-823 SPANISH BAY Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-056 'Occupancy Group: R-3 Type of Construction. VN Land Use'Zone: RL Owner of Building: CENTEX HOMES Building Official Address: 2280 WARDLOW CIR, STE 150 City: CORONA, CA., 91720 By: BILL GORDON Date: 3/12/02 POST IN A CONSPICUOUS PLACE