0105-054 (SFD)f LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F Chapter,9 (commencing with Section 7000)'of Division 3 of the Business and
W;. •• • Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
`.",Date;�+�t Signature of Contractor• ••'""-'N"">►
- OWNER -BUILDER DECLARATION �•�,
i'I'fereby. 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 isnot 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&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
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.
(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 pr vision §.
Date- M d +: Applid'011=--=_!7 -:AZ;) �
Warning: Failure to secure Workers' Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up Yo $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
application., jl
1. Each person upon whose behalf this application is made & each pe c�oJ
whose request and for whose benefit work is performed under or puts o
any permit issued as a result of this applicaton agrees to, & shall, in nify
& hold harmless the City of La.• Quinta, its officers, agents and emp es.
2. Any permit issued as a result of this application becomes null and void if
work isnot commenced within 180 days from date of issuance f such
permit, or cessation of work for 180 days will subject permit to canc Ilation.
I certify that I have read this application and state that the above inform
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 1t!
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT 1 � ,� rTRACT .,
JOB SITE
APN 3 ��
ADDRESS -
[�^�iQ"1� V,f#MIMlDA'11I
OWNER -
CONTRACTOR/DESIGNER/EN INEER
728Q WARDLOW C3 MA WJIT,' 15 0 .
2260'`4. RD OW CTt ME, BUXTE 150
CORONA CA 91720
CORONA a .A 91720
(909)279.4000- CE -14 5761 ;.
USE OF PERMIT
SPiD. LOT I1 jPLAM 30R.. PERNIfY' DOWNCIT INCLUDE OLDCK WAL-14 �
M)L OR DRAWMAY PRL)ACH. 7A PLAN 011949 REDUCTION FOR
PE,
AULTIPL.9ISTU.ANC E OF SAW PLAN TYPE,
CUSTOM CSI STRUCTION 3,21100 SP
PORC&!liPATIO 515.470.sy
0ARAWCARPOPLT (50)
EST', D COST 01,0 COMRDMON
266,148110
0f."1],10 T'RUCTION FEE 101-000-418-000 $1,224.00
PLAN CHEM. FIR 101-000,439-318
MWOMMAL F9Z 101-000-421-000
L!:I Y_CTPJCA,1, 'V9Z 101-000-420-000
PLUMBING M. F 101. 000.419.000 $198150
e.WRONa MR:)MW M a RESI0 101-0000 .2A 1x•000 $Aft,.f 1
f3Ft?iW-90 M, 101-000-423.000 $120.02
IN1yRMTRUCT0RE FRE 223,.000-443-342 $1,90no
T IN PUBLIC PLACES - r IT 01.000-255.000 $165.31
81M. 1 r . ,! comm. 011 LC.lFtl AN133 fO i`M13V We,T.'L[SJ+i .
$4,094.20
MAY 10 2001 XA r' �'� M Fm
T--0,00
TOTAL PERWr PTE01 DEP .i@OW
$4,084.30
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT
DATE;
BY
DATE FINALED
INSPECTOR
,F.
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
r BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings ��
Slab Grade r''
_
/ L
Underground Ducts
j Ducts
I Return Air
Steel
Roof Deck
O.K. to Wrap _
Framing ��(�(
Insulation
_ _
_
��
lu�3_
!Q _�
hJ
Combustion Air
I Exhaust Fans
F.A.U.
I Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
I Farts & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final 3�%8.0_�- _!_GG , .p,2al�l
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
��3t1 p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection�
/�
v, /
Pool Cover
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)
.rii7�i/oYBJJ` iiO/viii 6/ii�i6io QaO60G.�BdiiiY/�pLi/�ii68yOH%di-id.%��17/i/Si6/���BiT/�3�Q6/66ii 8BVBiB6iG6oQiQJo 868g17/LC
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy s
regulation, .California Administrative Code, Title 24, State of California, in the building at
• 8
PGA WEST, PHASE 5, TRACT 28960, LA QUINTA
IOT11 e
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
L 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 11
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,
I Y
oI o5�D��
Ce'dificate of Occupancy
� City of La Quinta
ou
Building -and Safety Department �oFti
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: '80-844 SPANISH BAY
Use Classification: SINGLE FAMILY. DWELLING Bldg. Permit No.: '0105-054
,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
�.•*� By: BILL GORDON
t Date: 3/18/02.
Building Official
POST IN A CONSPICUOUS PLACE
1 .