0105-053 (SFD)`r 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
Pate. Signature of Contractor
OWNER -BUILDER DECLARATION
hlierety.affirm under penalty of perjury that I am exempt from the Contractor's
License Law fdr.the following reason:
( ): 1,'as owner. of the property, or my employees with wages as their sole
comp ensation;'.wijl:do the work, and the structure is not intended or offered.for
sale (Seo.•7044;-BU6iness & Professionals Code).
( ) .1, 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
Suction 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:
Carver 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 visions.
Date: >•le,- Applicant=N fyfi `"A
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 Buil
for a 'permit subject to the conditions and restrictions se on his
application.
1. Each person upon whose behalf this application is made & rson at
whose request and for whose benefit work'is performed unde pur uant to
any permit issued as a result of this applicaton agrees to, & II, in emriifYaY
-& hold harmless the City of La Quinta, its officers, agents a d em Ioyees.
2. Any permit issued as a result of this application becomes ull an void if
work is not commenced within 180 days from date of iss ance of sucblTy I
permit, or cessation of work for 180 days will subject permit cancellation.. FIN
I certify that I have read this application and state that the above infr,rmation is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize rep-resentatives of this City to;enter, upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent xx:*r' „ Date � �tta.i CR
..tl �.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT, 7 TRACT
JOB SITE
ADDRESS t
80-€�62 SPAM51 DAY
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
crarMIX 140,10.8
CIENWX HOMO
32W'WA1W14YW CMC. :, SUITE 1150
2280 WARD.'. 0 0.11,0r.r 'i50
CA, 91920
CORONA 917,20 ;
57,61
USE OF PERMIT
MX0LE.FAb TXY DV&'LM4C.
"W") P {V).' 1a Pl�N aR - PERMIT 1,10='NOT INCI,LtIV, AT.00K W L,
POOL OR DRIVEWAY APPROACH,
CUSTOM Ct.348T RUCTION %M,00 S -ft
d�6�1�.C:T�lPA.'Ti?t) .901).lxilS'Xd
0AWWrYCARPORT(81) 1219S11,d0
X
11;STWA'Ii'lD COST OF C:O.iaS'.!RU(7110N
248,346.:
Y3506'f M SUZdKAR.Y
M OVIT` ICTION FM. 101.000=418-000 $1,101100
pu"N CHECK: FEE 101-0N439-141 S
VI CHMICALVER 101.000.47,1.000 $111.50
BUC'1 MCA.L M 101-000-420.000 $169.58
Pj.UMDI` O e'er, 101-000-419.000 $193.73
STROX1.3 MOTION ME • 1ZESID 101-000.241.-000 $2+4,83
GRAl:AHO{ Y: 101 -WO -A23-000 $2i1, t1
WRASTR13CTURF, YZE - _ 225-0i10-443.734P,� $1,90-00
AP'T rN PUBLIC P.uxw:Mir 70l.000µ256.0 0 311t).fry
�
Y 'TOTAL, 100 RUCT'1:ON AND ;FLAW CF€laCK,.
1 0 2001
IWd , IYEM ' FXV lk��IG?,' NOW
a °�.�a�
F LA OUINTA
WE DEPT
A,
RECEIPT
DATE 1
BY
DATE FINALED
INSPECTOR
1*41 .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs _ Underground Ducts
Forms & Footings 2 �lX Ducts
Slab Grade Return Air
Steel_ Combustion Air
Roof Deck ��� ? Exhaust Fans
O.K. to Wrap �_ / + F.A.U.
_ _
Framing Compressor
Insulation /9 �� Vents
Fireplace P.L. Grills
Fireplace T.O. '•, Fans & Controls
Party Wall Insulation ? Condensate Lines
Party Wall Firewall /,
Exterior Lath ��f' it �% ��� _
Dr wall -Int. Lpt�h /� 2 3
s
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines l �v
Heater Final
_
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection /(fJ�!
Encapsulation
Gas Piping _
Gas Test
Appliances i
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
FinalUtility Notice (Perm)
17
a
U
INSULATION CERTIFICAT VV
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 at
PGA WEST, PHASE 5, TRACT 28960, LA QUINTA
LOT 10
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
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 10
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: oTITLE: PRODUCTION MANAGER DATE: 02/12/2002
r.
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: 80-862 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-053
Occupancy Group: R-3 Type.of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIRCLE, STE 150
-r,-,, /4-v,
Building Official
City: CORONA, CA., 91720
By: BILL GORDON
Date: 3/21/02'
POST IN A CONSPICUOUS PLACE