0105-052 (SFD)s ► LICENSED CONTRACTOR DECLARATION
I hereby affirm urder 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
6/�l`
ate ,.�- Signature of Contra?;rori Fes.,
-
OWNERBUILDER DECLARATION
'�°- 'i,',-•. .�'. yr
','al',hereby affirm under penalty of perjury that I am exempt from the Contractor's
License`Law for the'following reason:
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 (Secr7044, Business & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting. with licensed
contractors 4o construct the project (Sec. 7044,. Business &` Professionals
Code):
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
1 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:
Cartier 'Policy No.
ZURICH AMWA1C',AN
(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.
Warning: Failure to secure Workers' Compensationco age 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 p 9 r Fee
at
whose request and for whose benefit work is performed under or put
any permit issued as a result of this applicaton agrees to, & shall, iif
& hold harmless the City of La Quinta, its officers, agents and em .
2. Any permit issued as a result of this application becomes nulla f
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to can ellatio
I certify that I have read this application and state that the above infor ation is
correct. I agree. to comply with all City, and State laws relating to the
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature•:, Daft�i d7
te
(Owner"/Agen +�°
t
BUILDING. PERMIT PERMIT#
DATE VALUATION LOT ��� -'�' YTRACT
1.48.40 r_~9 r' 2IS9oil0
JOB SITE ' -
ADDRESS �e—tw-
APN 3 �Q
"J75-1)31
clynt�e@t� �r� A y1 q� p'
If 0-M F'Yxsi.Y.MSUHd�.A; t'7
�a� �!
-M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ti.•A�at`l' .[.BIB d'J� 67+6A - - - - -
PP1 pp�t��•�� y•'��tpp Yys�• y�, P�Q•t���
•e�,,�,�I�. 1L9•�L;�,��y.�_-
01MIM 71 �6u�. i?�.JMM .
22T0 b1VM. A yW IUMIX, SlurrE 150
2280 WARDLOW CMC.'T 7, WME 150
CORMA C�,, 01720
CORONA Cts 01720
(909);094000 CWN 5761
USE OF PERMIT
SFD ,;1.. T ;9' PLPN 30L d t'iERM1 P. DOM' NOT INCLU LIZ BLOCK la ALi
1}ooL oR I?Rmimew APPItOA,C i. *% PjAH Ctirm REDUCTION fk)k
tayT3lt;E'ltt'L 'ISIMA,NIM OF 111AMV, PLAN 'P"'r1iZ
CI.tSTOM G: iNalf R.8 e ION .11,215.00 OF
PORCH/PA M0 535AN SP
iLAWCARP018X
R747MAUD Con, or C`.7ssTX.'i7'Cnos
2M,J48.80
CONSTR DC•t1014 FEE 101-00-416-000 $1,224.40
PLAN CH1£ "IC 1Yf,1: $2%93
MECHANH '. FEt 101-000-421-000 3118.00
ELECTRICAL PEE 101-•000-420.000 $174.79
P6UMI1.DIO 1;ys 101.000.419-000 $1"150
STRO1+6C# MOTION 1112, .M10 101-000-741.-000 $26.61
01RADINO MY, 101.000.423.100 MAO
1HVRAVrli.UC1'iJRZ FEE 2215.000-441•342 $.1,907.00
AFS 1"r3 PUB1,4C PIAZW - MRSIC 701.000-.955-000 $165.3?
O IX, CONMWTC 1TON AND PLAN CH0,M
$4,OQA.20.
LESS PRE -PAID FEES
$0100
MAY 7.0 2001 h•
TOTAL 11MMI" (UMS DIM NOV'V
� �1➢
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE..:—
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
_ _
Underground Ducts
Forms & Footings_/
to / jf p /
Ducts
_
Slab Grade 6l��6�
_
�,� , _ _
Retum Air
Steel
Roof Deck
_ _
9�
Combustion Air
Exhaust Fans
O.K. to Wrap
_(j
l6 - ��
F.A.U.
Framing�
Insulation
���9( Afh
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
3 2��� �l(1.
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
/X
_ 3l_I� (
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
��/���
Encapsulation
Gas Piping
Gas Test
—
Appliances
r,
j Final
i COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
N
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles,
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
37��d
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 at
PGA WEST, PHASE 5, TRACT 28960, LA QUINTA 6
LOT 9
CEILINGS:
TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW o
WALLS: .
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS:R-13 3 1/2"
GENERAL CONTRACTOR: CENTEX HOMES LICENSE:
BY: TITLE: S
e �
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2 s
• 'a
BY: ~—_G� TITLE: PRODUCTION MANAGER DATE: 02/12/2002
...................
INSULATION CERTIFICATE x
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 9
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: ITLE: PRODUCTION MANAGER DATE: 02/12/2002
j
Certificate pf..Occupancy o��
Cit -of La Qdin' ta
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: 80-880 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of'Construction: VN
Owner of Building: CENTEX HOMES
Building Official
Bldg. Permit No.: 0105-052
Land Use Zone: RL
Address: 2280 WARDLOW CIRCLE, STE 150
City: CORONA, CA., 91720
By: BILL GORDON
Date: 3/21/02
POST IN A CONSPICUOUS PLACE