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0105-060 (SFD)LICENSED CONTRACTOR DECLARATION I hereljy affirm under penalty of perjury that Tam licensed under provisions of "H •' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and c C, b Professionals Code, and my License is in full force and effect. c-� •�,m;, License # Lic. Class Exp. Date io IContra •• V m f v.( Date Signature of ContractolJ "OWNER -BUILDER DECLARATION r 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). ( ) F 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 �//yy�� yy ppyy��,��yi��tt��, Policy No. VIUMCH MYRYli:i'Y67L.d 4 FSP 0�9Jb 1� id .(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 pro r�on Date: iNv.fc?(()i Applicant: �. - . Warning: Failure to secure Workers' Compensation coverage=iskunlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and for a permit subject to the conditions and restrictions set forth dr, I application. 1. Each person upon whose behalf this application is made & each pe whose request and for whose benefit work is performed under or purst at it to any permit issued as a result of this applicaton agrees to, & shall, ind nify & hold harmless the City of La Quinta, its officers, agents and empl gees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance o such permit, or cessation of work for 180 days will subject permit to cance lation. r. I certify that I have read this application and state that the above informs &on Is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ,,. Signature (Owner/Agent. ti�`> Date(f� BUILDING PERMIT PERMIT# •TRACT DATE VALUATION LOT r Iii ;1:960 JOB SITE ADDRESS, APN �0 77$i43*1 Ml OWNER CONTRACTOR/DESIGNER/EN &NEER C Y°I2"3C 0 � CEN'i'Mt.10"W"VSI 1280' AM."):d.,0"M C OQ, OU•MM 1,50 2280 WA.'!L• , W Ui?.CLY, STUIM 150 COR.ONA. CA 91'7247 C:ORONA•. CA 91120 (9119)279.4000 CBLO 3761 USE OF PERMIT SMOI.. 3FD a LOT 70 PLA14 30L PP",�MIT 00Z I= I-NCLUDE BLOCK WA3,4 POOL, OR iJFkiV'1 Agt' APPROACH, 75%.PLAN t:HWX REDUCTION FOR Mil%./.4'IPLF ISSUANCE OF MINA, PIAN TYPP J ' CUSTOM CONSTRUCTION V13.00 SP PORCI(evA,'1 o -35.00 SP GAR.A.1VM,d` RPOR (W) %�W.80 166"'.>MAM) COW OF C7014F'�.�CM-7,100 266,148M) yy y�q(yq�y� y�y, �,7y.�y�,y R .K'.�7�y�FgqP'��S$gV.Y..i.��&yy q�fyy [,9//.��4+p�'e/,yIS�'��i.1�f1.CG�� /�y j�/' �fj y�Q Q�_� {yyj.�(j(� C?�.pNSTIL6�A CTION IME 101-000.415-000 S1,22A.09 PLM CHVfCX FIFE 101 -OW, 439.31.8 $250.93 WCHANIC.&L.FEE 111.000-421-000 S119.01) 91J=RSC.AL FEE 101.000-420--000 41".79 PLUMBING F11 101-000-419-000 1193.50 STRONG MO3ICM YZ - R ID 101-0004W-'000 $26.61 G A.i INO F 101.000-423.000 S20100 110"ST1iUCTUF2RL M. 225-000-4/13-342J $1,90100 ART IN PUSIAC PL.ACSS - W31C 7f11-{IdhY-2.5 4(300 110.37 gfje..T CO1 E'1dU1'9'!'[f.)2v •r!>9D 1'.1; M CIMIC $4,084.20 .. MAY 1 0 2001 j ma P.rm-Yp,,x snm 'I;0TAL MnW14"M36 DITE CITY OF LA OUINTA FINANCE DEPT RECEIPT DATE / / By DATE FINALED INSPECTOR N INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings �D Slab Grade Steel _ Roof Deck 8f� O.K. to Wrap Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath Drywall - Int. Lath Final I BLOCKWALL APPROVALS Set Backs Footings Bond Beam Final OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final POOLS - SPAS Steel Electric Bond Electric PLUMBING APPROVALS Gas Test Electric Final Waste Lines �'l0 s Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Gas Test 1-11101 COMMENTS: I ELECTRICAL APPROVALS Temp. Power Pole T Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice 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 LOT 70 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 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 located at PGA WEST, PHASE 5, TRACT 28960, LA QUINTA LOT 70 CEILINGS: g TYPE: Fiberglass BATTS MANUFACTURER: Owens/Corning THICKNESS: R-38 12" BLOW e WALLS: TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-13 3 1/2 a . e GENERAL CONTRACTOR: CENTEXHOMES LICENSE # _ s BY: TITLE: a SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2 e ' 6 ' S BY: �ITLE: PRODUCTION MANAGER DATE: 02/12/2002 ri�+rt+irvriirirrisiareuieiei�.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 BuildingCode, 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: 80-895 SPANISH BAY Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-060 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 Building Official By:' -BILL GORDON Date: 3/12/02 POST IN A CONSPICUOUS PLACE