0112-052 (SFD)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. s
License # Lic. Class Exp. Date
AD INC
/ Date ? ' �' ctrl Signature of Contractor
OWNER -BUILDER DECLARATION I
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law fo0he 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).
( ) 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
Se6tion 3700 of'the Labor Code, for the performance of the work for which this
armit is issued! My workers' compensation insurance carrier & policy no. are:
Cartier 'et7'EC'k1 Ff��r1IC 1'cl Policy No. �C$3A6-U3
(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 riot 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 proions,
'Date: . IfyfctE APPlicarite"
Warning: Failure to secure Workers' Compensation coverages unlawful and
shall subject.an employer to criminal penalties and civil fines up to4100,000, 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 personat
whose request and for whose benefit work is performed under or pursyant,to
any"permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employetLr,'l
2. Any permit issued as a result of this application becomes null and voic�i,
work is not commenced within 180 days from date. of issuance of so,
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information s
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
the,aC6ve-mentioned property for inspection purposes. 5
4 p
Signature (Owner/Agent) %G��` s ^� s ��`� Date V2,,
s L ?
BUILDING PERMIT PERMIT //
fj3.2 d
DATE VALUATION LOT TRACT
A ?4/, 28960
JOB SITE f _
ADDRESS�g ilAP'pia!�p
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
aE: NIZE"T. Ht„'OM -W.—AM)Um.)WE IV01
b
IT Habaz
2280INAKAOtV 0718- 'SLE ai�.l E 150
22130 `J�MI)LOW CMC Lt Sul:Ty. 'I 5(y
CORONA CA 91720
CORONA CA w 120
5761
USE OF PERMIT r.i�^•.. e--
SIM • Y E IT ri PLAN PAS . PERMIT . OES ?tai' INC;t i. DE SLOCK WALLS,
COOTOM COPdMtt CTION ZF
RO.+#'iCWIf'"ATICD 535.00 Sly
t'1.Ei 4LAMC:ARPORT 680.00 BF
XMWA L+D C019T 010 Cr01r RUCITO i
258827220
CONSTRUCTION FU 101-000-418-000 $1,190.00
PLAN C HWX FEE 101-€00-4 9419 3974.3I
M'GiMMICA-L VR 7101 -COO-- 21-000 S d 104JQi
;P.:11WIT ICAL ISE 101.000 -420 -WO
PLIUMBINO MT&I 101 -000 -419 -OW $186150
STR.tdttOMOTI+ON FFA, RESID 101-00-241-000 $23,83
ORADWO RE 101.-000-423-000 $20,09
3NI<'lsASTRC%Ci URR FLr•39 225N0.00-443•342 sn,9Q7.0ii
-ARS' IN P>< BL IC' FLAG - RESIL 270-000-445-000 ,-Ci00 $141"
co.,1 I;3°4-Rui om AtXD mm CM4`K
$4,146,48
1. LESS SS PE -PAR) FEW
$0.00
7!'OTi1L B'Ti :ff Xr' 9 DW NOW
x,746>48
DEC 13 2001
Cj 1,7
^
RECEIPT
DATE r,''
BY
L�� �J
NSPECT
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings Qdfj�/%
�� _ aQ�10
Underground Ducts
Ducts
A1—
Return Air
'
Slab Grade
3 S
Steel
Roof Deck
O.K. to Wrap
_
7 —19 _ _
c�L per,
Combustion Air
Exhaust Fans
F.A.U.
� —
-
Framing
Insulation
6% _
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 _
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
Waste Lines2�/��
_
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral/
Sewer Connection
��%9�01. r7�D�Q%/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
t_
Final
/—�
COMMENTS:
Final
— — -—
/
111t;
UtilityNotice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
A
Sub Panels
Exterior Receptacles
�—
G.F.I. l— -
Smoke Detectors ef
Temp. Use of Power
Final
/
Utility Notice (Perm)
4V W
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06!20/2013 21:31 FAX QJ003
INSULATION CERTIFICATE
a
This is to certify that insulation has been installed in conformance with the current er•ergy
regulation, California Administrative Code, Title 24, State of California, in the building at
80-949 Spanish Bay, LotF73, La Quinta, California .
CEILINGS:
TYPE: BLOW MANUFACTURER: Certairfeed THICKNESS: R-38
WALLS:
TYPE BAT TS MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: CENTEX HOMES LICENSE#:
BY,'TITLE:
PARAGON SCHMID BUILDING PRODUCT`, a MASCO Company LICENSE #221517
BY: TI; -LE: AOMINISTRIJATIVE ASSISTANT DAT'E:'8113102
...,. ... •r.,u . ;.n uYY:/•:�-iM::. ,••N•:t. •:4 .!' Y:ry v v v r n nr . : .> .. .. .. ..
:.,.. .. .'. :.e F /.s: :y.N,.•1':'r.J::r.,':yN»^:,, ...,%. a-.y'•:i.-:�.Y :v.. •.- :".:•.r .. . .- i ,i . .
INSULA'iION 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
80-933 Spanish Bay, Lot 72, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: F-38
WALLS:
TYPE: i3ATTS MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: CENTEX 140MES LICEtdSf� #
BY: rITLE:
PARAGON SCHMID BUILDING PRODUCTS., a MASCO Company LICENSE #221517
r
BT;_._—••-•-----.- •.TITLE: ADMINISTRATIVE ASSISTANT DATE: 8/13/G2
8