0007-205 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.1 amilicensed under provision�s�of ��
Chapter 9 (commencing with Section 7000) of Division 3"6f the Business and
Professionals Code, and my License is in full force and effect. -
Lice se # Lic. Class Exp. Date
7,1,4188 B
ate—) f-'"RK,f ))• Signature of Contractor `
_i
OWNER -BUILDER DECLARATION
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).
( ) 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 tb 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 GOLFDE7)q BA(jLg T139. Policy No. "C441065-02
(This section need not be completed if the permit valuation is for $100.00 or less):
(-)rlycertify 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
ubject to the, workers' compensation provisions of Section 3700 of the Labor
Code, .I shall forthwith comply -with those provisions.
1 Date:. Applicant --Y'. ,/tia'� J J >_-if
Warning,, FaiIure,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 ade 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 person at
whose request and for whose benefit work is performed under or pursuant 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 employees.
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 of .such
permit, or cessation of Work for 180 days will subject permit to cancellation.
I:certify,that I have read this application and state that the above information 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
he above-mentioned property for inspection purposes.
Signature (Owner/Agent) - % -Yt Date
BUILDING PERMIT PERM'
DATE VALUATION LOT -- TRACT -
Vi 4 0FL`0 - 22t�4f•3
JOB SITE
ADDRESSTQ2 L J �?TJ :
APN
-775-OW-(M
OWNER
CONTRACTOR DESIGN INEER
CENTURY C'Ttl'))WELL C:Cfmh%iAi n' r4al
C ItT"rmy CROWELL COAdMU'ta: rfES
1$35 80.'De `ux . . BILI f400
153500, °IY 111R=- MZ2. 0200
BA14 %: RNARDIN'O CA 92408
SAN BERN A&i?190 CA 92408
(909)387.6007 .' CB1h 2120
USE OF PERMIT
�[LJC$ WA2�LY I7d,1"pYC�
- ,
S1rD-W'r;53 1 14A1 AA PERMIT ODES NCYI t14CLUDS =)CfOVALLS OR.
P004 75% PLAN CHW.K PER REDUCTION FOR MULTIPIA ISSUANCE OF
SAME PLAN TYPE.
CONSTRUCTION 2.318100 8F
]CUSTOM
PCJRC:H/PAT10 166.10 MA•r
0A1I.AGEIC:ARPORT (317) 9, 00.00
LPS1VV1AT9D COV t`OF.O!)NSYRDM, 017
' PERMFr ' 'R g[TIdi;CAieAiE Y
CONSTRUCTION -FEE 101.000-418-000 $1.101.50
PLAN CHECK. FEE 101-000-439-31,8 $222,06
MECHANICAI,1)F...1+ 101,000.421.000 $92,00
TSLECfRICALFEE 101-0 0-420-000 $142.13
4 �'
PL.UMB'1NO PER 101-000-419.1000 $160.54
STRO NO MOTIO11 FEE • RESID 101-000-241-•000 $23.15
ORADING P ' 101-000.423.000 $20,00
DEVELOPER IMPACT 1rEE $1,907,00
� :• 3s .,
ART IN PUBLIC PLACES - RPSII+ 701-000-2$5-000
4►3 rB-T'Osr`AT,, C'ONSTR.U=014 AND PIAN CBROZ
LESS PRE -PATIO FEW
$0.00
'I'CirY'AL 2'ERMU MS DUE NOW
$3,75t5.17
RECEIPT
DATE
BY`! ,�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings 17,0AU2,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
/
Compressor
Insulation/
d/
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 _%
BLOCKWALL APPROVALS
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
/
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
Q(
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Sirvice
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) f
COMMENTS:
Certificate of Insulation
Your Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed
for today's safety standards and tomorrow's energy requirements.
Fiberglass is inorganic and therefore permanently noncombustible, so it does not have to be treated
with fire -retardant chemicals that will likely lose their effectiveness over time. It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: Tournament Collection Tract: Plan #: 4A Phase: 3
Lot No.: 53 Job Address: 54-490 Tanglewood
Ceiling Area: R-38 Blown Insulation Garage Ceiling: Non Access:
With Living Above & Sloping Areas
Exterior Wails! R-13 Unfaced Naffs
Overhangs: Access Attic:
With Living Above
Interior Walls: Between Floor:
Subcontractor.. OJ Insulation Co., Inc.
42620 Rio Nedo, Temecula, Ca 92590
Signed
Tom Berry, General Manager- Temecula Branch
R- means resistance to heat flow. The higher the R- value, the greater the insulating power.
Ask your builder for the fact sheet on R- values. Keep this certificate with your other
valued papers. If you ever sell this home, this certificate should be passed on to the buyer.
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: 54-490 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-205
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM Address: 1535 S. D STREET, STE #200
Building Official
City: SAN BERNARDINO, CA.,' 92408
By: DANIEL P. CRAWFORD JR.
Date: 9/27/01
POST IN A CONSPICUOUS PLACE