0007-204 (SFD)LICENSED CONTRACTOR DECLARATION
l.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 forrP and affart
License # Lic. Class Exp. Date
♦r 1:416 ° Bc��l/zc.
6/ate '%]t Signature of Contractor
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 to self -insure fo.r 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:
CartierPolicy No.
001,6EN i�A.OLF,' INS. f NWC-144068.02 .
(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
G'ode, I s�all forthwith comply with those provisions �!
.Applicant �i �Ir ys�R� A
Warning: Failure to -secure Workers' Compensation coverage iss'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 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
the above-mentioned property for inspection purposes. _
(/Signature (Owner/Agent) �V/ r Date// "
PERMIT #
BUILDING PERMIT 7
DATE VALUATION LOT 00Q7+. TRACT
$183,943.00 z i 846.3
JOB SITE APN
ADDRESS `T y� a fern tin
' Nw.2Sl(i1.�f4_s.CS's.%cbitV Qc , 775-�Yeii6^ )04
OWNER [CONTRACTOR) / EN INEER
COATI iky CPOWELL CC1vi4R/Ii:rA` .I ,. 6 CM URY C.ROVALL COR+.C1vIiJMT.S
1585 80.'V MR= t31R 4200 1535 30,"D" 11M'ETa MR #200
3M BXWARD TO C,A 92406. IMN' BMNARDWO ; CA. 9?AO8
. (90)381 -6007 CBLO 21120
USE OF PERMIT
SWOL E, 2T.A2r LY T7WELLI2+ G
3FI34 1'.52 1'I,AN:2A PERMIT DOPS WOT INCLUDE S.LOCK-WALLS OR
POOL,. -750A PLAN C,H.i3OK F� RED UCTf0N FOR MV,UIPLF. IS8UANM OF
SAME PLAN T`1P&
CUSTOM CONSTRUCTION 2.204.00 8F
PiiFWP,g TIO
174.00 SF
CiAit,AWCARPORT (8F) 9,9,?7 v
EWMAURRD COST 01P CsCa1� SMUCr'k'.1:ON
183,94 3.00
�� p
PERM1W S13MA4A►RY
CONSTRUCT -ON FEE
101-000.418-000
$933.50
PLAN CHECK FOR
101-000-439-316
$18917
MECHANICAL FTtE
101.000.421.000
$66.50
ELECTRICAL PUZ
101-000-4.20-000
$1z0.'7t;
C11
C s
f t t
PLUMBI140 FEE"
101=000.419.000
$160.00
STRONQ MOTION PER - RSSID
101-000-241-000
$18,34
GRADING FU
101.000-42.4.000
$20.00.
D L.'1TCLOPER IMPACT NZLr
$1,90?.00
-�»
_Z1
:3L1 B-1 AL♦ C0N:liR'E3C.`+n.0N• .AND FLAW CHEX.,1C $3,414,14
1X59 PR IPAW FM $0,00
Mf ERMT 1) DUE LOW $3,414.74
RECEIPT I DATE I BYr / (� I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framingp/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
o l
Drywall - Int. Lath
7-W'
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
I I
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
OC
Gas Test
/
Appliances
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
Final
Utility Notice (Perm)
I
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 #: 2A Phase: 3
Lot No.: 52 Job Address: 54-508 Tanglewood
Ceiling Area: R-38 Blown Insulation Garage Ceiling: Non Access: _
With Living_ Above & Sloping Areas
N:ztc'rior Walls: K-13 Unfaced Batts Overhangs: Access Attic:
With Living Above'
Interior Walls: Between Floor:
Subcontractor.. OJInsulation Co., Inc.
42620 Rio Nedo, Temecula, Ca 92590
Signed oma,
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.
a
t
Aw
4
!Certificate ofoccupan't y
City of La Quinta
Building and Safety Department
1.
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: 54-508 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-204
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: 9/26/01
POST IN A CONSPICUOUS PLACE