0007-203 (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.
License # Lic. Class Exp. Date
7.14 1018
Vate � � —^*� 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 coristruct 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:
Can GOLDEN I AGU 114,9 - Policy No. "C4544063-02
(This section heed 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
tode,_Ifshall forthwith comply with those provisions.
Date: ��J/.r' ai Applicant " .0. .s sl.I
7 r,
Warning:- Failure 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 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 inspec�tion purposes. �l
Signature. (Owner/Agent)' -1' j�E{t
BUILDING PERMIT PERMITN
DATE VALUATION LOT. L---- TRACT
$2()tjri4.t3t1 tS 1� 21846.3
JOB SITE
APN
ADDRESS R, �
OWNER
CONTRACTOR/ / EN (NEER
CE1`1'.t MY CTf OWIM L 1001AMUMMS .
('WMY CRO L COMMUMTM
1535 SO,-Dd.6'ERM, M. 0.200
1335 W. TP M=1 = 02m,-
SJW a'NKM A'E2 WO M 92409
SAN' B IMKI DWO CA 92 408
(909)361.6007 C.1 lit 21:20
USE OF PERMIT
;#INGLE FAYALY IMEiA1 M0
SM LOT:51 PLAN:38 PERMIT DOES NOT INCLUDE BLOC KWAL LS OR
POOii,'i %PIAN CHECK FEE REDUCTION FOR It1UI 1, IPL-911SS iAC'E OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION 2398,00 3F
Pt tR.CWPATIO 1.84.00 SIS
GARAC4I ICAR.POR.T .(S�) 11,093,60
'
ZSIYA IA= COST OF COi7YMUC:TION
2t1�9,345.0(D
s1Ry
CONOTRUCTION FEE 101.000.416-000 6993,00
PIAN CHECK Mrz 101-000-439-310 $d01,8S
MECHANICAL FEE 101-000-421-000 892,00
EL.ECTRICAI, tit 101-000 420-000 $12$.15
PLUMOINCI F - 101.000-419.000 $1611,50
r d
STRO1NC3 MOTION FELE - RMID 101-000-241-000 $20.03
G ADINO FER 101.WQ- 42,3.000 120.00
DEVELOPER IMPACT FILE $1,90 00
�•+ C � � ,�
AIT IN PUBLIC PLACE - RESIL 701.000.255. 100 $46
r
SUB -TOTAL, COAIMT3 MOAT A14D PLAR1' C IMCK
$3,531.97
ums ME -PAM 1 w
$0.00
TOTAL PERMff. S DUE now
RECEIPT
DATE
BY
//,/
DATE FINALED
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
41Combustion
Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
V Ad
Compressor
Insulation
// d/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
0,/
Drywall - Int. Lath
�6 Q
Final
Final
POOLS - SPAS
BLOCKWALL
AP ROVA S
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
VZ40Heater
Final
Water Piping
Plumbing Final
Plumbing Top Out
E=quipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
�>WAI h , ZYJ� 2 D1 ,
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)
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 #: 3B Phase: 3
Lot No.: 51 Job Address: 54-526 Tanglewood
Ceiling Area: R-38 Blown Insulation
Extei lur Walls: R-13 UnNeed Barrs
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Non Access:
& Sloping Areas
Access Attic:
Interior Walls:
Between Floor:
Subcontractor.: W Insulation Co., Inc.
'42620 Rio Nedo, Temeculai Ca 92590
Signed �a.►�----.,
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
B uildinand Safety Department �oF
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 ordinance:
of the City regulating building construction or use. For the following:
J
BUILDING ADDRESS: 54-526 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-203
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
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
-T"
Date: 8/23/01
Building Official
POST IN A CONSPICUOUS PLACE