0007-202 (SFD)LICENSED CONTRACTOR DECLARATION
I,hereby affirm under penalty of perjury that I am licensed under provisions of
'66pter 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
7118f�' t3 1.0/3112('
Date h �! �� Signature of Contracto -)�� !
f,Il
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).
O 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:
() Ihave 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 forwhich this
permit is issued. My workers' compensation insurance carrier & policy no: are:
Carrier C10OL`3�1 RAG' LE W. Policy No. N.WC-54406942
(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 provisions.
Date: -1 >%l . Applicant " ��' ` 1 /% % 1 A;e
01� rvti 'r r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the,cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made& each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date..of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of -this City to enter upon
the above-mentioned property for inspection purposes. f
rr . f.n
Signature (Owner/Agent)T/7t-'�� Date 6z9"�t
..,
' PERMIT k
0 _
00—
BUILDING PERMIT --
DATEVALUATION LOT`_TRACT-
_ - c 1846-3
JOB SITE
ADDRESSC-54-TA1 GIZWiiOi1`S.
APN
77_%-0 i (XM
OWNER s
CONTRACTOR /DESIGNERR / EN INFER
CENTM Y CROWZL CO2+�.'1Zf OW
C&TTURY C- OWELL OOMA4LT nus
1535 5L?, °1?" 3TRWrl S'TE, 0200
1535 50. -D' 5'IRM— , 5'M 0,200
SAN BnNARDINO CA• 92408
SAN. BFRNAM)WO CSA 97AO8
(903)381 �60W CUO .2120
,
USE OF PERMIT
S1 -401Z FA*,MY DWML NG
SirD LDT:50 PL. 4,48 PERMIT DOES NOT INCLUDE BL,OC1CWALL-S OR
POOL?$%PLAN CFiWX FES: REDUCTION FOR MUGTiPLE ISSUAiJc;EOP `
SAME PLAN TYPE
CUSTOM COKTRUCTION 2,918100 Sy
PORCHIPATIO 166.00 SIS'
0AfiA31EICARPORT (3F) 0180% 00
E911A7AIND COST +C r CON:v"MUC."A.'1O N
2.31,WO=
:iPF:RW 11TE SUMAIAR i
CONSTRUCTION FRE 101.000.4183 000 $1,101.50
PLAN CHECK P73 101 -CM -439-318 $223,06
MECHANICAL FIX 101--000-421-000 59160
9LXCTR1CA11ir17I; 101-000420-000 $142.13
PLUMBING FRE 101"000.4141,-0ti0 $160.50
STRONCI MOTION FES - RESID 101-000.241-000 $23.15
CIRAi}TAIc'1RE 101p000-423.00Ci 1i2G.w
DEVELOPtR IMPACT RE
ART IN P 91AC PIACI;' RESIL 701-000455-000 370.01
111 CJ
SUB-TO'TAT., CONSTRi3TTOKAND PIAN C`.1:WXK
$3,755.17
LESS PRF PAI)1=5
$0.00
' `O$'E,Te 1+ r A' • - PIT i OW
0; 75 X I
RECEIPT
DATE
B,Yf�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
_
Slab Grade
_ 404
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
lj o
F.A.U.
Framing
Compressor
Insulation
// p/ �pG'
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�22'*Idlg Lr -3�
7
1
Final
Final
BLOCKWALL APPROV LS
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
Gas Test
Appliances
jJ
Final
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)
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 #: 4B Phase: 3
Lot No.: 50 Job Address: 54-544 Tanglewood
Ceiling Area: R-38 Blown Insulation Garage Ceiling: Non Access:
With Living Above & Sloping Areas
Exterlor waus! x-13 Uhtacdd Batts 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.
ficate of Occupancy
of La Quinta
d 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
ollowing:BUILDING ADDRESS: 54-544 TANGLEWOOD
Use Classlf ation: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-202
Occupancy Group: R-3 Type of Construction: VN- Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
Building Official
Address: 1535 S. D STREET, .STE 200
City: SAN BERNARDINO, CA., 92408
By: - DANIEL P. CRAWFORD JR.
Date: 9/10/01
POST IN A CONSPICUOUS PLACE