0007-201 (SFD)LICENSED CONTRACTOR DECLARATION
khereby affirm under penalty of perjury that I am licensed under provisions of
Zhapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect, - -
License
p y# p o (yLic. Class Exp. Date ryr
✓Date ���� 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).. '
( ) 1, 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
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 U<9L.T3ikd 1L ou nos. Policy No. "C°-594068-02..
(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
Code, I shall'forthwith comply with those provisions.
Date: 3."� i�XT7APPlicant / -'e1 . t ` 11..`<
// :f� w a ...7
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. ]r t
�gnature (Owner/Anent)`�s'✓� Date /i""���r`
1 a BUILDING PERMIT PERMIT#
DATE VALUATION LOT O TRACT
21 �4fy3
JOB SITE
ADDRESS'i®Q��
APN
OWNER
CONTRACTOR/ / EN INEER
Ci?Ldi'UIt'Y CRi3�+Tl�.d.. CC1lIo13�dl�Al�'Cfl
C�F2`i`L°C%R,' CROW-ILLC'U1C1N1i7
1535 SO. -U- 9TCRE> , MY, 0200
1535 SO, "Do TTM, -r, STX #200
SAMBIMNARDIWO CA 92409
SAM BE"ARDINO CA 92.408
(900j381-60.07. CSL4 2120
USE OF PERMIT
SD;GLE FAbMY DWE) ,jLWG
SPD -LOT A9 PLAN.2fl- Pir.RMIT DOES NOT INCL.UDX SL.00IC'f:`IALLS OR.
110OL75% PLAN CHECK F ER REDUCTION FOR MULTIPLE ISSUANCE OF
SAME FLAN TYPE
CUSTOM CONSTRUCTIOW 2,393.0Q OF
PORCH/PAT10 194.00 Sia
0ARA091CARPOR.T
r -a
D COST CF:'' C,00STI2ii011011
� 2��45.00 .
y� gy+g �ESr&IAI'.i
PERA/ T M 9UBdKA . Z
CONSTRUCTION FEE 101.000.418-000 $933,50
j,=
PL AW CHECK FES $I o-57
N
MECHANICAL. FFX-
PLKCTRICAL MIX 101.000-420.000 $120.73
PLUMBING FEE l€i1.000-419-ON $160.00
C } Y
ST'R.ONQ MOTION EEE - RF. ID 101-000-241-000 $1109
^ � � i ; ('�j
C1F.ADWO f� E 101.000,425-000 320.00
� -w
DEVELOPER IMPACT YZE
SM -TOTAL COMSTRTICTION AND PLAN CI1FCK
$3,414.74
1 T_A-T, rrIM F-EK0 DIRE 70
4
93.414J4
RECEIPT
DATE
BY
W/.
DATE FINALED
INSPECTOR
INSPECTION RECORD
� OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
9— as
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
/
F.A.U.
Framing
Insulation
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
BLOCKWALL OV APPRLS
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
D
Appliances
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 #: 2B Phase: 3
Lot No.: 49 Job Address: 54-562 Tanglewood
Ceiling Area: R-38 Blown Insulation
Exterior Walloi R 13 Unfaeod Batte
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Non Access:
& Sloping Areas
Access Attic:
Interior Walls: Between Floor:
Subcontractor.. OJ Insulation 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.
11
Certificate. of Occupancy,
City of La Q uin'ta
�.
-andSafetY DepartmenBuilding�^�
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 foflowing-.
BUILDING ADDRESS: 54-562 TANGLEWOOD
F 7 -
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-201'
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.
Date: 9/19/01
Building Official
POST IN A CONSPICUOUS PLACE