0007-200 (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
�}Professi3nals Code, and my License is in full force and effect. -- - _ =
License # Lic. Class Exp. Date
714188, B 10/31/2C
Vote 7/7 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:
( ) 1, 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 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:
CarrierGOLDEN R ° OLU INS,Policy No - 1�d�JG'- 64660•@a�
(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 personin 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
(lode, I shall forthwith comply with those provisions.,
ate: "'J A 97-ia � Applicant
,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.
pplication.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 propertyfor inspection purposes. %
ignature (Owner/Agent)r,',��t1..1�' Date ~r A'•�'t��'
ti F �.
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT= __ TRACT
�+'2t2t1, .(l4D 21846.3
JOB SITEey���y:!�7�C� h
ADDRESS ( IditsSl�.saU. ��/J
APN
17754MM-004
OWNER
CONTRACTOR/DESIGNER/.EN (NEER
CkD3'L'CTR1C CROWM-L COWAUNITM
CENTURY CROWS L, COMMU:nTiT1'I:M
1535 30, 'D° STRI T, STT 4200
1535 30, wDa 5rrRTX*_r, Mme. 4.200
SAT BEEMARDWO CA 92105
Ski r3FRNARDWO CA 92408
(909)381-800'1 CB114 2120
USE OF PERMIT
83 QLU FAWL Y..DWMXW0
SFD.L,OT-.43 PLAN3A PERMIT DOES NOT INCLUDE HLOC KWAU w OR
POOL.75% P1,AN C.HROK IEE RED UC T ICN FOR MULTIPLE INUANOF OF
SAME PLAN TYPE.
CUSTOM CONSTRUCTION W92.00 Sly
PORCHIPATIO 184.00 SP
OAR.AGEICAItk'ORT (SP) 11,093,60
USTVVIA7700 COSI' OF C 0yWRLTC,"P ON
20t A&IS.00
I.VRWr W4 SUMMARY
C01MRUC TION F£,1? 101-000.416-000 $993.00
�_
PLAN CHECK PEE 101-000-439318 $201.33
t
MECHANICAL PEE 101-000.421-000 `9100
ELF',CTRICAL FEE 101-000-420-000 $128.75
r"C-I
Fn
PLUMB1NO FEE 101.000.419.000 $168.50
STR,ONO MOTION FLOP, • RESID 101-000- 41-000 $20.03
OR.AUINCB IRI? 101-000.423-000 $20,00'-
DEVELOPII'R, IMPACT FEE $1,907.00
.ART IN .PUBLIC PLACt�S - R.F81r 701-000.255.000
t
81T&'1 f T AL CON=L MMON .AND ):*J.,,,Alq 0MCI'
1X)9 3 PrM-FAIR F Y-3
$0.00
TOTAL ��_ITM9DOFNOW
$3"1.97
RECEIPT
DATE
B1 / ]
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4
Underground Ducts
Forms & Footings
Ducts
Slab Grade
���
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
4,
Final
Final
BLOCKWALL APPROV . S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
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 Z 72
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 #: 3A Phase: 3
Lot No.: 48 Job Address: 54-580 Tanglewood
Ceiling Area: R-38 Blown Insulation Garage Ceiling:.Non Access: _
With Living Above & Sloping Areas
)Cates lur WHIls: R-13 Unfaced Bun Overhangs: Access Attic: _
With Living Above
Interior Walls:
Between Floor:
Subcontractor.. OJInsulation 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.
11
- Certificate 0'''f-o.ccupancy
City of La Quinta
Building andz Safety De-paKment
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 bui/ding construction or use: For the following.-
BUILDING
ollowing:BUILDING ADDRESS: 54-580 T,ANGLEWOOD
`Use Classification: SINGLE FAMILY DWELLING
. Bldg. Permit No.: 0007-200
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: 9/6/01
Building Official
POST IN A CONSPICUOUS PLACE