0007-199 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
X4 H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C'r . W Professionals Code, and my License is in full force and effect.
T�AD m License # Lic. Class Exp. Date.
7;1�1s
Date f�P ✓) / J �5 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 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 0OLDgN EA(jL$ INS, Policy No. 139dC.54d063•t!2
(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 Applicant `) 0 <f ,0
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and.afforney's fees.
IMPORTANT Application is hereby made to the Director of Building and.Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose„behalf this applicationis made & each person at
whose request and for whose benefit work. is performed under or pursuant -to
any permit issued as a result'of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null.and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to .comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
th above-mentioned property,.; r inspection purposes. t X.
Signature (Owner/Agent). • % l `L �-J Date
PERMIT#
BUILDING PE..�RMITVALUATION
DATE oT. TRACT
_<�'
Iry
Wp'T 6•�0= I� �l' ' - 21W-3 3
JOB SITE
APN
ADDRESS 013-.�Y
775- �
OWNER
CONTRACTOR/ / EN (NEER
dWi'. TMY CIROWML Cammmwm
Cmm.I y, crzo .ELL lrOI►hMYJmms
1535 30. V MM -i, 917, 0200
1535 SO 'Do S E -7f, E^ E, 0-200
SAID BEMARUINO CA 92408'
SM BMATRL7l13.O CA. 92405
(909)391-6007 Cly 2120
USE OF PERMIT
sou,13'Al.0,Y i?'V6T£.5.._.WG
311).LOt.,47 PI.driNA&- 1'i?1,'MIT I).OES 140T INCLUDE 11LOC:KWA113 OR.
F001.1511a T'I" CHECK FFEE AMUCaTiON FOR I -SOU NCE or, 3AmE PLA.w
TYPE.
CUSTOM CONSTRUCTION 2,918.00 aF
PORCFI/PA:PIO 166.00 SF
GARAC)FICA.IRPORT (SF) 9,300.00
V`"I1 a1,I'EA CQST OF' CO.I`t'9'FRtraJa(.2N
232,30.00
P3?RW ° FE" SiT$MARY
CONSTRUCTION FIE 1014M-4184000 $t,i11.30
PLA14 CHECK MEE 101 -;1C}0 -d39 -31p $222.06
MECHANICAL FEE 101-000.421-000 $92.00
i;I:11CTRICAL, FEZ . 101-000-420-000 $142.13
PLUMBING FEAR 1101-000-419-000 $168,:50
r ,}
STRONQ MOTION nen • RESID 101-000--241-000 $23.15
� 71
OR&D1NO FRE 1.01r000-421-000- $20.00
c, ;
DEVELOPER IMPACT FFA
ART PUBLIC PLACES - RF.911+.701-0012"255-000 M, Ki
N
.IN
SXJB-TOTAL, CO14S`T .D''CTIO I II.ND ; LAR C�1'!. X
15. 1 -1
LESS PRE -PAID ITERS
JVTAL I ��"131u4.T1!W DUE Y40W
� s
!RECEIPT
r
I
DATE
r'
BY
DATE FINALED
INSPECTOR
ra
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I d
Underground Ducts
Forms 8 Footings Oi
Ducts
Slab Grade
s
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
p
Drywall - Int. Lath A
.
Final
Final IPOOLS
BLOCKWALL APPROVALS
- 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
A
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
C
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
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 M 4A Phase: 3
Lot No.: 47 Job Address: 54-598 Tanglewood
Ceiling Area: R-38 Blown Insulation
Exterior Walls: R-13 Unfaced Batts
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Interior Walls:
Subcontractor.. OJ Insulation Co., Inc.
42620 Rio Nedo, Temecula, Ca 92590
Signed
Tom Berry, General Manager- Temecula Branch
Non Access: _
& Sloping Areas
Access Attic:
Between Floor:
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.
r
Certificate of-Oc.cupancy
City of La Quinta
Building and Safety Department
i
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:, 54-598 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-199
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: 8/29/01
POST IN A CONSPICUOUS PLACE