0007-198 (SFD)LICENSED CONTRACTOR DECLARATION
;: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. bate
14188 8 f, 10/31/2(
Date f -h Signature of Contractor,7r ta' J�1
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:
() 1• 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 C't01.I7RIq LAOL8 INS, Policy No. MMC -544048-02
(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
ode, I shall forthwith comply with those provisions. �'
Date: '"7 > Applicant..., lhj' r / dl^ fr I
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. '
�,rtn
I'gnature (Owner/Agent), 1��7/a0`f;I Date
, ,
O �BUILDING PERMIT PERMIT"( -1
DATE VALUATION LOT L..::.��_• TRACT
(4� �11 21846.3
JOB SITE
ADDRESS-��1,�Q�1�D
APN
OWNER
CONTRACTOR/ DESIGNER / EN INFER
CErJTM Y CRQWELL co)am4n,ms
CFATUR Y CROWFU CONOAUNITES
1535 301 °D° MMUR. M20U
1535 so, V M'.CCW, ��"'1'.L. #200
UnNAR:L° INO CA 92408
l3At+l' 131aiAARGT1 O CA 92408
(909)381-60M CBIX 2120
USE OF PERMIT
A
STN Ga FSA .Y DWIRLING
SPD-L,OTA6 PLAN 2.A PM, -MIT DOES NOT INCLUDE BLAGKWALLS OR
F�L� 751AKM CHFZK .FEF; REDUCTION FOR iSSLIA,N(°C OF NAMIV PLAN
TYPE
CUSTOM CONSTRUCTION 2,204,00 3F
PORCHIPATIO 174.00 SF
OARACIFlCARPO.RT (SF) 9,937,20
J'Sm"T3� CQ Cly= Ci)' t17'C;nC.In
183,94.
:E ER,Affr Ti KE StIMMARY
CONSTRUCTION M 101-000-418.000
PLAN CHUCK M171 101.000-439-318 $.158.57
MECHANICAL FEE 101,-000-421.P000 $66.50
r>>
ELUCT.IUC.AL, FZE 101-000-420-0010
F'I..UMBI3NOiER 101.000-419.000
STROM NOTION FEL . R.ESID 101-000-241-000 $18 59
�" , �� • `J
QRAb%I4i FEE 101-00M23-000..�.�
C
DE ELOPER IMPACT FEE $1,907.00
�'r"I Tr7
baa
SUB -TOTAL COAf;i`I'RUC;`.CTC114 .AND X" CHECK
$3,414.74
I.SB PRE -PAID :ice
WOO
TOTAL i'F.121-+T PKES DUE 19C}W
$31414.74
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
Steel
T
Return Air
Combustion Air
Roof DeckExhaust
_
Fans
O.K to Wrap
F.A.U.
Framing
/
Compressor
Insulation
Vents
Fireplace P.g.'
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
0
Drywall - Int. Lath
/
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Gas Test
( p
Appliances
Final
COMMENTS:
"
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Onderground 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 #: 2A Phase: 3
Lot No.: 46 Job Address: 54-616 Tanglewood
Ceiling Area: R-38 Blown Insulation
Exterior Walls: R-13 Unfaced DMs
Signed
Garage Ceiling:
With Living Above
Over hangs:
With Living Above
Interior Walls:
Subcontractor.. OJInsulation Co., Inc.
42620 Rio Nedo, Temecula, Ca 92590
Tom Berry, General Manager- Temecula Branch
Non Access:
& Sloping Areas
Accem Attiei
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.
Elm
Certificate of Occupancy
City of La Quinta ���
Building and 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 ADDRESS: 54-616 TANGLEWOOD
Use,Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-198
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: 7/31/01
Building Official
r
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