0007-196 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C ,%ipter 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
71,4188rk3. :3
�J > 4 �.10131f2(
ate`�V 2 Signature of Contractor f ' r
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:
O 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:
CarrierPolicy No.
f7p1,D11N i?:AOL,? TNS. NWC444068.02
(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: �I> Applicant �"• ►�� * d AV
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. , iT
Signature (Owner/Agent) .l• n�5� f � r /.'--� Date, F�2 Y;�5
rz
7- ""BUILDING PERMIT PERM!Tq��-I---
DATE _ VALUATION LOT TRACT
4431X40M (K4: 21846.3
JOB SITE T �y_yy
ADDRESS (�-62 + iFL3'V0oj)7
A?.
ry 4� [�f 1
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CE:NMY CROWEL L C010A%INUMS .
CENTURY C4ROWELL ("ONO Afffirw,
1535 SO. *D" NR: ', S"TTE, 02.00
1535 30, "D° =M, ,M 4340
S.kW BERNARDINO CA, 924,08
SAN BEIMAR INO CA 92408
(909),381.6007 :. C811 2.120
'
USE OF PERMIT
MOIX, FAM 9,Y DV1ELLWG
,
SFID-LOT:44 P.LANAB PERMITbOES 140T 1NCWDE 13LOCKWAL S OR
POOL. •,
CUSTOM CONSTRUCTION 2,813.00 SI?
PORC"AT10 166.00 SP
0AF'.A RICIA)1.POFtT (OF) 9,800.00
IESi AIND COST!' OF C 0149iTi UC TON
231., .IX)
PR19Mff 11W. 811WWARV
C014STRUCTIOIJ FEE 101-000.418.000 $!,101.50
t
PL1{N:CHFICK FEE 101-000-439.,318
MECHANICAL FEE 101.000.421-000 392.00
X Tf,C'.TR1CA.L PEE 101-000-42.0000 $1422.13
T'1.U3dT8TA10 1MIE. 101.000.419'000 5163,50
cv C) C)
STRONG MOTION FEE ; RL91D 101-000-241.000 $23.15
OkADING FER 101.000 421-Q04 $20.00
�.
... .
DEVELOPM IMPACT FEE
.ART IN PUBLIC PLACES - MOK 701.000-255000 M183
FEES DEPOSIT 101-®QO-d3�J-31 S •$730.00
-`"
3-T0TAI, C0.N9'-1RLTC,t1`0N AND PLAkT CIMCK
$4,42114
LES PRR-PAM FM
4750.00
7TOTAL PLIU MT `, EXS DUE NOW
671, 4
RECEIPTDATE
BY�� f
DATE FINALED
INSPECTOR
INSPECTION RECORD
It OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
D -
F.A.U.
Framing
Compressor
Insulation
b
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
p
Drywall - Int. Lath
All
/
Final
Final
POOLS - SPAS
Steel
BLOCKWALL APPROVAL
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
jjQ
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
G Q/
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 #: 4B Phase: 3
Lot No:: 44 Job Address: $4-652 Tanglewood
Ceiling Area: R-38 Blown Insulation
L+'zterior Walls: R-13 Unfaced Batts
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 er-��----�
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 wiih your other
valued papers. If you ever sell this home, this certificate should be passed on to the buyer.
11 \9
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:
Use Classification: SINGLE FAMILY DWELLING
54-652 TANGLEWOOD
Bldg. Permit No.: 0007-196
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: 8/28/01
POST IN A CONSPICUOUS PLACE