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0007-195 (SFD)LICENSED CONTRACTOR DECLARATION hhereby 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 effPrt. License # Lic. Class Exp: Date 7141€ � _ 10/'31fZC, Dater %Y Signature of Contractor 'yE7 '- 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 carrieP & policy no. are' Carrier C1oI.F E1J.isAOL IIiS, Policy No. NV�C'•S44AuR-02' (This section need not be completed if the permit valuation is for $100.00 or less). O 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 :V bject to the workers' compensation provisions of Section 3700 of the Labor ode, I shall forthwith comply with those provisions. Date:7�f/�"lr Applicant �Y /77 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 andvoid 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 /thabove-mentioned propertyfor inspection purposes.nature (Owner/Agent)y� ✓''e Dater ?dd -00 BUILDING PERMIT PERMI(T'## DATE VALUATION2�,g LOT—"""""�'j'�` TRACT - 183,943:9) L44 t 21846='3 JOB SITE ADDRESSres ray OP C§ 67Y APN [� / J q?z OWNER CONTRACTOR / DESIGNER / EN (NEER CIIdTUI2.Y CR01j LL COIOAM= MIMMY CRO WELL G4MWtUMS 1535 30. '.Do Wlt=, STS. 0200 1535 $0, Do arRwy, .7m. 420!3 SART BF"ARDWO CA 9Z408 SAN REMARDINO CA 92408 (909):98i-6007. C13Lf4' 2120 . USE OF PERMIT SMOLL I AMIL:Y DVALUNG G VD-LUr.43 PLAN;2fl PERMIT DOES NOT INCLUDE SLOCKWALLS OR P001„ 7VA PLAN :,HECK FEE MUCTION FOR TIME-13OUANCE OF SAME: ' PLAN TYPE. CUSTOM CONSTRUCTION 2,204.00 OF PORCH/PATIO 1.74.00 SIR OARAGEMARPORT (SfJ 9,937.20 F.:A.774 COW OT CONS1R.MT10M 163,M,0119 CONSTIIUCTIO14 FEE 101-000-418r,000 031." , • a PLAN CHECK FEE 101-000-439 31 €S -Ti MECHANICAL FEE 101.000-42,1-000 $66 so ELECTRICAL FRE 101-000-420-000 $1A9.78 PLUMBING IEEE 101.000-419.000 $169,00 STRON10 MOTION FEE - RESID 101-000-241-000 $10.34 ORADINO ISLE 101.000 423'-000 $20,00 DMILOPER IMPACT FEE $1,90700 SUB-TOTAT- COD1d 1 -UCTIO14 AND Pi._M CBFCX $3,414.74 IMS M.PAII? MW $0.00 W, TIAL 1 '_ U FEE -5 D7_% 14OW $3..414,74 RECEIPT DATE By DATE FINALED INSPECTOR r 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 p pZj 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 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 Pool Cover Sewer Connection X.42%42 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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) M 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.: 43 Job Address:.54=670,T-anglewood_ Ceiling Area: R-38 Blown Insulation Garage Ceiling: Non Access: With Living Above & Sloping Areas 1✓atel iui Walls: R=13 Uufaeed Batts Overhangs: Access Attic: With Living Above Interior Walls: Subcontractor.. OJ Insulation Co., Inc. 42620 Rio Nedo, Temecula, Ca 92590 Signed crv- - Tom Berry, General Manager- Temecula Branch 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. :: . : '4 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: 54-670 TANGLEWOOD Use Classification:, SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-195 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: RICHARD K. KIRKLAND Date: 7/5/01 Building Official POST IN A CONSPICUOUS PLACE Certificate -of Occupancy O f La*QuintaCit oy .. �� w4 � tis Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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=670 TANGLEWOOD Use- Classification:- SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-195 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: RICHARD K. KIRKLAND Date: 7/5/01 Building Official POST IN A CONSPICUOUS PLACE 13 =■