0007-194 (SFD)LICENSED CONTRACTOR DECLARATION
'!thereby 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 I I -
License # Lic. Class Exp. Date
114188 B -~dry �
VDate �f" fF'7Signature of Contractor ff `,; �r �•1 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: b
( ) 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 peridlty.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:
Carrier Policy No.
�ioLDls't11�',01,]s rias; rrwG.544068-02
(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
6de,.l shall forthwith comply with those. provisions.
��.
ate: ')
f - e:s, Applicant x 't Ii4�', � - ..s.•
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 forWhose 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
theabove-mentioned property for inspection purposes.
/
$/Signature (Owner/Agent l /: ,��`L �i Date
�. BUILDING PERMIT PERM'�s�'��;
DATE VALUATION LOT TRACT .
$1 94 -
JOB SITEyg
ADDRESS -FAN '4..LKWO:OD
A,.PPNN
/ C24fo C/ /
OWNER
CONTRACTOR/GENOINFER
C1rk 1R_Y ltVVMI; iVJMCryS
MUM CROg.L/MAxVV1s
1535 80. MA MRM, UIR 9200
1535 SC?, 9)0 MMMT, ffm 0200
SAU BM ARDINO CA 92408
SM 3Eik: NARDINO CA 92408
(909)381.6007 c1 vi 2120
USE OF PERMIT
SWQTLE FAMLY Det 3.. G-
5170-LOTAQ PLAN. -2A- PERMIT 170n NOT INCLUDE OLOC1t;U1i'ALLS CFTC
PODL.
CUSTOM CONSTRUCTION 2,204.00 OF
PORCHIPATIO 11X00 SP
e� a
GAR AO +UCARPORT (SF) 9,93710
r ;
C:
,
r
ESMAAT.W COST OF CONgrRUClION
j ' � _ .00
CONSTRUCTION F% 101.000a41$;-000 $933.$0
�� f
PLAN Ci3Lr.C;K TWEE 101-00"39-:31$ 034.27
WCHA ICAL FTA 101-000.421-000 $66.80
►'i t, i
--1
1;1L=TRICALMr. 10 -00"20-000
PTIUMBYHO 14 101=000.419-000 8t6fl,00
STliONO MOTION 1 SE s )MID 101•-000-241-000..
O ADI O FFE 101.000-423.000 SX00
DEVELOPER 11A P AC r FEE $1,907.00
DEPOSIT '. 101-000.439-313 $SQtI.E!J
SUB-TOTAI, COl`TMLtMO AND PLAH 0,11 MR.
$3,930.44
I.3U 4 PRS-PAMA9.9
RM0,00
TO7J['A—f _rmw ms DUE 140W
A480
e
rf
RECEIPTDATE
B
r
DATE FINALED
INSPECTOR
r
0',
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ,f-
Ducts
Slab Grade
/
Return Air
Steel
Combustion Air
Roof Deck
a Z Oa
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing v
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
o!
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
I 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
D!
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) 4L
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.: 42 5(6bAddress:-54=688Tangglewood
Ceiling Area: R-38 Blown Insulation
Exterior Walls: Ii -13 Unfaccd Datts
Garage Ceiling: . x
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 c�•--�►
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.
Cee rtificate 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, r
certifying that, at the time of issuance,: this structure was in compliance with the various ordinances t
of the City regulating building construction or use. For the following;
BUILDING ADDRESS: 54-688 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-194
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
F City:' SAN BERNARDINO
•.t�,,� By: DANIEL P. CRAWFORD JR.
Date: 5/30/01
Building Official
POST INA CONSPICUOUS. PLACE