0007-193 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury. that I am licensed under provisions of.
.Chalj ter 9 (commencing with Section 7000) of. Division 3 of the Business and
Professionals Code, and my License is in fullforceand effect. .
License # Lic. Class Exp. Date
714188 By. �t0l31I2(
Le re � � 'Signature of Contractor �'' •E� �,: `
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 owneroof 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, OUIZKN KAOLZ TATS, Policy No. NWC444060.02
(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
bject to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply.with those provisions..-
Date: G / '� Applicant
r•
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.
1 Signature .(Owner/Agent) /�1 1` .-4'(f t� i(� Date I/
V o
BUILDING PERMIT -PERMIT"
DATE VALUATION LOT`--' TRACT '
-..21846-:3" -'
JOB SITE
ADDRESS D
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
CEkM1RY CROWEZL. coisow 4dnus
G"�,;WMY Ckawhu L C0MMY:11.+ n
535 SO, '1?' SV =, + r, 5-M. 9200
1335 so, WDII 101,mi .-,1:, UTBI #200
SANXIMN".DIVO CA. 92408
SAS'f 1WA1t: ANO CA, 924-08
(909)381-600 i CZL40 2120
'
USE OF PERMIT
i N' ,U 17AKLY DWRI YF O
SPD.LOTA1 PLAN! IA. PERMIT DOES NOT 1NC1 UDF, BLOCK'►kP'.AIA-3 OR
POc�G
CUSTONt C0NOTRUCTION 7,026,00 Sly
CLARA CARPORT (SF) 10,107.00
MATED C09r OF C 0149MTTCTION
� � 4U� D1l i x O
PERir M SUMMARY
C014STRUCTION 1.02 m000.418.0f10 $881:00
1-11'.--'
PIS 4 CHFZK FEE 101-000,439-318 $710.19
MECHANICAL fiIKF 101-000-421-000 $66.30
�:� ) t"j
EL ,CTRICAL FXC 101-•000-420-000 $114.21
+�
PLLIVIDINOFEE 101-000-419-000 $142.00
S T'RONO MOTION "Z • 1tESID 101-000-241-000 $15.80
GRAD11* 0 FER 1.01. -00.0.421.000 X30,00
DiVE1,0PBIZ IMPACT FES: $1,907.00
FEE DEPOSIT 101-000.439.318 _$500,00
LUSS PRF,-PA,TDPYSS
4300,00
TOTAL. P E .1' 1TES D�, NOW
A*
RECEIPT
DATE
B`Y�
DATE .,FINALED .
I.
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
/ZX
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
y O
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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 APPR VALS
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
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 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 followingT
BUILDING ADDRESS: 54-706 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-193
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
..�—d By: RICHARD K. KIRKLAND
Date: 7/5/01
Building Official
POST IN A CONSPICUOUS PLACE ,