0007-192 (SFD)r= LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty ofeperjury, that I am licensed under proyisions:.of
1'= Chapter 9 (commencing with Section 7000) •of Division 3 o the Business and
04 LLLJ . Professionals Code, and my License is in full force and effect.
c -j =) ch License # Lic. Class Exp. Date
'714188 B 10 3112.(
�jDate Signature of Contractor?'"<f+ ✓!°.���
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 carrier & policy no. are:
Carrier (9OI,.IaEN k'AC1,U INS, Policy No. NWC-$44068-02
(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
suect to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply with those provisions.` �.
Date: T�`¢'— Applicant '1 A'
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 a ove-mentioned propeerty�ffo�jr inspection purposes.
jIgnature (Owner/Agent) Date
PERMIT#
` �?00
R it BUILDING PERMIT
% ^
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS U13"
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CM1MY CRi?ti MJ1 COMNT(N1'1W
CENTURY CROyJI EI.J:. coji "= DFA
1535 SQ. "I)° S`T'R ?,T, S`1.E 02301
1535 SQ, "U° 3TF rT, STJT— 4200
SAN LM�NARDINO CA 92408
SAW BERMAi(DINO CA. 92408
.(9091381-6007 CRL6 21.20.
-
USE OF PERMIT
SWOLE �lT �p T��c�f f 1:c •� *,qli
s3l,av OLE F'aiaV�.f.�t.r7 Dl�.s.,�.�l.�d.ltl1.7
5i D-Lt3T:40 P'LAN:3A• ruk UGIT. nOMV NOT INCLUDE SLOC:IC'4tJ'.A'LLS OR
P *11
CUSTOM CONSTRUCTION %398.000F
PORCHVATIO 104,00 SF
CA,!(AWCARPORT (SP) 11,093.60
r
y -w x4-
F911M7XD COYr Or, C0X6r1RVC'I101T'L
op � 6045,00
PXPjJWff FU &1334MARY
L!..!
CONSTRUCTION FU 1031.000-4-18.000 1.00.00
� .•. �� ` � '
PLAN 0-1ECK FEE 101.006.439-318 $807.31
rri kJ
MECHANICAL FEE 101-00("21-w $9100
UA,ECTRIC'ALIn= 101-000-420-000 31a8:"i�
ate-
PLUME FHQFEE, 101-000-419.000 $163.301
;iTRONCI MOTION FEZ • SITS 101-00-0-241.000 $20.03
CH"D O FER 101 •(1010-423.000 $20.00
DEVFJ VPr.R IMPACT FE $1,907.00
ART IN PUBLIC" PLACES •.11WIL 701-000.255.000 S.96
FRE DEPOSIT 1 Q1 QOQ-439-318 4500.00
rte-:
S' M-T.TWA.L, CC` N81'xRWAON AFa'`D FLAW CHECK
$4,1 X7.45
LESS PRE-11ATD kTiRS
4500.00
RECEIPT DATE DATE FINALED INSPECTOR
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Z _
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
LT
I
Final I.
Final
Af k
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
Q7
Encapsulation
Gas Piping
Gas Test
Appliances
(JJ
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
17
Final
Utility Notice (Perm)
Cerfificate'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 #: 3A Phase: 3
Lot No.: 40 Job_Address: 54-724 Tanglewood.?
Ceiling Area: R-38 Blown Insulation Garage Ceiling: Non Access:
With Living Above & Sloping Areas
Exterior Walls: R-13 Unfaced Batts
Overhangs: Access Attic:
With Living Above
Interior Walls:
Between Floor:
Subcontractor.. OJ Insulation Co., Inc.
2620 Rio Nedo, Temecula, Ca 92590
Signed / �n
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.
ncy
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: 54-724 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0007-192
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
Building Official
City: SAN BERNARDINO
• By: DANIEL P. CRAWFORD JR.
Date: 5/30/01
POST IN A CONSPICUOUS PLACE