0106-299 (SFD)rt LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
ik—Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Lloonoo M Lie. 01833 CAP. Diiia.,
Date •.J�i, Signature of Contractor
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 Policy No.
GOLM WRIEIIdS,
(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
Code, I shall forthwith comply with those provisions.
Dater >- // - Applicant
Warning:/Failure o 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.
Signature (Owner/AgeniTI'.�,4 r a Date / /> �f
BUILDING PERMIT PERMTq
TRACT
DATE VALUATION LOT TRACT
21 V46,4
JOB SITE;.' ✓
APN
ADDRESS
54-700 s®.I'��'3��
��k�'-25.1-085
OWNER _ a'
CONTRACTOR / DESIGNER / EN INEER
(IMzi Y C:RCQUIL {"OM+atrMM
e r ply (MOWJ&L 0t)I'1`i`rt.°d
153.5180: a)" STIM nM STRI 9200
I X33 M To STIRL"Or. ST& IP200
,SAN IbFAlIARDINO CA 92408
S REkdNAY,10WO CA 92408
(909psi-600°,1 MIN x,120
USE OF PERMIT
KNx'I'T R. &.4WOC
M'C 1101 FAWLY DwKiL .ING
3-9757 '3 11U CH fil00
SSD - U -)T .79 PLAN 3,R ,= PZRMIT DOES 'NOT 1NC:1,7 rJX 3WC K: VIr"ALL,
11001: OR DRIVI A`#'A.PPROACAC 'M PLAN CHECK M IdMI.r(. T1014
API"; BD Ii''OR MU'L TIPLLY SAME PL,NN TYPE SUBM11"tED.
CUST04M tONS`1°RUC!'ION 2398.00 OF
PORCH/PATIO 194.00 Si"
AI1AWCAPPORT 566.00 SP
it �.eY N,3dV1AiiA/Cm1.+'t.e'TJA��R �'3 M:IiAxA7..i.AR+I.��r AA.�?.�T
'.�u�vr�`ce�'4:�.�i
Cfi�+�S'I'R�&6`:7IO� PTFE•: lt3i•i9fi30-�fi•1I~;Yi3tJ4 �3�:�,01~
PIAN IL HE :K FEE 101-000-439-318 4201.8.7
RCHANICP• L FFE 101.000.421.000 $92.00
IYd., " T3�6Ca�7,Ft4t< 101-000-420-000 $19&75
PltYMBINO PEE, 101 "Ct O -419 -OW 2168.50
w YR1NO APES rIGN FRZ - RESIU 101.000-241-000 $20.01
OP�,Ai)IK0 FPS 101,*00- 423.4111-'.1 M00
a"3LVF1QYZR IMPACT FEB $I,X117.00
APT 1114.PURLIC+ PLAC'F.:1 " RESK 701-000- 755-000 x.86
J
[,�I "."A!'b11 C4✓1.11 Cjl \T ANI) PLAN LHCLCY,
- •....
f I i�Fj 3?Its O. T `3
$0.00
I
J U L 1 3 2001 r0ma RFs mE NO
i
$3" 8.,97
CITY OF Lk (IUINTA '
FIIIANCE DEPT
RECEIPT
DATE/ /
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
J
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ _
Underground Ducts
Ducts
Slab Grade //
9���/d�_ J / U
Return Air
Steel
_ f
Combustion Air
Roof Deck��
cj Q� 6_
Exhaust Fans
O.K. to Wrap
``//- 7 d( 6i(�
F.A.U.
Framing
/�_ - (*/
Compressor
Insulation�il//
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
/$�/��Dy b
Drywall - Int. Lath
�2f
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
Waste Lines
2b/�
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
9��r'
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vokage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles .
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
_/'J
Utility Notice (Perm)
�Certificate
of OccupancyT
City of La Quinta
Building and Safety'Dqpartment
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: 54-760 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: .0106-299
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:. BILL GORDON
Date: 2/8/02
Building Official
POST IN A CONSPICUOUS PLACE
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