0106-298 (SFD)% LICENSED CONTRACTOR DECLARATION
I hereby 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.
Lioonco ff Lic. Clam Gcp: Daio
rPf�j kl / r; YJ�3Yf"a x
/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:
( ) 1, 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 ��pp/Nyyy ;;yy{11 KA
yy ((�� qy� Policy No.
�I.iWlEd4od: I K A��LS .INS'. Ci U9'Sr^FP'�'V�N&^iPJ�
(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.
Date: ".:, 7- --, / Applicant ' "�."" t' �� C
r nG..0 6//
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: % s•
Signature (Owner/Agent- R Date 4- /2.0
BUILDING PERMIT PERMT---------------�
DATEVALUATION LOT �)�j, TRACT
2 194 164
JOB SITE 1
APN
ADDRESS - -
1:''z?>Ci''ifC7f�
OWNER =— —� ' :
CONTRACTOR/ DESIGN INEER
1>35 00. 'IV M. JMIZ I;TiR ftofly
1335 go, rr1Da frim.,1.1. ON
A141�1�'�.L�L>rRDWO CA 92+ 09
3 s3'�M' KARDD,40 Crl� 92408
2120
USE OF PERMIT '
KNITTER. & ASSOC
(31EFAMR,X DWFLUNC'
nw s+b''.63I1 rmi #•IOU
: ,K) - LOT39 PLAN 3 R - F^.ZF.MJT CiO&S NOTINCi U'DIZ EIXJCX WALL,
POOL 0110,R.IV EWAY APPROACH. 75% K.M1 t;°I'tWK VAE FtFfi3UCT.ION
APPLIED P'OR MULTIPLE SAME PLAN, TYPE 5I1fiMITTE7.
CUSTOM COl`iHT':I1;t3LMON z31ttl o BF
PC'RCH/pATIO WT
0AMO IC.ARP"O'RT SF
7� QQ����,pp _ yy���yv��7 �y�p^�g �� y1�~f����:1:".�
S, .��.Y..:k1t",Y F .d hT S 9J.�1��8�!!�9.R7G::5 '
C oro'STRu anon mg 101-000-418-00 i $993,00
PLAN CHECK ,FZF 101-()Co,A39,I ES ? $41.83
RC HMIC.A3, FISS 4 01 uf3 -421 �000 g93.t1D
EL..H1'C'T91CAA ,• YC.E 101 -000 -420 -OW
Pfs'f iPo$.t4940 PIKE 101-000.419-000 $168.130
3TfW330 MOTIaN FEE - RESIT 101-000-241-000 $30.03
GPElt. INO 1.79K 01.000.423-001D $20,00
DR1I''I+;,l.OP'ER IMPACT FEE $1,907.00
ART W PUBLIC 'PLACES - RLUr 701-000-255-000 t9d
�� £ Tp C3°I'A AND IRT.
f L : _,� _ �M 7tli,i1dkt�1 ���C1.I'iC1
I
J U L 1 3 20 . E Xrs XYLTY, Now
SOX -97
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0F LF OUiPJTi
FliIIA dCE DEPT
RECEIPT
D—A^T�E
BY
DATE FINALED
INSPECTOR
C3 .
r�
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs _
Forms & Footings /11kulL FAM7 Slab Gradevjj''
Steel —T
Roof Deck ��/�-•—�-
O.K. to Wrap
Framing / /I 6AI
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall _
Exterior Lath �/
Drvwail - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts .
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
COMMENTS:
Final
Utility Notice (Gag) .
r
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp: Use of Power
Final,
Utility Notice (Perm)
Final
�
5-7— ///GL_ awnJ
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
-
Gas Piping
Waste Lines
Water Piping
PLUMBING APPROVALS
/
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out.
Equipment Enclosure
Shower Pans
Sewer Lateral
O.K. for Finish Plaster
Pool Cover
Sewer Connection G�
Encapsulation
Gas Piping
Gas Test
_
/I&AI
Final
COMMENTS:
Final
Utility Notice (Gag) .
r
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp: Use of Power
Final,
Utility Notice (Perm)
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:
Use Classification: SINGLE FAMILY- DWELLING
54-778 TANGLEWOOD
Bldg. Permit No.: 0106-298
�• Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
Building Official
Address: 1535 S. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By; BILL GORDON
Date: 2/8/02
POST IN A CONSPICUOUS PLACE