0106-297 (SFD)LICENSED CONTRACTOR DECLARATION v
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.
LI Vl'IJ # Lie. Oleis3 EAN. Dule
71-41 Mt L,� 1,C1i31f��:
Date- — 1, Signature of ContractorZ fy f "t t � P '
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.
. 00.1,DKk$FACLE INN. 3Te+d0444068-4
(This section need not be completed if the pe mit 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. f
bate: f Applicant �5- r% 'y •`
Warning:1Failure 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 enterupon
the above-mentioned property for inspection purposes. "`•
Signature (Owner/Agent] r 1.+ atc s r_ !lr1 P, Date—) `4 � Ali! I
• a.,�•e.. vL :,;:,, :T -� A'. per.,—j.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
. >� ✓`jl�
111MAN7.411
JOB SITE'S `� ` _ ..�..'— - -
APN
ADDRESS. p��,�1 ;..*�u"-ap'�•y�y�/-ty '����p�y�pC�
w54- I.:�'4f.11.4tAI.Y.0.S'd.67��Ui•-V�:./D..�'
ivy ".f 7d�4KA7
OWNER
CONTRACTOR/DESIGNER/ENGINEER
man crit t' cRows-L commim Es
CEMMY C,iZpiMML CdWJEUM:i"9:kr S
,f, �M? 6200
1335 E10. TR MRMY, Mr. W200
SAN HT"ARDW0 CA 92408,
RAW f31v MARl]WO CA 92408
(9o913e1.'60m r_%TX 2120
USE OF PERMIT
KNITTER A Asp. CO
MKO1.11:'FAMt.:Y 1`A•` E111 ',1
20131 sw BIRCH 4100
SFD i, LOT 37 PLAN 11312 - PEMIT DOES WOT INCL UDt1331.C.`CK WA1 i,
P-001, Ok i3WVIRiA A AP1'ROACK 71% P1,414'01M I`F,.17 REDUFO`I`ION
APPLIZY) I+OIu 3,AMTHI p SAME PLAN TYPH SL1) 6MIrPED.
CUOTONA CONSTRUCTION .11016.44 SP
c�ar�.AGFJf NkP0..9;X 52n.o+l sI
U°STa"7RD COSH' OF 4vORMUC', OW
168,01?AO
FFMf ff FRS: Mm"Ry
CONS RUCTIaN FER 101-000,418-000 INIA
PYANICHWK WE 101-000,-439-31.9 Itnruq
MECHANICAL M1 <: 1131.000,47.1.0..00 $66.50
111-PUMMO FEE 101 Ff.3G11�419,000 $14100
STROW 0 M.OVO Y FM a -RMID 101-000-241.000 $16.80
Oli A ?iW0 MR 101 dt3t 0.423•(4 O $20.00
$iI,9Q'7.90
fDt+'dll�.LOPER 3'it9PACT IAF-------------
I' °3A -a ov4 co= AND PLA X CHUCK
$3,325.9.0
A 1.:�'F�Sa3 1PRUA=:PRW I71
�h I�
$0100
J U L 1.3 IMP� ; � ` � TIES DI1.P
3325
CITY OF LA LIUINsA�
FINANCE DEPT
RECEIPT .''�
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings /}�,�p _
_ —
(�
_ _
Ducts
Slab Grade 1
d�
Return Air
Steel
Combustion Air
Roof Deck
��- rj
(�
Exhaust Fans
O.K. to Wrap
/
F.A.U. -r
Framing
Compressor
Insulation
/_2_ _5�0_/
(
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - int. Lath
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
_
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
lmaa
Gas Piping
_7Encapsulation
Gas Test
_
Appliances
Final
COMMENTS:
Final
-
-Utility Notice (Gas)
ELECTRICAL APPROVALS
k
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)-
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: 21846-3 Plan #: 1BR Phase:. 5
Lot No.: 37 Job' Address: 54-796: Tanglewood-. La Quinta, CA
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: R-11`Unfaced Batts
Between Floor:.
.(:Bathrooms, No ClosetsT
Subcontr-actor. :OJ'I&ulation Co., Inc:
edo.Tem ula; Ca
42620` N` ec 92590
Signed
Tom Berry, General Man ger- 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.
X-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: 54-796 TANGLEWOOD
' Use Classification: SINGLE FAMILY 'DWELLING Bldg. Permit No.: 0106-297
Occupancy Group: 13�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: 2/7/02
POST IN A CONSPICUOUS PLACE