0106-295 (SFD)r r
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.
LiCuioeed Lio.Olasa EXp.Dutc
71 i i3sr�' B
Date 'F f a o- Signature of Contractor
p sem,;/! ti•�/ v 7 7N-"Z,..T,-Lc_..: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 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.
GOLDS "N1 RA014 3140, I C-; 0f 3.03
(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 "' , -�.,� %7ii
".,Warning Failure t 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 I
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.upbrl
the above-mentioned property for inspection purposes.:
Signature (Owner/Agentj' "4: LLQ_ ¢' x Date ��'' f�)f�
BUILDING .PERMIT PERMIT#
DATE /j� VALUATION LOT Y dlA TRACT
/ fw,
JOB SITE JAPN
ADDRESS .�—-��--�� -, ------
OWNER - —
CONTRACTOR /DESIGNER / EN (NEER
t;.°.1�1T16£P Y CaOWELL C:C)MAECMMI
C-TN3,'URY C,k0WILL CONMRAWIM
153.5 30. T° SIRMAs 9M 0200
1535 SO, SY VIMW, s `rL 4200
SM RERNAIRD190 CA 92409
SAUBMNARDIVO Com. 92408
(909)381.60(( CE00 2120
'I NITTE.k &ASS V, '
USE OF PERMIT
1011 Y��A3 t, I)�ti1w3.,�.�I�CS
'165T SW BIRCH #100
SOD • LOT :J.5 P"N :11312.; PERMIT DOW NOT INCLUDE BLOCK WA14
POOL OR t)R).•1VRWA'T.A:PR4i43ACH, 7% CHECK ME REDUCTION
APPUED FORWULTIPLZ SAM.E RLAN TYPE SlpBMITTV0,
CUSTOM., CONSTRUCTION ?139&00 SI'
POtt'CI•li".1r iQ 184.00 S!t'
OWRAGWA.4iPORT 966,00 SP
;=JM7". COST OF CONIS'b'Ri70';.°Y'LI€. H
2w.;44500
M. M3T FEW WASLARY
CONSTRUCTIC3N= 307 -NO-41 8-000 4093.00
PLAN CHECK PER 101-000-439-418 $201:0
MKCHANICA L W -F. 3 C91=000 -i21 -w0 $9 8.00
ELECT RUCAL =0 0 101-000-d'.10-000 1112V3
I'UlM9190 Ft E 101 -WO -419-000 $160.50
V1; CYNO A,10710N FEE - RESID 101 -000 -7W -OW $20.03
'GRADING ING FEE 1011_000423_000 V0:00
1: lIiN',Y+.J.DIPPR IMPACT F£..i� $I„�SY'�".80
Wr M PUDIX P3ACUS - RBM1[ ?G1, -00G-2$5-0 4.86
r. 'RUC TTON AM PLAN (WEM
LESS M --P. 1.703
$3,,531.tr
$0. GD
J U L 1 3 2001. u_
CIYY OF EA, OUIN-IA
FIP!41eCE•DEPT
RECEIPT
DATE/
BY
DATE FINALED
INSPECTOR.
//
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings _t/j�
Stab Grade f�
Steel
Roof Deck
O.K. to Wrap!.
Framing
Insulation
9 ���
,
���
�
01
/2%3�/
_
_ _
�
(��/
Lam(
Underground Ducts
Ducts
Retum Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath.
Final ��6�dt�iePOD%li
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
PLUMBING APPROVALS
_
Waste Lines�� j/ljl
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Ell
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
���1 vl
_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
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
Final J
Utility Notice (Perm)
- Certificate of.
Insula, ion
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 thereforepermanently noncombustible,: so it does not have to. be treated
with fire -retardant chemicals that will likely lose their effectiveness overtime. 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 Lias been professionally'installed in this home
to provide the following thermal performance.:
Job Name: Tournament Collection Tract: 21846-3' Plan M 3BR Phase: 5.
Lot No:: 35 Job Address: 54432 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
Idterior-Walls:'R-11 UnfacedBatts BetweegFloor:
(Bathrooms,,No Closets):.
Subcontractor:. OJ Insulaion Co., Inc.
42620 'o Ne o, Temecula, Ca.92590
Signed
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.
Certificate of Occupancy
City of La Quinta
B uilding 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: 54-832 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING • Bldg. Permit No.: 0106-295
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, CA, 92408
By: BILL GORDON
Date: 2/6/02
POST IN A CONSPICUOUS PLACE
1. 11 ..