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0106-292 (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. .License # Lic. Class Exp. Date 714186 B Date A -A /Signature of Contractor r ' x� ��" �` l -.t 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. MUff--H RAOLE kF!` i A3IhiC- Ur3$•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: �i 'f 3. Applicant 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 linspection purposes: , Signature (Owner/Ageht)J"'� T t �`••"� Date} BUILDING PERMIT PERM T# DATE / VALUATION LOT TRACT r32 21846.3 JOB SITE ADDRESS �i-8 k:&r"0iTXW05D� APN ftiJW^2r' 4-yiSC��1 OWNER `" CONTRACTOR/DESIGNER/ENGINEER C:lv I�.•'d.3RY, movml L cCswdB: bm C1 1'6: RY MIMEEL 100I6AW FM 1535 30n Tp =Mrr, MIT, 0200 1535 so, V 711$1✓, am 41200 RAW BYP AT DWO CA 92409 SAN BM'.{�N�6wRDIWO CAi )408 Ol�91f2y4 ; KNI`!"t; ISR & APSOC: USE OF PERMIT fat: FAMILY I'tlt?M ®' '281 SY Sw BIRCH A] 00 SFO O • LCYr 32 Pd AN .MR • PER MIT Ir°tOYS W)T INC:LUDIS. BLOCK STALL, POOL:OR PLAN INAWK, M R.g: UCTION "PL,IED Y0lt.WIMPLE SAM PLAN TYPZ SU Rb,33' 21). Comm ecom l'12ucrlox ;0,39&00 OF Pt3.RC%iIPATIO 1940 SIS' 0,A)RAGRiCA,RPORT wami7m coyr ov CoZfS,: ntuCnoN 1'$ e�Vll SuNa'Ry CONSTRUCTION WIN pll.m L'.Hg".K. PUB 101-000-439-319 $201.93 MECIMMICtillIR1 �Llj�:'g',RIK"..Alo :I� D Cf'I-S1QQ-�$2CI-DQE $I2R."s'� PLUMB040 PUS.1 �aaa� .nada st . VROWO MOT30N 'PEE 1&I0 101-000-241-000 $20.43 ORAD NO We t�i1��Sil[i�•2��t� SB�.�fi1 MVEY.f;Jia'ERIMPACT ?FZ .a' 114 t'UBLAC PLACE S - I% I3G'1'1DP.4=1-255.000 tad UB -'1°(#A L CO C':ITC ' AND MAN 0M,113M $3,5:41.9n J U L 1 3 20G1 v� CITY OF LA QUINTA FINANCE DEPT RECEIPT DATE ..,'.�Li� BY DATE FINALED INSPECTOR . .. .•..y INSPECTION RECORD t, OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footingst Slab Grade J Steel _ d �/ i . - Underground Ducts Ducts Return Air Combustion Air Roof Deck //_ Exhaust Fans O.K. to Wrap Framing Insulation _ _ / ` /��./�� �JJ F.A.U. Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final 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 8�3 Water Piping 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�;ll Encapsulation Gas Piping Gas TestAppliances Final 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 Utility Notice (Perm) �v�� r Certificate of Insulation Your Home has been insalaW with ecdainTleed Fcberglass Insulation proikc , which ace designed for today's softy standards and tommw% enorgy rogwnacient9. jr6agiffis is inocgMk and therefoW PWUUMD* , so it does not bane to be treated With 5re-retardant cbemiwis that gill I&* lose their mess over tinct. ,It las M been Heated +with chcudmis that can corrode wlrhg or acetal FfetgLass will not abmorb moisture m will it r settle am time as may other in-tatioa inalerials. This aka cemfm that CertatnTeed Fiber Glass Insalatloa has been pnsfcionaliy installed in this r t a to pwvidc floc following tkermat performance .lob Ram Towmament Colk"an Tri 21346-3 )Ian 41-- 3AB pbmm 5 = Lot Mm-. 32 • Jab Address: 54-m '1mj*woa& La Quints„ CA . Cuing Area: R-38 Blown iamblion Garage Cabal;; Non Access: _ W-db tsviagAbm & SlopiegAreas RxterW W98: R-13 Unfaced HatesOveiftkow . AtomWim LWIug Above • Inserior Wallas R-11 Uaiaced Batts u �' - -- - Sa&oxtrador.. 4JInsu&t#ori Co., Inc. 42620 Rb Nelle, TeWATWs, Ca 92590 _ Torn .berry, Gerard, if&% ger- T=56CUM Bmffch R- menus resistance to heat ROW The higher the R- value, tic greader tine insulating Dower. _ Ask your bultder for the fact sheet on R malum Keep this cadificnte with ymi r . otbcx vakcad papers, .ifyon ever sell this home; this oeitiiicate should be passed on to tics buyer. y sl© Certificate of Occupancy / L-, City of La Quinhi Building and Safety Department. ,,,t 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 ollowings BUILDING ADDRESS: 84-886 TANGLEWOOD Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-292 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CENTURY CROWELL COMM ti Building Official Address: 1535 S D STREET ST.E 200' City: SAN BERNARDINO, CA., 92408 By: BILL GORDON Date: '2/11/02 POST IN A CONSPICUOUS PLACE MEN