0106-293 (SFD)LICENSED CONTRACTOR DECLARATION
.t 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
7141'!�&Rs
Date Signature of Contractor,, t fig t 44'�f�.� a
/ f ,
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
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.
OO1c)OLE ate : r� C• a�aa as ,
(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 anyperson 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,- L v�
Date:-_ � � 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 -'result of this applicaton agrees to, & shall, indemnify, .
& hold harmless the City of La Quinta, its officers, agent6` 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 �.omply 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
AS I
Signature (Owner/Agent)] (2,1 t Date
� w
BUILDING PERMIT PERM T#
DATE VALUATION LOT ♦TRACT
JOB SITE . ` r' • -
ADDRESS._-_
T�—,
APN
OWNER
CONTRACTOR DESIIGNERR/ ENGINEER
1IMd4L VS�iCRZkC8wr
CMIT.-MY 4P.liLLNOU MS
7:s p a y 117M.
1535130. T' VrIM, ff, &U?., #200
MMUEMA12I.31 O CA 9UO8
SA1ti BMI INO ' C'A 92409
(91:gj38160W C33A 2120
USE OF PERMIT
01ITTER, 4%.AS00C
RAalX,RAMt.LYDWF'.£.IM(3
20151 Sw Omni 6.1€0
ST -a3 - WT 33 PLAN 3Ar ,PE•iEMIT DOES 1+3 T INCLEYDE BLOCK WA.14
POOL O. DJUVERWAY APPROACH. 739iiPLAN CHWK POP, REDUCTION
APPLIED MR MLy.l. r1PLF SAME VI AN ' VIT, S@JDSId1`k"i?' M.
t;13;;;'1"Gai+>q CGtdVPRIYa TION 2398.00 SF
t?Od2G"Hy+8�'ATIO TA4.00 9F
'A�7�lG4XS�4�FwtCJ.'7.Ii,P6,YRT 15.66100 W
XS11'I d&TED COST OF C£AN> IMU ON
2 tr1 ,2445A),
PERWTIMP 94TWAAX r
C()x;6TRUC1'10.*S-•I PER 101-000-418-000 is9�3.it0
PLAN C llid:K. Flei< 101-000-4.49-318 $201.85
MECHANICAL FV,, 101-000-421-000 $9100
?1.PSC'1)?UCAL PM, 101.000-420-000 pn.75
PLIANHHHO a 101v000-A��,c»o
KCn10 MOTION 1102E - kFSJV_ 101 -0004A.1 -WO $20.03
113RADING F9i 1.€D1"0 42.4.000 $20.00
DtP4t"M,0PPR IMPACT FEE s1,9oun
sV, % ' IN PU}: UK N"CRO- &ISLE 701 -000-255-000 U6
^> t1D-`T AX f;11 d 7010N At°1.t? PIAN, Cll-MIK
J283 17RE-4)AW FEES
1 3 2001 a tic lis D Now,,.
E JUL
GITY OF L ' QUNf'A"-��
FmincCE DEFT -
RE EfPT
DATE—% /
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
D� _ _
Underground Ducts
Ducts
Slab Grade
/6�[ //
Return Air
Steel
Roof Deck
ZCombustion
(j/
Air
Exhaust Fans
O.K. to Wrap
�l/-Gp
F.A.U.
Framing
;- - ��
Compressor
Insulation
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
6
Drywall - Int. Lath
0jal"?/!�%
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
_
8�p���i
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
_
9 /9-6
/�
Pool Cover
Encapsulation
Gas Piping
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)
�����
n
Cer:`tificate of In :1
su. at�on
Your Home has been insulated with CertainTeed Fibergiass Insulation products, whichare 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 thea effectiveness over time: it. has -not been treated
with chemicals that can`corrode wiring or:metal Fiberglass will"not absorb moisture no will it
settle over tune as may other :insulation materials
This also certifies hatCertainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance.. .
Job Name: Tournament Collection Tract: 21846-3.. ' Plan #: 3AR ' ' Phase: 5
Lot -No.: 33 Job,Address: 54-868 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
Asee�s Attic:
With Living Above
Interior Walls:.R-11 Unfaced Batts Between Floor:
-(Bathrooms, .No :Closets).
S'ubcontracto'r.. 0 Insulation Co.�, Inc.
42620. Nedo, Temecula, Ca 92590
Signed'
Tom Berry, General M1A ager- 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.
=in
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: 54-868 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-293
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
�lf Date: 2/5/02 -
Building Official.
POST IN A -CONSPICUOUS PLACE