0105-291 (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.
Lioonoo A` Lit:. Olass GN. Dale
Date-- , P Signature of Contract �' f � f '�'-'r
�r .: . w ..- r--�.
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 I 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:
Camef Policy No.
00 WFIN PIA01.9 INS,
(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 shalljorthwith comply with those provisions. r r�
Date: w -? -, f %� Applicant
Warning: Failure o 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.
Signature (Owner/Agent] ) "? �' %` Date -I-,
BUILDING PERMIT PERMIT#
�.
DATE f VALUATION LOT _ _ -�j TRACT
a►1946 3
JOB SITE 1 k-
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
Sn�`3,�p5++��go.y��`'v,— ayy���I4:[���Tqq,"��: , , 02(00
, �ii�xyy .{�02Cl0
��I �)� p��
A7..`17.'H g-�+ES�A'Sl��tu1�1N`� CA 9LW�iW
�15�,0�ry5� •g`R�i�i,�7}..►°,Ig�"�U�ly��,.g /aft
W(,a�'�+.{,tl BEpl+L^'�.�tl CA
/A�(dyt�2JWO
gy9�I[A08 9n
�e�id��:aO4�Gdld! 1rR7Y.Jlf' f. 120
KNITTZR &AN0V.
USE OF PERMIT
5)M' C"i EYAM .'Y'MML31-1-40
20151 SW BIRCH MO
SFD • LOT ail FW1 .t,AR u TIE641T .1:10 ',3 NOT TJ1CJ:.UVFN 3L0CK: WALL,
POOL OR D.RrVEWAY APPROACH.
C°ti7ss"1'0M CONOTRUCTION 2,omgo OF
0ARACWCA,T?.P 0RT 52(.00 ssy
11MMMM waWARY
COMTRUCTUON FES 101-000-416-000 M1.00
PLAN Ci4ECK FEE 101-LiW4 39-318 1110,74
ML{;FIAN Ic"A 'ME kill -000-X121.000 $146."Re
R3, WsRI CAx,"NY 101-000-420-000 $114.91
P'F-00TWO FEE 103 -000-419-ON 9142,00
S2'File?F O hIC"iT1014 FRE? - RE31D 101-.000-291- $16.80
CAUDD40 FTS - 520100
J.10-1 EW PZR IMPACT, FM $pU'.xm
%CUA' � IST J�i� ��l�f�
�t ' A ' �' y{ LES, Ta1z'ffi-P' TD IT �`3
$3,851.85
$0,00
[
IU I �j
I 1 Now
''
J U L 1 3. 2001' ! " '
GlTy OF 1/a Oui;''a'S A _ i
FIiVANU DEPT'
RECEIPF-- '"" "DATE
_
9'
BY
DATE FINALED
INSPECTOR
�.�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings/2
_ _ _
(,I
Underground Ducts
Ducts
Slab Grade (/-r
�GJ�6�
Return Air
Steel
7
Combustion Air
Roof Deck
_ _
///S'
Exhaust Fans
O.K. to Wrap
��
F.A.U.
Framing
.l5'.��
f�_2%��
Compressor
Insulation
/�/y7/0 /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines .
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
�� Bi.GG✓
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
Electric Final
Heater Final
_
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
/�I
Encapsulation
Gas Piping
Gas Test
-
_
Appliances
-
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lary Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
_
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
��/� �i•
(Perm)
Certificate of Insulation 4 ,
• Your Hoare has been Jim1mod Wath tae WnTead P timim s insulation rm&d ,-ts, which arc designed
for kidWs safety standards and tmnarow'a energy mgWrements. '
_
"Mems is fn pmic and &me= ptxr==tiy aorncotnbushbh, m it rbcs aot have to be treated
with f le-retw&W cUmimts'duk will Mmly loco *err ei =Ovcmw over time. R has not been treated
With ahi]DiOla that ora corrode wiring or metal. Fftrgtass" not abmb moishm nor will it
settle over time as may odd insulation nmmatis.
" This also certifies. that Ca-WaTeed Fiber Grass mentation has Login pro lay installed in- this hame
to pmvitie the glowing mama pmfiownmice..
Job Panne: Taub Comities Trsri: 218"-3" Plan #. lAR _ Pham 3
Lot No.: 31 Job Atldmm 54-9" Ta Ocmmd- La Quinta, CA
Ceiling Area: R-38 Bbwn Insulation. ^ Garage 00w. - Men'Accesc
With Living Above &9Eopbg Areas .
Knei*ior Watt R-13 Uaftced -
Overtkmaw A[cem Attic
- With Taring Abom
r
taterier Walls: R-11 Unfaoed Batts Between Visor. _
i Bathrooms o Closets)_
_ ,SUbCORh dOT OJlitrWUUOW CR, IRC. — — -- -- -- -
' 42626ear; Tie; ca 90.
_ Tont Berry, Oral M �_�z
�'Brands -
R- mtmm Fesaftme to Lcat clow. The high= the R- vEdue, the greater the inning power.
Askyour, beilder far the fact sheet on R values. , Kccp this cediftme with your oticr '
valued papers. Ifyon evarseil,099 home, this"cmiHiicnte should be passed -an to the buret
Certificate of Occupancy
City of La Quinta s
Building and Safety Department Ofn
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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:
BUILDINGADDRESS-- 54-904 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0106-291
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
Date: 2/1/02
Building Official
POST IN A CONSPICUOUS PLACE