0106-290 (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.
, Picen; k Lio. CIa00 GIIp: Dato
71.4368 f, F r �I-am.1 /9
Date �' ,$ignature of Contractor l
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).
( ) 1, 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:
() 1 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 ' oerformance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
MI.TD I I r 0% IN& I Ti�3C-�Qp��•�3
(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: r>1,. rpt Applicant
,Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant 6
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and.void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and,hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)r' �'�+��`- '•? Date ��✓f (L''` °J
BUILDING PERMIT PERM T#
DATE % % VALUATION LOT TRACT
2 18 16,3
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
MrWTiD`RY` CROFT L CO)affiI� i't"19
CI~;NTURY CR.OWEAT... COMMUNTrA rS
1535 hoz. 0D9'Vr.A _;T, � 02.00
15.35 50, To m''ffrJ '.r°T, MIS. 42,0E
t1�Y �fARDINO CA 92408
SITBRMARZINO CA 92408
(90)381-60T/ C fT 2120
USE OF PERMIT
}} pey 1+ R pn
Fi}f'D a MW 30 PL AW 3AR a PERMIT 130ES °1403' INC LA'Ing HLOCK WALL,
Pool, OR DRIVEWAY APPROACH. 7S% PLAN CHECK WE REDUCTION
AP2sI.,3)"r:% POR MULTIP.IX SAME PLAN TYPE StSF$MI TTVD.
CUSTOM Ct,°NS3TRUC, I'ION %398,00 sy
PORCH&Arlo I1"A.00 SF
0AR A.0VID.e' RPC` RT 566.00 OF
A�bl�' TX9 COS' (V CC?,�ti'F' ;�6d;�ON
:�03 5.W
���'} �y p�yrt� �,t�^. gy..�p ��y`yF
.f WsR1311.W A fX �YUAMAA . B�
Coili'firrR iC ION i%% 101-000-418-000 $993.06
PS.&N CRECK VW! 101-000-439-318 $701.83
k+AECf1WICwAL i EE $92.00
101-piti�0.4ee
'
qq;lnly"(vy�0�0.
4}atl.J� CTRICA), � a.1Te b {.lr,[ -,006i-•T 20-01,. .$122.73
101-,000-420-0
jPI d.IM BDICf ''W' '. 101.000.419.000 S168"
.7TRONO Rv10TiON IEP, • f ID 101-0f. -00-241,000 $20,03
ORADINO POR 101 -,OW -423-000 $26.00
OZVEWPER )IMPrSCT 1,E $I;bt1l'i.iSO
AV IN PUBLIC PLt§M2 -INE 701.000-255.000
w'1yC ir., Coo ° USI .AND PLA4 CMCK
12.11,0 PRE -PAID FRE.,,
$3,531.97
�.00
ISL*
J U L 1 3 2001 ex ° . FE96 DLTE NOW
�.r.
DIN OF LA OUI ITA
hll,�AII CE DEPT
w e
RECEIPT
DATE% 1��
BY
DATE FINALED
INSPECTOR .
INSPECTION RECORD
OPERATION •
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footingsg
1ovti
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
A_
// / _ _
91_
//_�/d/
/�/s�/ (N
/
`�/N/d� (D
Underground Ducts
Ducts -
Return 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 //3✓�%-/���yQ/1,Odr_�
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 I
I
Gas Piping
PLUMBING APPROVALS
_
Waste Lines ��—
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
g�/�/�
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 _2
Utility Notice (Perm)
- l� Cl :Llll.�.A.1;�Vl..111a hlY�l h1V11 .. .
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' go 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 oumetal.� Fiberglass will notabso'di 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 #: 3ARPhase: 5
Lot No.: 30: Job Address 54-922 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
teri r Walls: R 11 Unfaced Batts
Between Floor:.
j bathrooms e
Subcontractor.. OJ Insulation Co.,: Inc. .
42620 Ri edo, Temecula; Ca 92590
Signed
Tom Berry, General.Ma er- 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
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: 54-922 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: CENTURY CROWELL COMM
Building Official
VN
Bldg. Permit No.: 0106-290
Land Use Zone: RL
Address: 1535 S. D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/31/02
POST IN A CONSPICUOUS PLACE