0106-289 (SFD)LICENSED CONTRACTOR DECLARATION
'...).hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with'Section 1000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date -�✓r �i' o Signature of Contractor
P
OWNER -BUILDER DECLARATION ''r
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&RC. 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.
00LID9W MOLD IN11% "C4`14068-40
(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- rApplicant �r-ter r^r• a
Warning Failure t0 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/Ageht)-1 V . 1/4J z ,J- ° >1'11 Date.
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BUILDING PERMIT PERMIT #
DATE �! VALUATION LOT ()�,) _ TRACT
21846-3
JOB SITE -
APN
ADDRESS
TANYGLEWO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C ' MAY, C'Rt3'tidWELL Cow. UNNIks
CMY11CY CROVM 11 0011 1'yN tEs
1535 so, TM STREET, 1'gZ 0200
1535 SO, Vu SI'>~ MEZ SIR 0200
SAN'BMWARDWO CA 9=9
SAX.BMWARD)NO 'CA, MOS
(909)381.6M OBLIf 2120
USE OF PERMIT
KNITTER &A630C
W90LE 17ANDLYDWIK.UNO
201515WJBMCHMOD
a 13 - LOT 20 PLAN MR, > P[;iR AIT VO1R5 N.01" 1NCP..CSDE DID= WAL4
POO 1, OR. DAV.RMAYM.PR!CACK 154A PAM CHK0K. F1;91�r.: UCYION
APPLIED POR Tu3UI TId?t E RAMS PLA14 TYPE s'Camn'TFb.
a',"USIM CONSTRUCTI(ifi ZIN100 OF
PORCHMAT10 174,00 SF
(LARAWCARPORT $07,00 SF
.?NS`1RUC T ION nE 1`01-Ctoo-41 `<100 5 Cyt. U
PLAN CHECK FK9 101-000-439-.318 �1ffSK.. S y
WCHANICAI., FEW 101-000-421-000 $K
1,0L R1CAk1 "19 101 -MID -4,20-000 $120.?s
I'iIUIVIB040 "R l0a Rt1d3f�41 �QOi?rS �l .�o
STRONO NiCTION PEE > R'.SS20 i (1Y -000ry 1-d�CaO $11R.39
ORADl O MM 101-000 -423-000 42t4.t11b
DVN1a PER]HPAC`Y'I $1,907,00
°A aP'1'x`I;cfI°AL L 1.1'�13'C'1.7t 9 AUD PLAW G1T%ECK
1
$3,414.74 �.
IMSPRUU PAWI FXIUZ
't
J U L 1 3 2001. L FXX.YEYKS DUE NOW
$0.00
414,74
cls% OF� lh MIKA
s 1`110NCE DEPT --
RECEIPT
DATE- y g
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms &Footings
97��
Main Drain
Slab Grade
Approval to Cover
Steel
Roof Deck
Equipment Location
O.K. to Wrap
Underground Electric
Framing
Insulation
Underground Pibg. Test
Fireplace P.L.
Gas Piping
Fireplace T.O.
APPROVALS
�7/b/ _
Gas Test
Electric Final
Heater Final
Party Wall Insulation
Plumbing Final
Party Wall Firewall
Equipment Enclosure
Exterior Lath
O.K. for Finish Plaster
Drywall -Int. Lath
Pool Cover
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor.
Vents
Grills
Fans & Controls
Condensate Lines
Final WG- O&IM_4 -(—)
BLOCKWALL APPROVALS
mnar
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING
Waste Lines
APPROVALS
�7/b/ _
Gas Test
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
�( f
Encapsulation
Gas Piping
01.
_ 1.
Gas Test
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underqround Conduit
Low Voltage Wiring
Fixtures
Main Service ..
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tema. Use of Power
Notice
;1
. Certificate of In"
. sulation
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, so 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 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 has been professionally installed.in this home
to provide the following thermal performance..
Job Name:, Tournament Collection Tract: 21846-3 Plan #: 2BR Phase: 5
Lot No:: " 29 ' 'Job Address'. -,54- Tanglewood- La uinta, 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
Interior Walls: R-1'1 Unfaced Batts . Between Floor:
(Bathrooms, No Closets)
Subcontractor:: OJlrisulation Co., Inc..
42620 Rin Nedo, Temecula, Ca 92590;-
Signed.
2590.:Signed
Tom Berry, General Man 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-'an' d 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: 54-940 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING. Bldg., Permit No.: 0106-289
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: 1/31 /02
Building Official,
POST IN A CONSPICUOUS PLACE