0106-288 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
'Lhapter 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 Cxp. Date
7Vr1f3a/ /, 1I1 )W.
Date Y/ : f / Signature of Contractor ��
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).. 1.
() 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:
Cartier Policy No.
(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: _ f�.+�X'�47 Applicant
f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. . q
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant -to
any permit issued as a result of this applicaton agrees to, & shall, indemnify..
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work. is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon .
the above-mentioned property for inspection purposes f F
Signature (Owner/Agent) T;? • %�1'_. Date
f
BUILDING PERMIT PERMIT#
DATE /f VALUATION LOT ,}i TRACT
JOB SITE
ADDRESS -
APN
OWNER
CONTRACTOR/ / EN INEER
30. TL l MMYT,
1535 50, "DR Tx nw T, YT2 0200
SAN 102NARDINO C' 92408
SAW BERNARDWO Cad 92408
(901' 13 tli1 Lif 2120
USE OF PERMIT
KNITTER ! ASSO ;
1 20151 SW BIRCH #10110
S „ !. r 29 PLAN -43R m PaE,.6$bUT DOIZ WOT rNCY.t: OP, folXX= WA1,4
POOL OR DRNEWAY APPROACH.
CUSTOM Cf3A7S'1RUCTYOW ;w-.ouo Sr
0APAC4WAKPORT %6100 OF
E9MI�1A= C0S ® G4CD iS"� ��%� $
PE + ' :fit .Wri. NITAO1I Ry
COHRRUCTION FE, Tr 101-000-418-0 -0 59.0100
PIAN CHFIC K ».yl 101-0I0439-318 $907.31
11G)"4C HANIICAL FEZ 3.01-000-421-000 342.0
1;II.E021C A L P'llf 10.1-000-4,20-000 $122.75
PI.UMBINO FEE 101.000.419-000 $1,6&50
STRONG MOTION F > WUSID 101-J! O-241-000 �2G. Gi3
G1tAOINO F99 101-000-423-000 $moo
DLVI tA)PO,R IMPACT ME $1,907.00
ART W 1sUB13C PLACES • € ESIE 701 -000-255-000 5186
TO ONANDT-tLAMCI-DAX
*4,1:0.45
•l�
J U L 13 200, /
4
CITY OF LA i UINITA
F11%1;.niCE DEPT
RECEIPT
DATE --1"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs!
Forms & Footings
Slab Grade
Steel
Roof.Deck
/b(
_
/�/�Q
ro
r _
_ t
Underground Ducts
Ducts -
Return Air
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
g
Gl// . D/
!./.._ /DI
F.A.U.
Compressor
om P
Insulation
Fireplace P.L.
G/ .�9�a�
Vents
Grills
Fireplace T.O.
Fans & 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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Waste Lines 8/�G�[ _
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
Pool Cover
Encapsulation
Gas Piping
Gas Test
//7�0 fi
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
Utility Notice (Perm)
COtiricate of14$41a.�.ion
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 . 1
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 if
settle over time as may other:insulation materials.
This also certifies that:.CertainTeed Fiber Glass Insulation has been professionally installed inthis home
to.provide the.fonbwing thermal performance..
Job Name: Tournament Collection Tract: -.21846-3 Plan #: 3BR. Phase: .-5
LotNo.., 28 :Job Address. 54-958 Tanglewood -'La Quirita;CA
Ceiling Area: R-3&B16wn Insulation . Garage Ceiluig Non'Access:
With Living Above &`Sloping Areas
Exterior Walls: R-13 Unfaced Batts
:;Overhangs:.. Access Attic:
With Living Above..
Interior Walls: R-11 Unfaced Baits . Between Floor:
(Bathrooms.;. No.. ose s.
Subcontractor..:OlInsulation Co., Inc.
J620 Rio, Ndo, Temecula, Ca 92590
Signed :.
Tom Berry; .General Manage 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.
Buildinga'"'n'd SafetyDepartment
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: 54-958 TANGLEWOOD
Use Classification: SINGLE, FAMILY DWELLING Bldg. Permit No.: 0106-288
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
Building Official
Address: 1535 S. D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/31/02
POST IN'A CONSPICUOUS PLACE
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