0106-287 (SFD)f LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
X6pter 9 (commencing with Section_ 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Lice) Ise u Liu. Class ExN. Daie
Date`Signature of Contractor K�'p1
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
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 permi?"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.
- dltlt,•3�1z�t ti;>��I It^�I: 3��� 4���G3 : �..
(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:"' Applicant
Warning: Failure ,to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.'
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his,,,.
"application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to.comply with alb City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)' Y `+ % -1 / �.�� Date 1
PERMIT #
BUILDING PERMIT -_
DATE` f VALUATION LOT �e� TRACT
pi
JOB SITE
APN
ADDRESS p(�� q��1 Y`
�97_6 T"G..��1EW00$J
y t�ryy� p�,�•
"76.9-252.43M
76.9-252.^4o{Jy.7
OWNER
CONTRACTOR/DESIGNER/EN INFER
C wm, Y CRowE, T, C:C fWAI rX, 8
CMURY, Clzowh%I. IOMMUIR1'�r.,0
1:535 DO, 'IV U1° %"r, gr.rr! 0200
1.5.35 §110, ")° MIR1°Q '; X42-40
am B11M.�+`..1rDWO 1 CA 92406
SM' MNAW-190 CA 92408
23.20
USE OF PERMIT
MM &A -330C
&TWO.I.,W.FAMILY D MUM
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SM, - LLT 27 P1J.A1q AAQN.K • Piii.J�IJLIT WES V9 0T INiy..U13 , B 'r'..1CK 1A?,AU,
P010111 OR DRIMN"APPii.O''ACK §
1't�,t3•CTION �,.%ieD S
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ACqO771yW
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1��19y'�'IMAT 3 COSTOF �g��.NSTR M. ON
..may
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d:"J ST48.14 iY HUMMA. 76
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ICIFN FEE
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-
MECHANICAL -MIS '10190004ZI-000 W'"
E.MTRIC'ALF'1UL 101- X4.20-000 $12011V
PUNAAIl NO RX, 101-000449-000 51601"
S-'kW1?FONOT1014 FFA - RESID 101,000-241 -00 $19.39
MA01HOI' E 101.000,413.000 $�tD,ttl1
i�1:I..OPL?R: 3�ffi'Dats.CT }�1�, $I,90'� 00
L
! � 4:1Ojj¢''A' 1�RJ'�./�Y.db/1.Y C'AN•C3.C.I.a.Y91.51 i'�L\.iK
$3,980A4��
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U U L 1 3 2001 '` �x ,����
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�Ir OFCF
DEN
RECEIPT
DATE/ �'
BY
DATE FINALED
INSPECTOR
/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
Underground Ducts
Ducts
Ducts
Slab Grade
f� ��/f(
Return Air "
Steel
!
Combustion Air
Roof Deck
ld! ��/
Exhaust Fans
O.K. to Wrap
�l j��/_
F.A.U.
Framing
Insulation
��9�/ -
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ANx
Drywall - Int. Lath
6 _
Finalq��-�
�jueo
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines/���
-:::T
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
=mer f. _.
_
Pool Cover
Sewer Connection
a_�
Encapsulation
Gas Test
//y��
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)
- Certificate of Insulation -
Your Howe bas teen insulated with CcctelaTmd Fi ass [nsulatiaea
beagl 'pro&wts, which ate dcsigm d'
for today's sa si'ma xwds and tomgmWit energy ngairements. '
•
F1=91M is inorganic and tlmefere peammently uoeoa ubus iblc, so it does im have to be treated
M& fimremtftzt dwmkals that will Wily lone tbeir effacth corn over tim It has not been trcatcd
with dvmd b that can eorradc wwag or mclal. Fiberglass will riot absorb moktwe me will 8 y
,r _ settle over time as may other insulation maicriais `
° This also certifies that CotainTeed Fier aim [asula m has bees prcfession ny`lnstalled in this ltotne. � to pro" thc,folfowizig tlmmml pmforhtaaoe:_
m Jeb Naerc: Tournament Collection a' Trate 21846-3 Phe ll: TAR Phase: 5
Lat Nw 27 Job Adm 54-976.Tauglewood-.La Quuda, CA,
z •� . w
J.
Ceiling Area: R-38 Blawn Insulation Garage Qiffnw Nen Acceitc n ,
glUnfimxdExterior Wa:i�R-13 Batts Witb LivingAbwe & Slopin=Areas
w . r Overh mgwc Access Mtict
w Wdb Lwin Above
lReftmem
Z - .. .. 1 _
o
/nteriiw Wallw R-11 Unfacad Batts _ 11100r.
,
a abL'1t7)lftaot .. 0.1 i11S1 h1 oil CAL, 'IBM 7_
z
246.W0 Tcaecala, Ca M90
o , .. _ SiVtd
N
U7
Tom Berry, Genera! Ai Tuella Brawk
' R- means rete to beat flow. The higher the R- value. the greater the itmnlating power.
Ask •your bw7der fm the fact sheet on R- valnen. Keep this certificate with your other
r valued papers_ If you ever NO this b me, I this oerNf=te should be passed on to the buyi.
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:
54-976 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 0106-287
VN Land Use Zone: RL
Address: 1535 S. D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/29/02
POST IN A CONSPICUOUS PLACE