9909-252 (SFD)LICENSED CONTRACTOR DECLARATION
(..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.
License # Ltd. Ula§§ Lzp. Date
Date ��� Signature of Contra CoJ� —1 -
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).
( )°L 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 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:
GOLDS -24 FA.GI.E "{NS. 19WC 544068-01,
(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 provislons'of Section 3700 of the Labor
Code, I shall to with comp)yy>with those prov slo s.
Date:.(^i Applica`ra 1�1t 'r
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 all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prop "Srty for inspection purposes..
1 r
Signature (Owner%igen j; t 1= Date f
BUILDING PERMIT PERMT#
DATE VALUATION . LOT' TRACT
TRACT
JOB SITE
ADDRESS
6T
APN
r6-15#141 i
OWNER
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CEP�t'fSItY GII(�.i�`fs.i.i� Ct I?�ri1�%L12J1"1'iI S
C".F.MI1 ,Y CROINTLL C 0MN1LNNS'FfES
1:31.5 SO. `D" MkE1!. •r, StF., -9200
1535.90. "D" .STREFT� Sr . #200
SANT BERNARMNO CA 92408
SAT: BM f.ARDINO CA 92.1018
f4�19�y1 s(�07 c>L. 2120
USE OF PERMIT
tiINGY.E FA- LY 1�'1?V•K?.1 t.KI+xG
SPD -• L- '26, PLAN 3R, .- PEitNOT DOES NOT INC.100E BLOCK WAT.L
OR Pc;iOLA LAN CIV'CK.FFE REDUCED 7,5% FOA P44TIPI.E 13STJANi E OF
& W TL AN TYPE.
WSTOIa-I CONSTRL.YGr.ION 2 :498.00 SF
PORCWPATIO 176.00 SF
QARAQ3v stC.r'il P0R'r X51"
rsi'1f0' .Tct9 h om, 6F co. iSuuerm
n1rP.23s.6o
PE1:'::^3lfT FEE SUMMARY
CONSTl LfC ION FPXI 101• -OW -418-000 $993.00
FLAN CIifiC"•K. FEE, -10 1 -000439.318 $204.1.1
I�11»r�1•l��zaAc;al,:s��� �0t��0c1-42.1-OI?t3 �as:��
r•�>
1. .C't'RICAL FEE $152.75
Pif fll lilll3 T7=.r^ , l(31-ID(tEb 419w'20>I. $174,50
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i •
TRGNO N1(Y 1GN 1+'FC - R&SiD 101--000-241-0019 44�.0� .
p
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GRX01NI Q FEF 101-0W-423.0 it)
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%3i,'€!ir:Lti:;a1i� Ti1•�AC'1 F'E� _ 3+b,9E17.0i3
r�,•�
ART IX_ P1JBL C TIL Air,.M - RE= 701440-255-000
SUB -'1'L71 Al, C'CJi ."A..'RUCl ION AND PL -AN Gt3l C`14
S),: 20.48
iiESS PM-,f-F.!'i1D FEES
Zw
TOTt> , PERNIFT.FEE 3DUP, NONNY
S3,820,48
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings/
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_4
F.A.U.
Framing
Insulation /
Fireplace A.L.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
I
POOLS - SPAS
BLOCKWALL
APPROVA S
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
Electric Final
Waste Lines
Heater Final,
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
//
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
Utility Notice (Perm)
Certificate" of Insulation
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: Tr21846 Plan #: 3AR Phase: Phase II
Lot No.: 26 Job Address: 54-994 Tanglewood
Ceiling Area: R-38 Blown Fiberglass
Exterior \Nall@: F.-13 Unfaced Batts
Knee Walls: R-13 Unfaced Batts
Signed
Garage Ceiling: Non Access:
With Living Above & Sloping Areas
Overhangs: Access Attic:
With Living Above
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. OJInsulation Co., Inc.
42620 11i Nedo, Temecula, -Ca 92590
Tom Berry, General M�
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:
Use Classification: SINGLE FAMILY DWELLING
54-994 TANGLEWOOD
Bldg. Permit No.: 9909-252
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
--7-.4, /4-1,
Building Official
Address: 1535 S. D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 111211/2000
POST IN A CONSPICUOUS PLACE