9909-251 (SFD) (2)LICENSED CONTRACTOR DECLARATION
I hereby. affirm under penalty of perjury.that I am licensed Linder p-rovisions 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 # Lic. Class ` E p: Date
a
"14108, t 1t�t6R9?
�r-
bDate '�'J � Signature of C;ontracM_
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 permit is issued.
`) 1 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. aye:
Carrier Policy No.
t301aT t"sN I✓!wGLiE .1NS. NWC: 5444116&01 .
(This section -need not be completed if the permit valuation is f6r,$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 sb 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 Selcii'on 3700 of the Labor
+ I provisions
hal
CDode��sh f„forthw.ith comply wit Yjhose�provlsion hIL
1aKte: �/� 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 resteictions 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 propeTrty for 1 spectioMpturposes.
Signature (Owner/Ag nt)
BUILDING PERMIT PERMTII
S,��
DATE VALUATION LOT_ TRACT
1 C� ' C X884;2 64)
JOB SITE
APN
ADDRESS5J 4) 1; C�L OD
C,
769-250-W 69-6 0-g
OWNER
CONTRACTOR / DESIGNER / ENGINEER
U1 IMY CROWELL COMMUNMES
CENTURY .CR%lW ILI, C0MM1.iNITLES
1.535 SCI. QD` STRtET, S'i'b. W206.
1533 SO. "w S°1".IR a t'; S" I°�. #200
SAN BERNAP..DINO CA 92.4041
SAN i3MNi ARS IN0 . Cry 92408
�93I31-fiiifl7 CBL`tI 2120
USE OF PERMIT
S AIC"r1�.'. FAiVEC%:9'' J.C�l% .1.tAIC�•
.
4FD - ILO'f 25, P1 -AN 2R, - PERMIT .WES NOT flit °E..1.TIDE SLOCIC. Uti°,qLL
OR POOL. .K AN CVECK FTE ft -D .fCED 73° FOR. MU.TI:P'IX ISSUANCE OF.
WE— MAN x+t"PE
CUSTOM COX.STRUL130N Z204.00 Sri
iPORC`I-I/P flO Say
GARAGWGAItk ORT :410'7.00 a
ESTIMATED COST OF CONSTRUM
184,23.U0
Tf°ERYWtaa FEE SUMMARY
CONSTRWI70 FEl? 10143410.418-M �9�rt1Q
FLAN QJECX FFE 101 -NO -439-318 3.193.52
:tdtF 'kU V21.411tAL• FIM ILi9-t)OtI-EE21-#31;0 398"50
FI.ECTIUCAL 101-00t7-420-000 $141.78
1'1.&!G':IBJNG FEE M-000-419.000 5173.25
STROtdt3MOTION FEE •- RFSID C91-00-241-000'_ _ $18,42
GRADING FFX t#J'1.-000-��d3 0{Pt9 $20:00
b ,�? �•
DEVICsL0I'L'1•i. AfPAt;ai FhF $1,907.00.
ART IN PUBLIC. PLAC,09 - RESTr701.000.255-M $210.59
51: B-'tyNe1•L (:ONST1I.r7t '1101 AND PLAN CHECK
$3,703.00 .
.
55 Mt"!AACS
D0.00L3:
TOTAL TIEWNIFT FEE DUE NOW'
$3,7433,06
RECEIPT
DATE
BY ! i
i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footing As 6 Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck pa 3 Exhaust Fans
O.K. to Wrap j F.A.U.
Framing
/
I Compressor
!
Insulation
Vents
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
Final
POOLS - SPAS
_
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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 /0
Encapsulation
Gas Piping
—
Gas Test / ME
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: Tr21846-2 Plan #: 2BR Phase: Phase H
Lot No.: 18 Job Address: 55-138 Tanglewood
Ceiling Area: R-38 Blown FIberglass
Exterior Walls: R-13 Unfaced Batts
Knee Walls: R-13 Unfaced Batts
Signed
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Non Access: _
& Sloping Areas
Access Attic:
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. OJInsulation Co., Inc.
Rio Nedo, Temecula, Ca 92590
Tom Berry, General Udnager- 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
Occupancy Group: R-3 .Type of Construction:
55-138 TANGLEWOOD
Owner of Building: CENTURY CROWELL COMM.
Building Official
vti
Bldg. Permit No.: 9909-244
Land Use Zone: RL
Address: 1535 S. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 10/26/2000
POST IN A CONSPICUOUS PLACE