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9909-250 (SFD)LICENSED CONTRACTOR. DECLARATION I hereby affirm under penajty of perjury that I am licensed under provisions of Chapt4r 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 Exp. Date t ; Date j'f'. Signature of Cont actor -(;-_° s . OWNER -BUILDER DECLARATION - I hereby affirm under penalty of perjury that lam 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). O 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 whichthis•permit istissued. ( CJI 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:carri6r & policy no. are: Carrier Policy No. ' GOLDENEAGM, INS. (This section need not be completed if the permit valuation- is for $100.00.or less). (-) f 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; 1 shall fo hwith comply, with those provi lonsi� ## '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 37.06 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 160 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 ppperty forinspection purposes.' /'Signature (Owner/ g 1st) -'Y=�� - (' �q_--•Date f V:4 Y.r y BUILDING PERMIT PERM T# �� "7_i" -k ----TRA T DATE VALUATION LOT . -' .1114"1S2-28.4547.4110 ,24-A JOB SITEz , APN ADDRESS �t �1 1� rrL Q {1•+0657 -169-250.067 OWNER CONTRACTOR / DESIGNER / ENGINEER CENTURY CROI ELE.'. C-61vi114[." [TIES Ch"AS'f9L1ia Ci .01 rELTI COIVSMiJ1V! rIES 1335 9-0, "i u STi'k':E "i',. STE. #2.00 1535 SO. "D" SMET,;S'T'E. 0200 SA14 BERNAR.MNO CIA 9.2408 SAN BEtNr1RD NO CA 92408 f; 0� 3 1 4K1"r 4 'BL'# 2120 USE OF PERMIT SiNaLk FA.M11-Y ONi'FLUNG S D - LOT 24 PLAN 4R. - PERM, DOES Af©"i INCLUDE BLOCK WALL OR ,POOL, PLAN cHEC% nF w R> • i313C.10 753 u FOR W,8."a'.>Pt E (SSi.3Q:Pt E OF SAME PLAN iCir'PE. CUSTOM CONSTRUCTION 2,778,0(1 SF PURCH(PA110 176.00 Sig GARA,+,3FJCARPOK17 500.0019F, ` AV -ST FAINTED COST Ole NST'R�.f4;°T�4 =,5-47.00 PERMIT FEE SVMNbkRV COAs'4*1 tLfCT10N FSE 101-0{)li-iii$^i3�Jij $1,if3l..f�0 FLAN CEMCKFEE,tO.i-Q(Ja- 35� 31 3 52 3.3k3 MECHANICALFEE 10.1.0111 Alf -1100 4i�.SCO j1r1,1 C1'.R1CAt, rEh- $164.73 r PLUMBING FEE 101-000419-M,- STktONO MOTION Fi- - RESD) 101 -.000 -241 -NO, CttYA1J'YAj"G FFE $2wbo 1010)?!'.;OPORIMfsA,CTHIM e AXf IN PUBLIC"* Rr-S,Fr 701-000-2SS.l01 1 $321.37: 711 •? SU&TOTAL COM3' UCTION AND.,PLJVq CHE C $4,022.;33 LESS VU -PAID FE, ES `T'O'T'ATI PL -miff rm Dim. N $4,022.33. RECEIPT DATE i ' BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &Footings /L Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 00-0 Exhaust Fans O.K. to Wrap F.A.U. Framing _ / Compressor Insulation _ ¢L /�L Vents Fireplace PL. 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 elzma 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) Y T 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 #: 4AR Phase: Phase H Lot No.: 24 Job Address: 55-030 Tanglewood Ceiling Area: R-38 Blown Flberglass • Garage Ceiling: Non Access: With Living Above & Sloping Areas Exterior Walls: R-13 Unfaced Batts Overhangs: Access Attic: Knee Walls: R-13 Unfaced Batts With Living Above Interior Walls: R-11 Unfaced Batts Between Floor: Subcontractor.. OJInsulation Co., Inc. 42620 Rio N o,Te cola, Ca 92590. Signed- Tom Berry, General Manager- T mecula 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: 55-030 TANGLEWOOD Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-250 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: 'CENTURY CROWELL COMM Address: 1535 SO D STREET, STE 200 City: SAN BERNARDINO, CA., 92408 . �.� By: DANIEL P. CRAWFORD JR. Date: 10/27/2000 Building Official POST IN A CONSPICUOUS PLACE �1� r, 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: 55-030 TANGLEWOOD Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-250 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: 'CENTURY CROWELL COMM Address: 1535 SO D STREET, STE 200 City: SAN BERNARDINO, CA., 92408 . �.� By: DANIEL P. CRAWFORD JR. Date: 10/27/2000 Building Official POST IN A CONSPICUOUS PLACE �1�