9909-249 (SFD)LICENSED CONTRACTOR DECLARATION
I 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 # Lic. Class Exp: Date
c
Date ' Signature of Contrac or, -
OWNER -BUILDER DECLARATION
I hereby affirm under.penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
as owner of the property, or my employees with, wages as their. sole
't 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.
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.
GOLDENVAGLE INS. t�C 54406S-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, land agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,I sh 11� ocjhw,ith comp`ly/�wi those pr v sto1 s. I • ��
Date: Applicant-1�'`'^°""'''
VWarning: 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
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 pro rt for,it�nspec ion purposes. _
�Slgnature (Owner/Age tj'`'�.�--^Date`-�w" /•/.
BUILDING PERMIT PERMT#
Ink
9"9449
DATE VALUATION LOT, TRACT
��^'�' «.� / �++y ey rye,® .....,.----•----- —: -
JOB SITE _
ADDRESS 0.
APN
769-25X067 '
OWNER
CONTRACTOR / DESIGNER % ENGINEER
CR'N'1'CfRY C KONVELL CX) MI NIUN':MES
C.EItUAY CRiCa.VELI. C;(7MNILTNUT1ES
1535 SO, "BJP' 9MEEt STF. 420-a
1535 SO. 'IT)" TrR. , S'i'd, g200
SAN BERNARD010 _ CA. .92408
SM BtRNA.RD:M10 QA 92 308
c xi j � 7 CBL# 200
USE OF PERMIT
�I'I7 - LUS:`�,',PI..Ai+i 'R, . PEILhhi['I' i�7F'sS Idt:�"i° I1dCL;i7l�E FL,f::W,4lli. ': "
OR P0101 MAN CfjWtCK FLEE RM- 1XIM 75?4h FOR f4iffLTI.PIX, ISSUANCE OF
SAM PLAN TYPE:
CUSTOM L"C)N.STWla""ii'I+t N Z.393,00 IS
POR. H)PA'i �O 1176.00 SF
GARAWCARPORT Sr
TII1'IATED CWT OF CONS` RIII)C TION
2t) 42A.6fb
PERMIT ME SUMMARY
ARM
C ONISTRtfL;9" ON FEEfl :A-i}00-�1<t3�47�?E? $ :IFC►
PLAN t:WC F—F-E 101-000-419-318 $204.I1
1M.''FIANTICALFEt '. to1,-0100 21-V0 $98.50
.. ^rl
'
ELE'v" ZICALJW.� $152.7
S1X50
STRONG W40TION FEE, - RESID 401-(M-241-000 M
€a7
GR13f)I1�G 1.03-000-03.000
-fi''rrr
F . -
i7F"sVlr:LOPER WPACTRMI,i,�1t)7.i�3
r
Wr IN KIB1,.IC PLACE51;- X511: 701:-000-255.9300,.0
(. ,
;5t .]B-?"YXE'1 I.A' CO- SI'RLW lON AN,%3 PLAN C YECK
$3X0,48
LEW OU -PAID F131.,,5
$0.00
TOTA.I, I'ERAUT FEE.S 10U9 NOW
$3,920.48
AA,
RECEIPT
DATE
BY i it
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms &Footings Ducts
Slab Grade /f Return Air
Steel /-' Combustion Air
Roof Deck Exhaust Fans
O.K. to Wrap F.A.U.
Framing I Compressor
Insulation Vents
Fireplace Pg.L. ; Grills
Fireplace T.O. a Fans & Controls
Party Wall Insulation Condensate Lines
Party Wali Firewall A+
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
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral A
Pool Cover
Sewer Connection // r�
Encapsulation
Gas Piping
Gas Test Q
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 wiringor 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 #: 3BR Phase: Phase II
Lot No.: 23 Job Address: 55-048 Tanglewood
Ceiling Area: R-38 Blown Fiberglass 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.. OJlnsulation Co., Inc.
42620 Rio Nedo, Temecula, Ca 92590
Signed .
Tom Berry, General Man (r -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 LaQuinta
` 5
BuildingSafety and 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: 55-048 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-249
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
'/dam
Building Official
POST IN A CONSPICUOUS PLACE
By: DANIEL P. CRAWFORD JR.
Date: 10/27/2000