9909-247 (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,arid
Professionals Code, and my'License is in full force and effect.
License # Lic. Class t� Exp. Date
vDate Signature of Contractor -
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).
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 which 'this permit is issued.
(k)) 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:
Cartier Policy No:
GOLDEN EAMv WS, td WC WM-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''compensatlon prow dons of Section 3700 of the Labor
Code, I k•�sh ll forthwith complyiwlt�i�those:provlslo
gate:.`I � ��c . t APPllcart�r_ �, 1,:++•dl.�?� r fes;-"'""; . ,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer, to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT. Application is hereby made to the Director of Building and Safety
for .a permit subject to .the conditions and restrictions set forth on, his
application.. "
1. Each person.upon whose behalf this application is made & each person at
Whose request.and for whose benefit work is performed under or pursuant to
anypermit issued as,a result of this applicaton agrees to; & shall, indemnify
&, hold harmless the City of La Quinta, its officers, agents.and employees:
2. Any permit issued as a result of this application becomes, null and void if
work is not commenced. within 180 days from date of issuance of such
permit, or cessation, of work for 180 'days will subject permit to cancellation.
I certify that I have read.this application and state that the above information is
correct. I agree to comply with all City; and State laws relating to the building
construction, and hereby authorize representatitves of this City to enter upon
the above-mentioned propertytfor inspection purposes:'
b9,
S gnature .(Owner/Ag t)• .�w-- � +�""",Date -e'ef
PERMIT #
BUILDING PERMIT"
. ; �~��-�-�
a-^"-'_"-�
DATEf VALUATION LOT �.� TRACT
JOB SITE
ADDRESS
APN
OWNER _ _
CONTRACTOR / DESIGNER / ENGINEER _
1.335SO. IVI STREVD':, SIT, UNI
1535K ":D'° S''T F'[ A- . #200
SAN BBRNAR D,WO CA 92408
MN BERNARD N1 0 CA 4241$
(90:}3 I-6007 • , CBLN- 21.20
USE OF PERMIT
SINGAY VAMILY 1'iiYTILING
ISk' O - LCA 21., .PLA 4R, - .PULW DOILS NOT •BY+FCLU�1 a BLOM'4 ALL .
CFTC. POOL. KAN CFI7xx r,ev RliMICED 75-APOR MULT.%PIX rISSUANC`6s OF
SAME PLAN T%W. ,
COMM c£?NS rRUC`rION —178,00 SIF
PORt:I PATIO , 176.00 SF
GA.Er2ACaMARVI t' ".0.00 SF
1,S'F 1 E D C(XV l' Dli CONST'R(3UIIDN'
'vi7.d4�
PERIWlf FEE SVMM A RY `
C-ONSTRUC TIOTf FEE $1,091.00
'PLAN OEM R 01-M-439.31.11 S=138'
WiCHANICAll.'J. n_' -000
ELEC"'i'Rtc Xf. VC. lA;f-a4Ei %tii-4 $164.13
PLUidvR [� l 101 -000 -419 -OW $174.55.0
STRONG h9OTILIN !: » RESLD '101-W-24'000 $2'2 85
CYRA1DIN FEE 101-000423-000' $20.0
w
it r
YMWSLC►PEAIMP.Ar-1' Fkid?
�`
ART IN F43BL.?C PLACES - RSM 701•d1W255-000 SS33.07
O9`4f r
SUB -11- IS�'�t� SC'IIi.?N �.ND P1.e� 1 CHF.C. K
$4,422 33
LESS PRE -PAID FEE -a
►.tDl,
'1~i3TM, .1V°ERTkUT FEES DUE NOW
�t9{D'ZZ.33
RECEIPT -
DATE
BY �`+'
DATE FINALEDINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
k
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
!�
Ducts
Slab Grade
j
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
_
(�
i Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final _
BLOCKWALL APPROV LS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I 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 Ins-Ulation..
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 #: 4BR Phase: Phase II
Lot No.: 21 Job Address: 55-084 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-1 i Unfaced Batts Between Floor:
Subcontractor.. OJInsulation Co., Inc.
4 620 Rio tedo, Temecula, Ca 92590
Signed
Tom Berry, General Mang er- 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.
s
Certificate of Occupancy
City. o -f La Quinta
Building and Safety Department
This Certificate 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: 55-084 TANGLEWOOD V
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-247
Occupancy Group: R-3 Type of Construction: VN Land UseZone: RL
Owner of Building: . CENTURY CROWELL COMM Address: 1535 S D STREET, STE 200. .
City: SAN BERN ARDINO, CA., 92408
J;ZZ.,.`.►� By: DANIEL P. CRAWFORD JR.
Dater 12/5/2000
Building Official
POST IN A CONSPICUOUS PLACE
I
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