9909-246 (SFD)LICENSED CONTRACTOR DECLARATION . .
I herehy 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 infullforce and effect.
License # Lic. Class Exp. Date
11 Y `r ��� ! ��
'7141P-0/31114.
s
ate 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:
(.) .1, 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
Ihereby 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.
GOI<DEN EAC.L.E INS' NWC s440694A
(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 ifI should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall fo hwith comply witfj'those provisions. p u
Date`i/11/4 r Applica`n't t�,%1 FaL
V 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 employee's.
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 propertyfor inspection purposes.
,� %�M ,
V/
Sgnature (Owner/Agent is � ;A^' Datet- �J
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
-
JOB SITE
ADDRESS
55402 TA� GLMMI i
APN
769-•2W0617
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A3"i`d T1'ti' :R'�3�PEt:d. A�V1l Itft' '4 :'S
CEIo?ITIXY C.ROWELL COMMUNITIES
153.5 so. "m S'I:�.E T, Sn. 42.0o '
1.53 30. "M SfiRE.FT,. S"i'E, 9200
SCAN 1311tNARDINO CA 924418
SAN SEXNARDINO CA. 92409
t 9U�S3381. 3;' C81;0 1120.
USE OF PERMIT
'SANGLE FAMILY DTVI EN 1:." O
Si'U -LOT '?4i, PLAN 39, - KiTt filo'?.' D(1YR5.N10T JNiri:UDR'EIWCX WALL
Olt POOL.MAN CWC" Ii: M, 4ZE Y CM -750/ao FOR :M LTIPLE 1SSUMCE OF
S Yilth'E PLAN 1 -YM.
Ct1;y'I'OM CONSTRUCTION SF
t Rr UP�1'i"IO MAI Sr
GABA 3E1&ARPORT
&STINAM MIST OF CONSTRUCTION
2001238.60
, RMIT FEE SITIMMARV
CONSTRUCTION FE's lflld)�ttD�diS-t?SDt? $�93,Oi)
PLAN CBECK `tri I pI M0 -XV -318 $201,11
NMCHANICrklI FEE $98.60
'fiLil-di+30w4�11
f LEC-rRICAL FEE 4112.75
LUPOINNG FEE, 101-000A9-000 E9 -t0 $174. _%
STRONG MOTK)N EEE - RtES9D 101-000-241•-M $20,02
4
O e YFiCI :F 101-0004Z3-000' 320.00
-1
DEVELOPE„1 AMPAC:T FEi»
. RT IN PUBLIC; PI -ACF -3 -11J,31C 701-•1)110-15"00
l rl �'11(iTfii L. {rC7�i$TR{ �C"fl N �I� D F'.I.;�l1,iV. CR E(:'•1�, `�
' .3,'tl". 0,
LESS PRD PAID EEE
$0.00
tI�3FAL .$!1rRM17 %j♦'E:ES .Dill; N(XW
s3"S20 A S
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 via 01_
F.A.U.
Framing 'fi
Compressor
Insulation
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -
Drywall - Int. Lath _
Final
Final
BLOCKWALL APPRO ALS
POOLS - SPAS
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
'i
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 M 3AR Phase: Phase H
Lot No.: 20 Job Address: 55-102 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.
42621D Rio Nedo, Temecula, Ca 92590
Signed, i
Tom. Berry, General Manager- 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.
Certifica'te.ofocc-
upancy
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: 55-102 TANGLEWOOD
-Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-246
Occupancy Group: 13-3 Type'of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM Address: 1535 S.'D STREET, STE #200
City: SAN BERNARDINO, CA., 92408
'��1.►� By: DANIEL P. CRAWFORD JR.
Date: 10/20/2000
Building Official
POST IN A CONSPICUOUS PLACE
t I