9909-245 (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# Lica Class Exp. Date
77
,/Date• % 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:
( J
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
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,
(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. '
(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' compensation provils(ons of Section 3700 of the Labor
Code, IQd1l,fort6ith comply wit tljoseprovlsios. gate: IApplicants C x�
Warning: Failure to secure Workers' Compensation, cove rage 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 riot 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'upoh
the above-mentioned property for ins ection purposes.
VSlgneii
Signature (O.wner/Agtj _ Date < I%
BUILDING PERMIT PERMTk
DATE VALUATION - LOT . TRACT.
-
-
JOB SITE
]APN
ADDRESS 554201OLEWOOD,
7ML25 X67
.OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENI'i,RZ Y CR.CI1e'rTLL C:oIv""VIlSN'rMs
CL"' i°my mCIwal, Cok"ItIIfi,TMITIE
1535 SO. "n" b"I RE'F'i"; 57P., #20o
1535 -SO,.. "V
SAN BERNARDINO CA. x408
SAN BEIiNA�d.DINO Cts SC408
909y1I3"L-Gi307. d;:8LO 2120
USE OF PERMIT
9
3FD - LUr 19. PLAN 4k - PERNT DOES NOT INCL;WE BLOC.'K. WALL ti
OR, POOL. PLA.14 CHFM' FEF PaFDUC"Fd) 7% FOR, WLTI[PLE 64SUANCE 4
CUSTOM, CONS'Q•k+`UCrl"10r4 :2,7178, 0 SIS
POR-C"ATIO 176AV SP
GAR AOF)C:ARPt•�''�"I 30tJ.f11? SF
5'1'.IMXrEV CWTOff' C*0 STRILICT10N
22, 4 47�ao
PEM1IT FEE SUMMARY
CONsmiT(";-io'14FEW' 101•-000.418-100 S1,091.00
1
PLAN QMCKFEF S =138
td601XXICAI.fill, . 401:447 T2IJ30€1 $99,50
_;� _.....
Es,ECl tl�; 103-000-112.wo 3164.73
P[.Y:fIb1BIM FEE '101- 419.400 $174.50
STRONG Ar10!".(ON FEE» REMD 101 -ON -241-000 $22.8+.5
ark{ "DING Fit I If irfllTti- 423»��U
0L?VQ,1 J1?R R0PAC'1' Y -FA 31,907..00
ART IINPUBL'IC PLtACES..I'',F-SIC TO I -OW255-400 'S32.4,37
�
•
4K�
SUl3=fiYl'AL C€7NIST42:i1i. HON AND .PLAIN CHECK
S4,022.T-4
LESS ER.&PIUD PERS
50:00
`7'
t
RECEIPT
DATE
BY j
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 17
Underground Ducts ,
Forms &Footings �dL
Ducts
Slab Grade /
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
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
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
Pool Cover
Sewer Connection /
Encapsulation
Gas Piping
Gas Test _ S
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)
0
0
u
Certificate.of Insulation
o
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 Glas's 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.: 19. Job Address: 55-120 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. _
4;620 Rio edo, Temecula, Ca 92590
_ Signed
Tom Berry, General Mo
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.
r
Certificate of Occupancy.
City of La Quinta
Building and Safety Department � o,�°
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: 55-120 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-245
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
i
Owner of Building: CENTURY CROWELL COMM.
Building Official
Address: "1535 S. D STREET, STE 200
City: SAN BERNARDINO, ,CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 11/17/2000
POST IN A CONSPICUOUS PLACE