9909-243 (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.,,
Liceritew Lid. Class Exp. Date
IdI4: � J 4 iW31ft4--
of Conra
r ,
�te' Signature tctor ' `-tl
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
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.
GOLDE q E ACIL F, INS. .NWC 54406"1 -
(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 Iperson 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 wprkers''compenlatlon pro�visionsF§f.-Sfectlorf 3700 of the Labor
Code ;Ishall-f fthv�yith comply w h those Oro,`vlslo. S—A
�•
Date: ` ( �.% 'r Applicant '`±".•" k ". ""'.•.
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
&`4hold harmless the City of La Quinta; its officers, agents and employees.
2. Anypermit issued as a result of this application becomes null and void if
work is not.cohimenced 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 l have read this application and state that the above information is
correct: 1 agree to comply with all City, and State laws relating to the building
construction, and hereby authorize,,,represefntatives of this City to enter upon
the above-mentioned propeity for inspection purposes.-
Signature
J
�(Owner/Ag'ent)" rte° • Date
a
BUILDING PERMIT PERMTk.
'
DATE VALUATION LOT r TRACT ,
J
JOB SITE
.+
ADDRESS769L2_%
APN
067
OWNER
CONTRACTOR DESIGNER ENGINEER
=l
C�h` l.Ro aq-T1 Cy1J�11TiSs1J
CENIdRY SSOYILILL 1Ip VxIS'
1535 90. "M" GIREET, SIT -A-206
1535 SO. "D" STREET,; 4Z
9200A:
SAN BERNARDR40 C 5�21=
'M
SAN BEt2NA:RDINO CA 92,408
(909)381-6007 CB.LY .2120
USE OF PERMIT
IT
GS��17r++ff��G1I ryr� 6s�� i w t p
p p��q-;��.��,7zy.I�rG4.r �e � ��� �� cwt Y Y �} �7 /� 7 WALL
.SM, LOT17. 1 . fq.AN IR, - Y" F'il.�.i J.r rES iw,+. 1. 'rW. 1JIDE BLl..YM W�3L.L. .
Olt, POOL. FLAN CHECIs FF93 RECATC mi 7750A FOR 2+''fLTIMPLE ISSUANCE OF
SAMEPLAN T"9`PE.
CUSTOM CONh"i'RY1CTION 21026,00 4KF
PORCHIPATIO 2:39.00 'Sig'
OARAGWC.ARPO}3 T 5.MOO S'F
i',S1"(MA�`I?:IiD (+t*T OF C;IDWS'fRMAC`AX
171J96 E4i
PERAl 'i' FEE SUMMARY
C'0NS`KLTC I1DN FTE 101, -M -41S -I00 $891,50
"? A
PLAN ILMECK FHE IS $181.41
t EX'HANICAL NTs.'U6.50
a y
Ei:IwC1'&2tf;A'L, F l�,.Y-irfYU=420�Qrafi3 $138.81
Pl;iniitl38NG rHEi 101.000-419-000 $148.00
STRONG I4Lt�3'.l�YN PEF.- RE U) 101 !41 -MID, $17.32
GRADING FEE 101-000.421,000 420.00
DEVELOPER IWAC9' f
ART IN PUBLIC PLACE-3-:8.ESM70t41'00- 55.000 sI7'7.XJ
SuB-1oI`a i"omSTkucTioN.AND ni%a t ctirG
3,s� 3t
LESS ERE<IsAt'3'FEES
$00i
x'017 i.F i''VR'i�vil.ff FEMS DUE NOW
RECEIPT
DATE
BY ''
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR 1 OPERATION
DATE
INSPECTOR
r BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs 17 Underground Ducts
F rms & Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck A Exhaust Fans
O.K. to Wrap F.A.U.
Framing - Compressor
Insulation % Vents
Fireplace W.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
i Final
Final 1
POOLS - SPAS
BLOCKWALL APPROV S
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 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 #: 1BR Phase: Phase H
Lot No.: 17 Job Address: 55-156 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.. OJInsulation Co., Inc.
¢26200o Nedo, Temecula, Ca 92590
Signed
Tom Berry, General M�
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 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: 55-156 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM.
Building Official
VN
Bldg. Permit No.: 9909-243
Land Use Zone: RL
Address:
1535 SO D STREET, STE 200
City:
SAN BERNARDINO, CA., 92408
By:
DANIEL P. CRAWFORD JR.
Date: -
10/11/2000
POST IN A CONSPICUOUS PLACE