9909-242 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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.
",[Sate Signature of Contra'btor. , --_ �;,•-,: _..
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).
() I am exempt under Section B&P.C. for this reason t
Date Signatureof 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.
(Wl'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.
GOLDEN :EAC E INS, . 14WC 54406M]
(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 provisions of Section 3700 of the •Labor
Code, I shall f • rthwith comply, with -those provlslons.
D fe:jle '� / ? f • APPlicani 3 , ' _ tti+� �r..�4�, _:._ .»•
turning: Failure to secure Workers"Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section'3706
of the Labor Code, interest and attorney's.fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set.,forth on'.hi's
application.:_ -
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this applicatiori becomes null and void if
work is not -commenced within 1.80 days. from date. of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above mentioned prop rLy for insp \tion purposes:
Signature (Owne:_ge
PERMIT#
BUILDING PERMIT
DATE. VALUATION LOT °�' TRACT_
..
f::.. t.;_, ,C"tr✓'; �'i�2�jS�•7.18R - �pr5`J`_'_`�----.•
JOB SITE _
ADDRESS f`59-174 TNdi;E�_ 666
APN
769-2S0_067
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CEI+J"1YJi Y C�CD'WE ,1. �90�r8.t UNi�'1ES
CBN'��."iX'�Rl�1�rE 3: CC3iv4 ftlNf'T't TS
1535 SCS. hew S'.1"RE%1, S`1�F. %
1;35 s0. "IY MEE-'�','>`�'i >. r# Qt}
SAN BERNARDINO CA 92408
SAN BER.NN3t:{?iltiO CA 924008
i0_9)381-6007 CBL# 2120
USE OF PERMIT
:91NUE F."M X DNATILING
- LOrr l6, PI..AN 4R, - PERt�i T DOES NOT C`1iiIlJE BLOCK IYAU
OR P001,, PLAN CE1'EtsX FEE REDUCED 75%FOR NiULT(PLE, 16aaUANCE Of
SANX PLAN T'Y'PE.
CtJMM CONS RUCTION ' ,778.00 SF
PORCHIPATIO 176.00 8F
GARA,MCARPORT S'F
IA+YA'$TED COS Or, C'•OOYC' UC7'10N.
;228,547.04
'PERMIT FEESUMMARY
CONSTRUCTION FEE 101-000-41"00 5.1,091.00
PLAN CUM FEE. 38
MECNANICMGFOS $9:5.150
1 t
.
MECTRICAL FE8' .'101-400-4720-000 S 1541.73
p1.I3N fNGFkY. $174,50
», M
13`i`R.L7ri#{1.111Uf1ONFill — RX. SID . 101-000-249.-000 •s2w.8S
l�''� °
GRADING FF 1t1�-�ct(9-42`'►-OQ�J �2ta.��,r
f7
DE1II&LOP:R IMPAC"1'.F1ES $1,907.00
Ali f. IN 1rtT6L1C PLACES •• 11tE.SM 701--MO-755-000, 3321.37
SLtB-i' 1 [0.1, C-ONSSi"f4ttClICiN.ANf)1' PFPN CREC K,
$43022-13
CESS .PRE -PAID t EE',
$0.11
TOTAL PERMIT S DUE NOW
54,12213
RECEIPT
DATE
BY l/. ` 1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
Framing
Insulation
Compressor
Vents
_
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
zD�
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
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
I 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 M 4BR Phase: Phase H
Lot No.: 16 Job Address: 55-174 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.
42620 Rip Nedo, Temecula, Ca 92590
Signed,
Tom Berry, General Mana�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: 55-174 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 9909-242
VN Land Use Zone: RL
Address: 1535 S D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 12/7/2000
POST IN A CONSPICUOUS PLACE