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9909-241 (SFD)LICENSED CONTRACTOR DECLARATION . I hereby affirm under penalty. of perjury that. I am licensed under provisions of Chanter 9 (commencing with Section 7000) of Division.3•of the Business and -0rcfeisionals Code, and my License is in full force and effect. License'# L10. Class Exp. Date ".1 �1-Y.W i . 4©1119! A �' i DaieSignature of Contractor . OWNER-BUIL'DER1..DECLARATION I hereby affirm under penalty of perjurythat 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:s 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,,4or,the performance of the work for which this permit is issued. . 0.) 1 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._ t'iOMM EAME INS, (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' compensa, on pro,oision�oYSection 3700 of the Labor &ode; Irs all,for�hwith comply with tliose�po�slons ✓ ate: 1 Applicant i Warning: Failure to secure. Workers' Compensation coverage is unlawful and shall subject'an employer to criminal penalties and civil fines up to $.100,000,•%n addition to the cost of compensation, damages as provided for in Section. 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a •permit subject to. the, conditions xarid' restrictions set forth: on, his application. . s 1. Each person upon whose behalf this application is made & each person at Whose request and for whose benefit work is performed under or pursuant to any,permit issued as a result of this applicator agrees to; & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is' not commenced within 180 days from date of issuance of such permit, or'cessation of work for 180,days wili subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all'City, and State laws relating to the building construction, and hereby authorize representatives of this City to, enter upon the above-mentioned property for in �pectiApurposes. gnature (Owner/Ag nt) 5 Date ")f . PERMIT # BUILDING PERMIT �21. DATE VALUATION py►� y r LOT TRACT J ��' .. .. .. r JOB SITE ADDRESS APN 7694;9 ��9% OWNER _ _ CONTRACTOR/DESIGNER/ENGINEER _ CD, T1 =Y CRONlyIELL :.;i MIAjurP,'i�!��' G`E1�1►T� k'Y (I�C2�V'EE:.�:; C:(.��'R1I�`+1�•ES 1 3a S0. : v :ii 1� ' T; .. #'>4ti 1535. SO. 111, S"i"k�.E,��I';,; S �. '200J �sERNA�.D'� O M CA. W408 SAN BE,OT IN0. - CA 9208 t(i931313' ., C13.14# 212Q, USE OF PERMIT D -1.OT f3, PL.AMIR - .►> iVi3 F .00.9 E+iC33' tAtE;S.Ilk� iS: WALL OR POOL. PLAN C# FM' FW. RTff JC F.D 750,4 FOR MULTIPLE 13-S 1'A1`fMIF SANTE KAZ4 i'i'PIE, CUSTOM i"ONSTRUC;;'ION 2,��8.bt► "� PO.RC: P AT.10 176.00 S GARAGEVC-ARPORB - 566.00 SI% EST IMAITO COST OF CONSTRUCTION 280,238.6-4-1 TERAYFF FEE '$i3�'tie`fI.eARY C O`N9T UC110.'N "FEF 101-000418-000 PLAN C.MC K FEE 01-0)439318 sm".11. tllFrC�%tAPdIC:;��. 4�: ; .: • .. - i 1.11-t3(��1-�� x -tom �3.StD 0,EC:`I'R.1CA L:.fn01440421?-O00 $152.75 PGCPA,iTiATaC�r'�`E 101-0019-000 $974.:'t0 Y"y . _ S'CIEi(,YNC34fO1'IGN ii -;t .0.E.»000-34140 CI:N',7x1VGR L7RVTJ- OP'M. NIPAC; T FEfv 'a;'t =� ART IN"PUBLIC PLAC,F:S - R681, ` 01.-OW-255-0i2Q.. -S251),s51) f r rte. i SMWrAL CONSTR[iMO N ,AND PLAN-C;fiW9. $3,821.481 LESS PRL -PAID FEES' M00 T(YFA1,.0ERM1T.F.M DUE NOW SOMAS RECEIPT DATE BY$ DATE FINALED INSPECTOR SIK+:1 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &Footings y Ducts Slab Grade Return Air Steel Combustion Air Roof Deck / Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation � ' Vents Fireplace Pf.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ ; _ 1 Final 2� GZ� BLOCKWAIZL APPROVALS Final steel -�Y-i,4 POOj.S Set Hacks Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines d' _ 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 #: 3BR Phase: Phase H Lot No.: 15 Job Address: 55-192' 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. 42670 Rito Nedo, Temecula, Ca 92590 Signed Tom Berry, General Manarr-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. 11 - Certific'te-.of.a Occupancy 4-- t. OF & Safety Department _Building ,'This Certificate is issued pursuant to the requirements of Section 109• of. the California ' Building Code, certifying_ that, at the time. ' •issuance, this. -structure ,., was in compliance with' •the - provisions of 'the Building Code and the -various. ordinances of -the City regulating building construction and/orwse. - . BUILDING ADDRESS: 55-192 TANGLEWOOD k Use classification: SINGLE FAMILY DWELLING Buildirig Permit No.: 9909-241 Occupancy Group: R-3 Type of Construction: VN � Land' Use Zone: RL t' Owner. of Building:. CENTURY CROWELL COMM - ' r Address: 1535 D STREET STE. 200 City, ST, ZIP: SAN BERNARDINO CA, 92408 r -By: -GARY HARTMAN _ s TDate: SEPTEMBER 22, 2000 Builcli6g Official POST IN A CONSPICUOUS PLACE