9909-240 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch.4gr 9 (commencing with Section 7000) of Division 3 of the Business and
"P,rofbssionals Code, and my License is in full force and effect.
,License # Lic. Class Exp. Date
pN ate f - p 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:
(.) 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 project (Sec. 7044, Business &. Professionals
Code).
() 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 certificate of consent to self -insure for worker's'
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
Sec ion 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 EA:01.E 1NS.. NUIC.' 5940f"l.
(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, hand agree, that if I should become
subject to the workers' compensation provisions -of Section 3700'of the Labor
Code, I sIforthwith comply with those povlsions.�
Date: /13)'-42 �.. -APPllcant�-_L'- !�
V I arning: 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 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 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 property for insplection'purposes.
Signature (Owner/Ag nt)�`i'-' '*Date _
BUILDING PERMIT PERMIT#
DATE VALUATION. LOTTRACT
$228,547.00
JOB SITE -'r-''"p� 'r � !
ADDRESS (.%,g1��,i7�.Jf-G�I,r iC. vi> :kM1 C�M�D ..
.::APN
tt ry� n
W �t
JF►i'=.w�!tA- ►!%
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CEN Y C RO%IM1.L CONINIMUTES .
C1 N'iT_1RY CRCAITfS3:nL COMMUNMES
1535 SO. "!D" Vkt,' 'i', S' t 4200
1535 so. IV, 31,RE'FT",:STT. ;<200
SA:N HE1�.1�d.6A,17,.jC WO CA 92408
SAN BERN AR )INO CA 92408
C8L0 2120
I
USE OF PERMIT
SING1,F i:'FlFftY 1XVFI).:I..ING
9M! - L01 14, PLAIN Q, - .Pk"lr .Ari T DOES NOT WC UME BLOCK WALL
OR .P00I., PLAN C.HFCK kms+ REDUC ED 75% FOR MULTIPIX ISSUANCE F
aAr%T- PLAN T V?F_.
CU.T OM CONSTRUCTION 2,778voo SF
POR.CIVPA.T IO 176.00 Sr
C'sARAG-E.iCr' RPOR.T
CXK OF CORSTRUC110N
514
AUS, U0
PERMIT FEESUNIMANY
CLINS°t'RUCiONFI~E 1l31�63f �1t1it��f} �t:tr).i.at7
P11ANC"}1EM FEE 141-000,4:39-311 S^,Ln. 33
iWikCHNANUCAL i+F�.E 141..00t1!12b-GZZp $98..40
Ei::EC'fRICAL ME. 101 W07420-000 111164.73
i
PLMM11.10 FIE R.6?I-i)f)d8 iX 9.0 iD $174.50
r ,
.TMONOINI TICONFEE,-R.ESID, 1010-211.000
GRAD040 FW, 101-000-42.3-000
DE ELOPER IMPACT FEE
ART 1N.PUBLI.0 PLACRS ,. RESIr 701-.M10-,`65.000,
U_*
SUB-TOT-ALC`G31<i.;�'"tP11si"I.4(,��i AND PLAN CiEC1�.
$4,022.33
LESS PRE -PAID FEES
T TEAL PERMI! r FEES UE NOW
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
_
�lf
Return Air
Steel
0-1
Combustion Air
0-1
Roof Deck
Exhaust Fans
CK to Wrap
_
F.A.U.
Framing
Compressor
Insulationt
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
G+/,
r ZZ
Final
POO S - PAS
BLOCKWALPROVALS
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
t — —gyp
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures '
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
�i
Final
L
Utility Notice (Perm)
OA
Certificate. ofInsulation
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 #: 4BR Phase: Phase II
Lot No.: 14 Job Address: 55-210 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.
42620 Rio Ne emecula, Ca 92590 -
Signed r% o
Tom Berry, General Manager- Tklnecula 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 Occu,'",
ancy.
pof
uTm
Building & Safety -Department
- This Certificate is issued pursuant to the requirements of Section 109 of.the California Building
Code, certifying . that„ at' the time of issuance, this .structure was in compliance with the -
4
'provisions of the Building. Code and :various "ordinances of the = City regulating building,
.the
construction and/or. use.
4 BUILDING ADDRESS: 55 -210 -TANG LEWOOD ,
Use classification: SINGLE FAMILY DWELLING - Building Permit No.: 9909-240
Occupancy Group: R-3 - Type of Construction: VN Land Use Zone: RL •
Owner' of Building: CENTURY CROWELL COMM - Address: 1535.13 STREET STE: 200 -
S , City, ST, ZIP:- SAN BERNARDINO CA; 92408
By: GARY HARTMAN
Date: SEPTEMBER 22, 2000
Building Official
' J POST IN A CONSPICUOUS PLACE