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9909-238 (SFD)LICENSED CONTRACTOR DECLARATION' I h8reby 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 # Lic. Class Exp. Date C r� �. P . {• £max: d A Jd� •v�:�+a:..:... y©ate 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:. ( ) 1, -as owner of the property, or mg.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 a certificate of consent to self-insure.for workers' compensation,• as peovided for by Section 3700 of the Labor Code, for the performance of the work for which this peemit is issued. (yji 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 •rio' are: Carrier Policy No. C.'OL[JkTI RACaI.E 1N3. NWO, M440684 r (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 es to become subject to the workers' compensation laws of California, and agree0hat if I should become subject to the W rkers' compensation provisions of Section 3700 of the Labor Code, I shadfort. . ith comply-witl{4i•those provl'sloas., f /warning: �(, APplica`n;} A�1 ' Warning: Failure to secure Workers' Compensation coverage is unlawful and. Shall subject an employer to criminal penalties and civil fines up to $100,000, iri 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. mployees.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 inspection urposes. j T Signature (Own 'f i ,1 �eDate. BUILDING PERMIT PERMIT#_ DATE. VALUATIONLOT �— TRACT $2 1.00 �8.. tr ;:cert JOB SITE JOB APN a �Yt ADDRESS ' d� t�at�CsIF�iv�W6,7$Q-�1O»067 . OWNER CONTRACTOR / DESIGNER / ENGINEER L"EN'1't3P,Y covvELL .COry IUNfiT:iLS (� ENr�CJW3 r�ROWELL COt'1�MLtP�.� ..ES 1535 SO. "L3".. STPLE E Ti SIE. # 200 15.35 SO. "D" 8 MEET, SIR k"200 SAN BERIrN,ARLDINO CA 924109 SAN BERNARD WO CA 92408 (9t?!paI�6w, CBL# 2120 USE OF PERMIT S7N?:Cai.l il=A�Qrd.Yi3A�,'3~LU NC OR POOL. PLAN CMC"t,: M. RIM- T4M.) 7.il,"o FOR MULTIPLE ISSUANCE OF SAW PLAN 71'PE CU., i'C M CONS `R.UC"S'IO N 2,77$.00SF POACWPAT10 1'lb,tm :tip GA AG CARP II Y 300,f1t1 'liF PERAUT PEE SUMMARY ~t CONSTRUCTIONt :$"its 3031-'tf{►ii-4i -OLt� $9.t3911.4kD Tf PLAN CHUCK FEE 101.-000AV-318 •�a,38 1 �CYA fNGt'+I..F 101-000-421-400 ��•�Ci 4 a1iRi+."..'%FRE t(3k-0-'?C)•U�t19 $.164.73 _4 z . PLOT EIrNG F'RC: $174:50 .c GRADING FM $?W.00 i213FL OP R AVAa.0 F 1 BR. ART114 PUBLIC PLACES - RESIC 70.1-i3004.S$4w $321.3`?' �W S1 TOT. L N. ONS'MMi'Nt:)N AND PLAN C'RECK $4,€2-233 LESS PRE-PALIFEES' U):.',() iD 1 � 1[.1� 0 �'..KES �DiJd::t�NOd�' RECEIPT DATE[ i DATE FINALED INSPECTOR INSPECTOR a I; INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &Footings Ducts Slab Grade j Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap _ 7 F.A.U. Framing Compressor Insulation / Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final ?oN7. 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 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 .9/707- Encapsulation Gas Piping Gas Testi~� 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 Certain Teed 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 #: 4AR Phase: Phase I Lot No.: 12 Job Address: 55-264 Tanglewood Ceiling Area: R-38Blown 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: 1 Subcontractor.. OJInsulation Co., Inc. - 42620 Rio Nedo, Temecula, Ca 92590 Signed Tom Berry, General M ager- 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. �;d9rdficate n p"y City o L�'a Quinta Building and Sa'"fety Department This Certificate issued pursuant to the requirements of Section 909 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: 55264 TANGLEWOOD Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction Owner of Building: CENTURY CROWELL COMM Building Official v ni Bldg. Permit No.: 9909-238 Land Use Zone: RL Address: 1535 S.- D STREET STE 200 City: SAN BERNARDINO, CA., 92408 By: GARY HARTMAN Date: 9/26/2000 POST IN A CONSPICUOUS PLACE