9909-237 (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 3.0f the Business and
Professionals Code, and my License is in full force and effect. -
License #
ffect.-
License# Lic.Class I Ex pi.
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:
( ) 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 & Prof essionals.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 Sectiori 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.
(�J 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. aye:
Carrier 'Policy No.
GC3r�7 ,`Lla INS. N - 544068-1011
(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, land agree That if I should become
subject to the workers' compensation provisions,.ofzSection 3700 of the Labor
C' de, I shal forth ith comply wl those=provslonsl
te: /C; O : ! Applicant
Warning:,Failure•to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up' to $100,000, in
addition'to the cost of compensation, damages as provided for in Section 3706
of'the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made, to the Director of Building and Safety
for a permit subject to the conditions and. restrictions set forth on his
application.
1. Each person. upon whose behalf this application is made & each,person at
whose request and for whose benefit work is performed under or pursuant.to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the.City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180•days from date of issuance of.such
permit, or cessation of work for 180 days will 'subject'permit to cancellation:
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby: authorizeyrepresentatives• of this City to enter upon
the above-mentioned prope4,for iAsSp'tebctlo°t�purposes
C
pSlgnature (Owner/Agent)' •-'Date
BUILDING PERMIT PERMT# .
DATE VALUATION LOT �` TRACT
JOB SITE -
APN
ADDRESS y��
t l
"M282 ,�$i'ii(.1 '``'t!'1wo
76f-•2.�'SM-•067
OWNER'
CONTRACTOR / DESIGNER / ENGINEER
4;ENIMY CR.OWELL.COMWIN'MES
CENTURY CROWELL CO11RMUNIMES
1535 SO. "iZ" 8-MET:S"17. #200
SAN BERN RDINO C ik 92408
S,N BERNA.RDINO CA. 92408
(�3i1 X81-fi0t1 � CBLO 2120
USE OF PERMIT
-1 n .67 i A AIA t NI `,
. .
SFID - LOT 11,1 LAN '2I2, - PEWIT DOES I Cff INCLUDE BLOCK. WALL
4R POOL. PLAN LACK FEE REDUCED75n FOP, NiULTIPLE r`3St1AV_4C ` 00.
SAnr1E PLAN'i^kW
C= 01%4 (X)N3TRM10N ?,204.00 SF
PORCH/PATIO 148n.(SO gF
Crt? RACIILYC.ARY+ORT Nf".-'.00 SF
W:MUTE D 0=* OF C:ONSt'.L':RU01ON
1844233140
PMMIT jjt RE SUMMARY
C0NSTRUCn0N FA-,' $9370
PLAN Ct�"CK FEE 01-SiW439.318
IkiI:.,01ANILAL F'7F.
U- SSC11RLCAL Fm 1i?1-tM30.42U-43SN) 51 3.7i#
711
PLIU BINO FEF 101-000-41940 $173.15
STROW MOTIC.)34'FEE -RE,811D _ 01-400-241-000 $15.42
Ga Uki' INGr FU $24.00
DFIVELC. RNR I: IPACIT fir
AWf IN Isi,iE4LX PLACES-.RE31l; 701-000.255-0es
a
y
SUB -TOTAL CONSTRUCTION -AND P.LA N CHL"C �
$3,7703.0.6
LESS >r'iti -PAID FEES
$0.00
N.. .`TCD7tAL, PBRMIT FEE ,$ -DUE, NOW
RECEIPT
DATE
BY E
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing i
Compressor
Insulation
= Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
f
Exterior Lath
Drywall - Int. Lath
Final PR
BLOCKWALL APOVALS
Final
POOLS-SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
i Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
j Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
j Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
J Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
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 ##: 2BR Phase: Phase I
Lot No.: 11 Job Address: 55-282 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.. OJlnsulation Co., Inc.
42620 o Nedo, Temecula, Ca 92590
. Signed
Tom Berry, .General M4er- 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.
ricate of :. ccupanca
City of..La ®nfa
Boildijigand Safet Departme*nt0 E TNS'
This Certificate issued pursuant, #o. 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:
a
BUILDING ADDRESS: t 1 55-282 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-237
Occupancy Group: R-3 ;Type,of Construction: VN Land Use'Zone: RL
F I
Owner of Building: CENTURY CROWELL COMM
Building Offit-51i'al '
Address: 1.535 SO. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL. P. CRAWFORD JR.
Date: 7/28/2000
POST IN A CONSPICUOUS PLACE