9909-236 (SFD)j� LICENSED -CONTRACTOR DECLARATION, .
. •1 hereby affirm under penalty of perjury that I. am licensed under provisions of
�1- •;.� Qt4teir 9 (commencing with Section 7000) of Division- 3 of the Business and
• W Professionals Code; and my License is in'full force and effect.'
O ch License # Lip. Class Exp Date
f` dLO
iIr �
I` t i A
Z t,6` to v Signature of ContraC
O
00 f\ r
J.V coo OWNER -BUILDER DECLARATION
W w 1. hereby affirm under penalty of perjury that] am exempt from the Contractor's
~ a License Law for the following reason:
Z. ( ) 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).
LO () I am exempt under Section B&P.C. for this reason
N bate Signature of Owner '
rn
,CL Z WORKER'S COMPENSATION DECLARATION—
'It
O I .hereby affirm' under penalty of perjury. one of thefollowing declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided, for by Section 3700 of .the Labor Code, for the
ti J. Q performance of the work. for which this permit is issued.
Q U {x)t I have and will maintain workers'" compensation . insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for. which this
d rn H permit is issued. My workers' compensation insurance" carrier `& policy'no. are:
�. z Carrier Policy No. " - ;
co =) " „.
r- 0 43_AX1)E%4SA.CAX I? -4S. NWC 5440613401
Q (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 ithat if I should "become
' subject to the! W91kers'.compensatld6 provisions of Section 3700 of the Labor
3 Code, shdforfh ith comply wit t ose prow stons� v
Date: 4 Applica`n. �!� �< - w�..., ;x•
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 Stafe laws relating to the, building
construction, and hereby authorizerepresentatives.of this City to enter upon
the above-mentioned grope_for 4 sp.eytio•,n�•urposes.'
ja
4Signature (Owner/A ent)_�` ' ^A"�`""roateT i
BUILDING: PERMIT PERMIT#
DATE VALUATION LOT ..r TRACT
� (� • � • �,�� . ' ����8��47��3� , ., "� toy :� t � • ..
JOB SITE
APN
ADDRESS r-d3ii7 �.'•9tw�•v�.r,7✓7vSJ_4.�JiJ. .. .
qq�m}p tt!�yrTCny`
�- 7(AY`-Gr�-VYC�
OWNER •
CONTRACTOR / DESIGNER / ENGINEER
CENTURY CROWELL C`.0MW.T'' rr1ES
C'EN t'E.MYCR?}v�d�'i�ILr.COM, WI`S"l i 1F s
1535 $6. ro. at ST
1505 so.. 11011 SSI REE- 4 Sv , #200
SAN BLtt'RMRDINO CA 93108
SAN :BERN"AiWRIO CA 92.408
2120. .
USE OF PERMIT
bAfCTPr :1 a iR . X
- LO`P .I9, PL- AN 4R•. - PERWt DOES NOT INC•'Z DE—BLOCK WALL
OR FOUL, PLAN CHEM VEM R.MUC#J7 75% FOR WLTME IS3- VA �C,F OF
3APv PLAN T TPF_
C[tST%?cM CE3N Trikua itatq. Z778.0 SV
1
PORC WATIO 176.00
GAi'l.IAY.;tl ti"•:ARPO...k°. .= 500.00 SF
ESTIMATED l�F� "trA C CD +`GUNS'. RUCTION
'128,54.1-00
� Mq'pIYG'
-[-X•.IIW1V118 74 Fritm1,
's VIFA
CONSTRUCTION FEE 101-t)ikif418-000. Loo
PLAN CHECKT,749 1.�1-E3it0-439-3i� 14M�.::s1t
iAF"ANWAL.FRE.: x®d tifltl. l.I-ta it 19830
ELECTRICAL Ff% "" $1k7''3
PLUNMING FEX 3174A�) "
i' w
S'I't2C7:E!it3 'NOTION M - RJ ;Sfi3 •101-000-241-M) $V.85
.
CiRADlidt)FEE .4014,1100-423-00
DIMI OPER WPALT FEF $1,907,40
Ulf
re.�.
ART' rN PUBLIC PLACSS - RES').0 701-i?€ O -255-0f1() $321. �7
"•
tT -
SUB -TOTAL CONS'17t (7fiON AND LAN CHFCK
$4,022.33.
_ ..... ESS P RE.,I'Ali'11"jCrS
so-oo
TO'!'AY..3'ERNUT SEES DUENO W
S•4.��tZ�33
" t r f�•M1 "
RECEIPT
I DATE
BY j ;
/
DATE FINALED
INSPECTOR
t .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
_
Steel
Combustion Air
Roof Deck Mv_
Exhaust Fans
O.K. to Wrap /
f 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
POOLS -SPAS
BLOCKWALL APPROVP LS
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
Waste Lines
Gas Test
Electric Final
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 overtime. 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 4AR Phase: Phase I
Lot No.: 10 Job Address: 55-300 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 'o Nedo, Temecula, Ca 92590
Signed
Tom Berry, General ger- 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. Quin'ta.'
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
ollowing:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
55-300 TANGLEWOOD
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: CENTURY CROWELL COMM
Building Official
Bldg. Permit No.: 9909-236
Land Use Zone: RL
Address: 1535 S. D STREET STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 11/21/2000
t
POST IN A CONSPICUOUS PLACE