9909-234 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.) am licensed under provisions.of
,'Chapter 9 (commencing with Section 7000) of Division 3. of the Business and
Profeasionals Code, and my License is in full force and effect. .
License # Lic. Class , - IExp. Date
J.TJ�t , t%31i1
VDate T 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).
() 1• 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, for the
performance of the work for which this permit is issued.
7 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. are:
Carrier Policy No.
GOLDEW EA. ME INS:. ri r>v .moi 1
(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 agre?Athat if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,(ishalhfotth .ith comply withyhose,provlslons.
pate: Applicants 4�= -
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 3.706
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 But horize representat'i(ves of this City to enter upon
the above-mentioned propert�y.for inspior•oses. %
/S'
gnature (Owner/Ageent)°"_��T'`L. ate
PERMIT#
BUILDING PERMIT
'-- '
DATE _ VALUATION .. _ LOT - -TRACT
f.�,, , i.7 • z,�l.xie
JOB SITE
ADDRESS '
�.€: TA,�i�lL.�t�4DO�a
APN
- 769-2-;&067
OWNER
CONTRACTOR/DESIGNER/ENGINEER
svENIMY CRilWT11 COMNIUNrATES
CEDt'I IRY CROWELL CO1MMtJNMS
1535 SO. -D" ME -E`1', STE, 4204
1:535 SO. IV' 51''P,wETT , STE, .0200
SAN BE1t.NrARDMI0 Cts 92408
S�{ey��N DINO ` CA.
' -
^�BERy�N `
�9j24{08 ry/�
(hPr/p�'i{Y 1''V�! - L'Sd}1R• G1&V
USE OF PERMIT
SFD - LOT 8, FLAN lit, - PEiR&41'T DOFS NOT MCLUDS 91.0m WALL
OR .FOOL.
CUSTOM, CONSUR.i;j'irTION V)26.00 Sly
PORMPRT.IO 239.00 9F
GARA CARPORT 420.00 Si'
F,S'I'ffIIt+IEA]TIM COST OF. dj`LlNS`d`.Ri)t' TION .
171,196.10
CONS3.4CLtG'l01-#.t+'FR 101.000.419-000 $8991.50
MAN GUM FEE, • 101 -000 -4.3? -315 31725:515
N%CKAxfC.,\L 1!W 40149)0-421-000 r0
r
ELEC"11131C:AL h F: ' 101-(ii)0-47.0-t60d3 $1i$.iil
�•; -,,
PC.UM1.tit'NG t7FTF 103••0004194530
k'1"R0N0 NKYrI0N Ffi:1'- REBID 101-000.24.1-.,000 $17.:12
y .:
(MAT INCL FM' 101.000-423-000 $20.00
DEVELOP3M ."AL'T FEEF 7,1,9131.130
.
AWf mt PUBLIC PL.AC` S - RESF.C. 701 ••0 255-000 $177.99
SLIB-TUFAL CONSTRUCTION AND PLAN CREC;4,;
LESS PRL-1�k�1t3 -ES
�I3.1ifi
TOTAL PERMITREES DUEt, NOW
.$4,092.67
Ab
RECEIPT
DATE
BY + �,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/ p
Ducts
Slab Grade
��t
Return Air
Steel
7 4
Combustion Air
Roof Deck
-3111M 114
Exhaust Fans
O. p
F.A.U.
Framing
hv
Compressor
Vents
Fireplace P..IT
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
_
POOLS - SPAS
BLOCKWALL
_
A PROVALS
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
Z.0
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
9a U
Encapsulation
Gas Piping
Gas Test
y
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
0-1
Final 57
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 G1ass.Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: Tournament Collection Tract: Tr21846-2 Plan #: 1AR Phase: Phase I
Lot No.: 8 Job Address: 55-336 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.. OJ -Insulation Co., Inc.
] 1 2620 Nedo, Temecula, Ca 92590
Signed
Tom Berry, General M 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.
.. - . ,..-... r.� .-.—.... w ..t.- ww�+: :�.Jr v:G+ i � .s ,.+w►+a. � .J� M1,F���+'': t �!"r #". r
�- ! � �'� •ji`r'�#y � .'� -ver /���,�.rf {�, .
Jtt + J.3r r ��
C1^it!rfi,a toof Accyppry Oil
0
Lip ® t Of�a Q�►��ta.Y
. s •, + as •, '� � � � ��w
usld�n. ands afety� Departrint.
This Certificate issued pursuant -46' the requirementsof Section- 109 of the Uniform Building Code,
cartifying'that, at, the ,time �fissuan -e, .this structure was in .compliance with the various ordinances
of the City regulating bui/ding constructiori or use. For the.fol%wing.
BUILDING ADDRESS::,. .+ '55-336 TANGLEWOOD'
Use Classification: SINGLE FAMIL,Y,DWELLING. ",-Bldg; Permit No.: 9909-234
Occupancyr Group: R-3 Type .of Construction: I VN " Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: :1535 SO. D STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 8/30/2000
Building Official"
POST IN A CONSPICUOUS PLACE
r.1