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9009-233 (SFD)LICENSED CONTRACTOR DECLARATION I hereby 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 f , Exp. Date 't y q ate /11� Signature. Contractor. - >�• 'r' r OW NER-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 theproperty, am exclusively contracting with licensed contractors to construct -the project (Seca 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 00 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. GOLD!42I EAGLE ft& NWC 5444"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 agree that if I should become' subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shallforihwith compl with those,provlslons. t` Date: /f �!Applicant[:3.ata �Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties andcivil fines up to'$100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to•the.conditions and restrictions set forth on his application. 1. Each.person upon whose _behalf this application is made &each person at whose request and for whose benefit work is'performed under,or pursuant to any permit issued as a result of this applicaton agrees to, &.shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a.result of this application. becomes null and void if work is not commenced within 180 .days from date of is of,such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. K.,� gnature (Owner/Ant) ��:4'- - ©ate-�'d�`� BUILDING PERMIT PERMIT# �F r 71 Li.J TR . DATE VALUATION LOT ,� --TRACT �� _ •� . �}G� S�2'29,5+8'I:fi�i Q � JOB SITE ADDRESSr-4Q � --♦♦-��y��(�-}}yy- ��pp��gg wu�.7':'. 5_ �ETA19�.,7YSe6' MOOD 6, � APN �,r �� yy n� f� 9 -2 -'WO, 67 OWNER CONTRACTOR/DESIGNER/ENGINEER 1�'�'�RY fy'R�V�.''�Li, s�C)R�€i"M'�i�S : t":�T�'itft'ir"ft•Y' <';�tZ€�'�T..�� CC�vF.�ti,"�'�'i%S i535 SIO. "I?" S" E`$EFF, M-11204 1535 SO, -7.5=9i;.STH, 9200 &W BFftNriRIN O CA 92408 WN BE3dNARI)M CA. 92408 (909)381-4007 CBL,# 2120 USE OF PERMIT (41MO R F X11/f. t: F SM, - LOT 7. PLAN 4R, - PERMIT DOES NOT i�'i i gH BLOCK WALL OR .d OOT • PLAN CHEM FFX REMI;CIM $.;y, FOR 'XtUJ,,'. fP1 ii ISSUANCE OF SANIM PLAN TYPE. CU!PffO i CONURUCrION 2,718.00 S PORC.I ATI? 176.00Sty Cat" RAGEICARPOU 300.00 5 EST WA"t'ED COST OF 1ONST UC�'it1 ON 547A0 PERMIT FEENUMMARY r, NSTRUCTIONrEE 108-000418-M I7t,A 1C".E 'C .i E lUl- ti!# -439.318 $2=1� mmitli+i'ICAL Fri It9 9-fifl0.421 dBOQ $98.50 •e t LG i'Tfi?I('AL [+ dfli�f}t1t7-iia(►-flfll3 316"4, 73 I;. PLtwsltva r , 101 -MO -4194300' �iA'EcC3>NG.MO'i1C3Td:f�EE-iY TD. 9.41-01(1-}41=0 ii t,MATING FETE 101 -000 -423 -NO ART SEd PUBLIC PLAMS M'S'W' "•`01 -OW -255-$91x) $321,37. SUB-TCIFAL CO.NV: rRUc rIO d PLAN CIE, i.`K . $4,w.2.33 U S, ' . r SMD FP sw $x)•(90 RECEIPT DATE BY (""�/ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings �J� �� _ Slab Grade �_ �! Ducts Return Air Steel _ Combustion Air Roof Deck ��� Exhaust Fans O.K. to Wrap F.A.U. Framing /kg Compressor Insulation 3 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . Test Final I I IGas 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 Appliances 10 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)47/ 4V7W 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 #: 4BR Phase: Phase I Lot No.: 7 Job Address: 55-354 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. --,--42620 ]Vo 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. • I CertifiOcc-upanc- y ca to of r City Building and Safety Department OF�ti° 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 fol%wing; BUILDING ADDRESS: 55-354 TANGLEWOOD Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-233 Occupancy Group: R-3 Type of Construction: VN. Land Use Zone:" RL Owner of Building: CENTURY CROWELL COMM Address: 1535 S. D STREET STE 200 City: SAN BERNARDINO, CA., 92408 .� By: DANIEL P. CRAWFORD JR. Date: 11/29/2000 Building Official POST IN A CONSPICUOUS PLACE ,I1