9909-230 (SFD)LICENSED CONTRACTOR DECLARATION
I hc)reby 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
41' L.
t' "/�
ate
DSI nature of Contract .r
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). '
() I am exempt under Section B&P.C. for this reason
Date. Signature of Owner
WORKER'S COMPENSATION DECLARATION r
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.
(4)� 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.
(30LDEN PaflGL'E INS. iy' Gv`C S%3f1 !I�li.i
(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 agreeithat if I should become
subject to t e orkers' compensation provlslons,of ;Section 3700 of the Labor
Code, s�h II fo , oygith comply with(t ose pravlslons. , , t
Date: C, Applicant".-.t.-�"':- .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. - . . . .
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall,. indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
,work is not commenced within 180 days, from date of issuance,of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned yproperty for inspection, Wposes.
Signature (Owner/Agent) _ �� r`-- Date j� r
BUILDING PERMIT PERMITy0'';
DATE VALUATION �yT.,.. LOT TRACT
JOB SITE
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENTURY 0110MMLLCON �i?,+'CUNMES
CENW,,XY•C1KJWV1XCi:aMTv1ti.Sr+fM'ES
153S S0. " i" S" t ial, S`i . #200'1535
.''.C9" S'T PLEVY STE #'20.
&W BE AR1.i. INO CA 92408.
&AN Di RVIARDIN0 . ' CA 92408
d'Sii9 31ta-tiflQ7 CBYI# 2120
USE OF PERMIT
nSi.�J+�;-��1+,L}H!F'AN;�`.TL3LP,YAe',` D1�j�',1.:�%�I�ay��-l�,s.`�("ap
pt 'y y
q �Ttq }� p�5 BLOCK
w�`~.d'U tiJi Ss MAN R,— P.Cal��Ydb7�� DOES NOT S,IV"L.�R.4f;.A ,47F..V'i.-.I:S• �CVALL . s
OR K)C'!L.
WsTONZ 11. (;.IONS.l°RUCTION 2204.00 iii'
f�t�3tG¢IYixSe:ilJ i96.iit7 S.t<
(3ARA08JC.AidSe'0f!i.'! 5ill.fltt RI
C.S�'Y4i1.��'�EDC.CS'�.O CONSTRUC3�:f�;6i
�53,23.$,.3s�E
MUC7aANICI ;L S28,50
L"
L Cry �C Ai. FEE. J C i -1�i f2Ci-Ofl(} $ E n.7a
PLUMBMIJ FEE $173.2
S'M£dOlOT1101dFw,-RWA-000-241-M,p�, sift 4�2
MPDgyG MT.,,
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VEN—PL(ip'M NII)Ar #' FEE Si ,S►C17.i3to
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MAT, MMW-TWIC711 1N A:ND Rtw,_ N Ca11ECK
1'0° "Al PERMIT VVI&S ouilKNOW
$4: q"631
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade Vp
a Z41
Return Air
Steel
Combustion Air
Roof Deck
/ prp
Exhaust Fans
O.K. to WrapAx
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
I Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
i
Exterior Lath
5
!
Drywall - Int. Lath
•
i .
Final
Final 3
BLOCKWALL APPROVALS
I POOLS - SPAS
I
Steel
Set Hacks
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
; 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
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 #: 2AR Phase: Phase I
Lot No.: 5 Job Address: 55-390 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 a �ger-emecula 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.
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City', Of-Ta...u c!
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uf� : ,: r #,%artMintuilin,"'a'nd S60e!y, De
This Certificate issued.pdrsuant -to th rements'of Section. 109 of' the Uniform Building Code,
� I - _e requi
at the' of issuance;: " -
certifying that, -, this, structure was in comb#Once,. with the various ordinances
cq1_ - - - .4 ! ,
7 of the City regulating building- c6nsifiucdon or use.' For the fd)Mwing.,
BUILDING ADDRESS: .55-390 TANGLEWOOD
Use Classification: SINGLE FAMILY -DWELLING Bldg: -Permit No.: 9909-230
Occupancy Group: R-3 Type -of. Construction: VN Land -Use Zone: RL
Owner of Building: CENTURY CROWELL4COMM. Address: 1 535 ISO. D'STREET, STE 200
City: SAN BERNARDINO, CA., 92408
By: DANIEL P. CRAWFORD JR.
Date: 8/3012000,
Building Official',
POST IN A CONSPICUOUS PLACE