9909-229 (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 o the Business and
Professionals Code, and my License is in full force and effect. '
License # ; , Lic. Class f e Exp. Date
'o. �g
/ (Sinature ntracto
of Cor,,
Zatee•- � .
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 ofthe 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
I hereby affirm ,ur der penalty of perjury one .of the following declarations:
() I, have and.will maintain a Certificate of con`sent,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.
have and will maintain workers' -compensation insurance, as required by
SectioIn 3700 of the Labor Code, for the performance of the work for which this
permit Js issued My workers' compensation. insurance'carrier & policy no: are:
Carrier Polioy No.
COLDEN'S GLE MS. ' NWC X5406&41
(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 w5fkers' compensa=iyon provonsfoftSection,3700 of the -Labor
Code,JI hall f hwi h comply with those provlsldns.
16ate_% Applicant=-ll\.i'✓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 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 representatiyes'of this City to enter upon
the above- mentioned.property�for insptection purposes
�iSignature (Owner/Agen� Date
J
BUILDING=OERMIT PERMIT#
DATE/ / • VALUATION LOT0�'2 TRACT r
v
JOB SITE_
APN
��ii �
ADDRESS ' $_400 TAN'�.riXNVW riri s),
OWNER _ -'
'y
CONTRACTOR / DESIGNER / ENGINEER
w t
l�j i:�'�. iri +1.:AGd Ld-��.oYY'���.x���,A.ib'�:�1�'`l�l�v1.71.1'na
•`M L`Cr ISJd�, .i �lw��Vtl.6wAr.1�. F..�iVALti.i lJ.l,10,.i, 6i:�S
. , 035 so. °0" gl?.E , s _- 9200
1135 sa aDo S"f Irvr; snz, o2oo
SAN BERNAR1%NO CA 92409
SAN .BERNAR1 TNO (,,A 924M
(909)n I.6wi CUO 2 Ili}
USE OF PERMIT
�� CAC1C)I.,. I��.3\.N •G.i�:�.,.C`EE dt�1l'f4;�10 ?J°f� .if �7dZ :RIiU3.:3'ifsL'Iv Io;SI,f r'4.�7�.`F3 C��
SAIVrE P.LAN TYPF_
CUSTOM COXS'1 iiL 3,101�f 2. i 78hi) >H
P0Rt`.9?AT1Cs 1.76.60.5F
(3 ARACiWt;ARPORS' .500.00 SF
fffl'ai:iVi :MATED COSH' O t.MNI STRUCT:ION
2=4', .04
PERMIT FEE SUMMARY
CONR'i'Ri'UMON FEE 9.tI1-(?iii 4A1i�f3t'�fl �S,@)Al.flli
P 'N L' &K FE:E 101.OW43.9=318 $21.33
MEC ANICAL 1`;M : '101 .OqO-421-
S164.7 3
PLUMBING FEE 101.060-419-000
iTRCs3rONIOTI N.IEE_--RF,--iED.-. .101- 241-w4` S2185
r,�. �.•}_ j
GtIADIM, rEE 8i7i.�il(3t1-4'23-t31id3 9; U t)0
� - �,
L)L'vozoEft NP.XCT Eb`l . 31,Jfs :ltii
Lr I"Al rT •y
ART IN i UMAC; .MACIRS - IMSYC 701-000-255411?tD $32.3.:�:r
w.c .
i,it -* i
SUJ3-'t'(YFAL CONS �'�aUi~' ION•AND PLAN CHECK
$4,022.33
LUNS PRE-PA(T)FEES
yl.cw
TOTAL ltyk lQ�f`.Ftc 81f �' �`dfDOr
14,022,33.
,f
RECEIPT
DATE
BY
�f
DATE FINALED
INSPECTOR
j
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck f
Exhaust Fans
F.A.U.
Framin
Compressor
nsu ab
Vents
Fireplace P..
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall _
Exterior Lath
Drywall - Int. Lath
Final=APROVALS
BLOCKWA
Final
POOLS-SPAS
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
Server Lateral
Sewer Connection
Pool Cover
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-: Plan #: 4BR Phase: Phase I
Lot No.: 4 Job Address: 55-408 Tanglewood
Ceiling Area: R-38 Blown Fiberglass
Exterior Walls: R-13 Unfaced Batts
Knee Walls: R-13 Unfaced Batts
Garage Ceiling: Non Access: _
With Living Above & Sloping Areas
Overhangs: Access Attic:
With Living Above
Interior Walls: R-1 l Unfaced Batts Between Floor:
Subcontractor.. OJInsulation Co., Inc.
4262o Nedo, Temecula,,Ca 92590
Signed 7
Tom Berry, General ager -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.
- .t
Certificate of Occupanc y,�-
City of.La. Quinta
.Building and Safety Depadment., OF °
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: 55-408 TANGLEWOOD
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-229
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
77 &, By: DANIEL P. CRAWFORD JR.
Date: 11 /30/2000.
Building Official
POST IN A CONSPICUOUS PLACE