0106-396 (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 Exp. Date
714 180 B Iokl 1/01
Date"`5 1�1 f. r,4 Signature of Contractor
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
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.
1 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.
MWEAN LUX, T133.
(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 shall forthwith comply with those provisions..
Date:1l Applicant 1 f � 'cn ,.—.�r,r
��
Warhing FdiluPe' o -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 property for inspection purposes.
Signature (Owner/AgMent)-���,, _. "4
BUILDING PERMIT PERMIT#
'
DATE / VALUATION LOT y�{(ryy" TRACT
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JOB SITE t ,.
APN
ADDRESS
5.426 'EAMMEWOOD
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1535130, O YMME , E, 0200
1 aT3a po, T# L/d.[dLRla E�7im 0200
SAN BERN "aI'�DWO. CA 924 08
&MbLM1,TARDW0 C', A 92A08
(909)381-60(r; CEiI. O 2120
USE OF PERMIT
��"a.P�1GLL' t�ur7.c T.r DIMPId.M40
Sk'D - LOT 3 PLAN 3RR P117,IFMIT DQ&c; NOT `NC1,,UDF, BLOCK 'WALLS,
POOLS OR DPWRWAY APPROACH
r
CUSTOM Ce31WROC f ICEN V08.00 0 OF
POltCWA TIO 194AW 8W
0 -AR O 4CARPORT Sr
"fMWATrW COS"! CYP' Cf3MTRU'C;"�'.ECyH
200.345.%)
CONS'1RUCTIO14 F`.�,E 10]-000 &18.0:0 5903.00
I%LAN CHECK FEE 101-000.439-318 attl:�t
MUCRKNICAL FRE 101 -000 -421 -OW $9100
~UCP1a"t.VIM; 01 - -4 20-f;0
E�NlNBINO FE"K 141"000-"19000 W 87Ki:.7V
.
8`CRO140 MOTION 1819 • "- SID 10 1 -00044 1-000 $20.03
ORAD31NO VFP,, 101.000.423.000 It.
13INF,ELOPER, IMPACT E
ART IN PUBLIC PLA,' w IiiUM 701.000.255-000 $.80
mid C � UC -1-10,' WD PAN (W.=
13 LT03 M. -PAID YMS
04,137.85
"1100
' FM M's'r+1 :S 1) U. Xow
2001;i1 `
$4,1,37.45-
9,1,37.452001
CIT'! 0; L::'�Jift7a
�FECEIPT_—,- DATE" - ,+
, •� / 11
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings /%ply fL-
_ _
�'— !�(
Underground Ducts
Ducts
Slab Grade
Al /fir
Return Air
Steel
Roof Deck
_ _
/
Combustion Air
Exhaust Fans
O.K. to Wrap
!�� i
F.A.U.
Framing
Insulation
� �(/
��9lv�
Compressor
Vents
Fireplace P.L.
j.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall .
Exterior Lath
Drywall - Int. Lath
Final/���
_
�� ��,Q�ytJ
Final I
POOLS -SPAS
BLOCKWALL APPROVALS
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
_
�j�/(,�
Heater Final
Water Piping
JPlumbing
Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
GIB/b�
Pool Cover
Encapsulation
Gas Piping
Gas Test
I
Appliances
Final
COMMENTS:
4V
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
2 ./
6/0/0
Utility Notice (Perm)
S/0/ CV
f• i
Com"icate of Insulation
P•�
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Your Home has bees insntated with CettainTeed Fibergiass Insidatbn products„ whici ate designed
,.
for today's safety standards and tomormw's ener9Y rcgniremouts.
•
Fiberglass is inorganic and dwrehxe perauaeeetly nonoonibiestiWe, n it does not have to W trcated . s
r
with firc-r t dmicals that will I&dy lose thdr effaotivcam am timL it has not bccu t=ated `
to
vrith dmmiwla tbd can cords wiriag or om W. Fiberglass will not abo tb tnoisinre not will it .
settle over time as may other insulation materials.
r
,
7& ats cutift mat C�iaTeed Pi Glass I has been pmf lly installed is this boats
N
to provide the Mowing thavnl performanae.-
46
.rob Nam= Tournament Collection Trust: 2184&3 Pluo tk 3BR pbam. S
-
IM Na: 3 - Job Adam SS -426 T�La�CA
CetiltAg Area: R-38 Mown Insulatimt Garage Cam Non Accem
_ With Living Above & S1*qg Areas
g
Zz*Aor Watts: R-13 Un%ccd Batts ` Actieas Attie
E
v 't _ With Living Above
W
. r Interior. Walls: R-11' Unfaced Batts Betwau Floor.
P•�
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Certificate of Occupancy-
City
oQuin.ta
f La
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 fol%wing:
BUILDING ADDRESS: 55-426 TANGLEWOOD
Use'Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0166-396
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: BILL GORDON '
Date: 1/29/02
Building Official
POST IN A CONSPICUOUS PLACE