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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
Date -� 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 4/Professionals
Code). ,
O I am exempt under Section !_ - .B,&P.C. f ,this easo
Date- �� ; = Signaty re, of Owners
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.*
( ) 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:
Cartier Policy No.
T'.A,'1 R RAID W.93.03,:.94
(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, aqd agree that if I should become
subject to the workers' compensatio provi ions f Section 3700 of the Labor
Code, I shall forthwith comply with ` oseAr'ovisi - ns..-
Date: -7 ?� Applicant Ar
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 repre'sentatives of this City to enter upon
the above-mentioned property V inspection purposes.
Signature (Owner/Agent)A �} Date L 'ey�0)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT d1,� TRACT
J �9}L
V.f.a?'ipcL 765 � f.+.r'1✓�<7
JOB SITE
APN
ADDRESS btu gt y perk y p DRIVE
604-l> �tt�
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
D FF P,i'£I*WRIS, LI. C
WoRf.$1DEWE ORMENIFn WC
4-3n TX W'Y I1 B ITIU IW
74.333I'1WY I.l'1 M'i's 103
PALM 1111'a'T CA 92260
PAU1 �7t 1. f Ok 92260
(760)568.25155 (ITLO 5028
USE OF PERMIT e
IWO A WT t1, .i'k, a4 21a; PEPWIT DOES 1400 1NCLLf D?, bt�t7 ,X
wA6.Poo7uAPPRo.A,c,H Dki'±i'�b'� iy - ` x, FI,m aiiri vfi, I+'n RMUC':T ION
,M1t;.11.tiri).F1.Nf:E O1: SAME PL A14 TYPE.
TRACT CONSTRUCTION V39,00 3F MAN
022001
PORCH:P.4tTIO 212, SP
11AMC11feK`A.RPICYft.T (N) 19.2.as. 00' Y U
Low. umi
l,
f
; romm#$T <'ov cnr C omwin'Lx-rit)fdi'
'a: .196.vo,
PE1tv31'A' ME SUMMARY' x
C-t7Ai3`1'RUM, 1014 AES 101-000-418.000 MINI
`
PLAN C"tifaC::B::.tME�; 101-it343C1434'-318 $153.418
MEC! d1;ANW.A1,VeR 101-000-421-000 $98,50
L,t,tr('713 iL PRE 101-eICtC)-420-060 girl. 15
PIri,8MB1A1O .FEV 101-00D419.000 $15;9.`r`�s
S'C'1tON O Rl:>;.i"rI ON IAF„ �. -17 ES10 '0101-000-241-000 $13.92
C4itkii).iNO M" 101.000.423.000 $20,00
DZtiF�,3,XrPEIx IMPACT I+ZE S1, n 40
HILM-I"MAL COW A'RUC2M.r'' D P;C,VI011ICK.
Ims PRIFI1-'AI) ims
$0.00
Al8'I'AL PERMH PERMITES S I3UE NOW
RECEIPT
DATE !j
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
I
n
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 323
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap_
Z
F.A.U.
Framing _ _
Compressor
InsulationInsulation
_ZZ —d�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
_
9�(
Final
POOLS - SPAS
BLOCKWALL APPROVAL S
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3' L` (5+` Y
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
COMMENTS:
Final
2
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)
�11
Certificate of Occupancy
City*of La Quintal
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 following:
BUILDING ADDRESS:
Use Classification
Occupancy Group
79-515 DANDELION DRIVE
SINGLE FAMILY DWELLING
R-3 Type of Construction: VN .
Owner of Building: D F PARTNERS, LLC
Building Official.
Bldg. Permit No.: 0103-020
Land Use Zone: RL
Address: 74-333 HWY 111 STE 103
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.-.
Date: 9/26/01
POST IN A CONSPICUOUS PLACE
AUG -10-2001 13:32 WESTERN INSULATION
909 686 6786 P.11/19
WESTERN INSULATION, Le Fe
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 rax (909) 686.8786
INSULATION CERTIFICA'T'E
THIS IS TO CERTIFY THAT. INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT-
TRACT / PHASE: SUNFLOWER #29623/PHASE 2
LOTH: 8
SITE ADDRESS: 79515 DANDELION DR. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS -8
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BATT BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 131, R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: 2!2!T TION MANAGER
DATE AUGUST 10, 2001
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