0103-021 (SFD)61
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
dhapter 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
43867 f 1..,/IL-
'i.12d3
112t
Date °'Y"V Signature of Contractor J'�°
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). 'r .4
O I am exemp•, und._ er SectionZ-B&P.C/ o -t is'reas�on
Date��='t� '� $i gnature•:of�Owner
WORKER'S COMPESATIO `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
perforriiance of the work for which this permit is issued. '
( ) J 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.
STAT9, FUND 151 393 ��
(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 agreg that if I should become
subject to the workers' compensation p(ovisions of, 'ection 3700 of the Labor
Code, I shall forthwith •comply with thos lSrdisioj�._
Date: -1'd Applicant ✓ '�- of
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 repfesentatives of this City to enter upon
the above-mentioned property r inspection purposes.
f r.
Signature (Owner/Agent) �- Datel_) • 2t___,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �)!(),J�, TRACT
{� e/������j y}��y � yy }}pAy/� �t
wi12.9,26.1 0 Y 274X23
$12.9,26.130
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INFER
D F PA 3' 1R Pa, Llai
WORLD 17 .VEi.(1€ -21U; WC
74".i 33 J:SWY i I I V179103
74-333 HWT 1 I I WrE AD3
PAL x)WErRx CA 92260
1>gN.;DY- zT (,"A 92260j
t;?C.ifl)%8-2s-5 IG. tP2
USE OF PERMIT
A.
R
;tiff > IM T, P ftN 14 P1+ hilT 1; OI-P';e HOT MCLUi?1 BLOCK'
'WA,LUMOUAPP%.OACH DRIVEWAY - -A% PLAN CHWK
POR, OF i1: lr&PIA14'ryFLF.
TRA ; CONTz UCTiON 4104100 SF
CUA 02 2001
VG)Rlo.�ldlao'f'1ii
GEhR AMM1.PORTP 131� 14,166,80
U� ,
Leii�"�A �
Z' K
Nt AlMD COST OF Cf.'MM�X3C 1rIN
1i29,,2,6, .30
1rUR..Eif FEE SUMMARY t
CONit'1`1Ii CvVIC01" ITTZ I01.-000=418-000 011.0
'
PLAN CH1€XIX rMii� � 101-000.439-318 $153,46
IAECki"WAL k 1 101.000.421,000 560160
EUX 'Ml!Rr.€61, FP. ,�+ 101-000-420-000 , '� $121.66
10-1 -000-41.9-0106 SWAO
STRONG MOTION WE - RYSID 101-000-241-000 412,9:1
OR DING PIT, 101m000-423-f.io U0100
M'aJ•810, PZ11..4.i4IPACIT ME �'194't.0i4
7A-MMAL COMMUCTIf3W AND P) AW CbTC:C.
$3,•164.05
LESS PR17►.f AID MM,
$0,00
TOTAL P' ,Ill.[' FEEN DUE, NOW
RECEIPT
DATE-� ))�
1 ?ai i�
BYyi ,
a `••r T
DATEFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs ` Underground Ducts
Forms & Footings _ Ducts
Slab Grade
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
Insulation
, _�rC
_ Z� �
_ _ .Q� _
F.A.U.
Compressor
Vents
Fireplace P.L.
`
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
t`CL,0t,M►
Final9�/
Final
POOLS - SPAS
BLOCKWALL APPROVQ.�S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Electric Final
Waste Lines
j� Com` `�
Heater
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
_ _
d ��
0. K. for Finish Plaster
Sewer Lateral
/ % r'
Pool Cover
Sewer Connection
Gas Piping _
Gas Test
Encapsulation
Appliances
Final
Final
Utility Notice
ELECTRICAL APPROVALS
Power Pole
Fixtures
Main Service
Sub Panels
G.F.I.
Smoke Detectors
TemD. Use of Power
Final
Utility Notice (Perm) 6
COMMENTS:
G �ox%l C �v
AUG -10-2001 13:32 WESTERN INSULATION 909 686 8786 P.12i19
t=
WESTERN INSULATION 9 L.P.
4211 Latham Street, Rivetoide, California 92501
Tel. (909) 686.8760 ('az (909) 686.8786
INSULATION: CERTIFICATE
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
LOT #:
7
SITE ADDRESS:
79519 DANDELION DR. LA QUINTA, CA
EXTERIOR WA
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS
B
MANUFACTURER:
GREENSTONE
THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS:
�TTS
BLOW
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 13" R -VALUE: R-38
GENERAL CONTRACTOR:
WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN
INSULATION, L.P.
LICENSE NUMBER- 794484
BY: ;;i��
TITLE: PRO
ION MANAGER
DATE AUGUST 10, 2001
REGISTERED INSPECTOWS WEEKLY. R.EPGFrT
37630 W001001 Ave.
Palm desert, CA 92211
office (76.0) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE STEEL ASSEMBLY ❑
D .POST TIENSiOXED CONCiMM 13 ASPHALT ER
❑ REINFORCED MASONRY. QTIREPROOMiG, /LLczjb66j 0
JOB LOCATION p ,� `
1111 ►Y) ifi
REPORT SEQUENCE NO.
OF�•,UREE/J
RUCT
PERMMN,fOil•
DAY OF WEEK
MATwRIAAAL !OOESCRIPTaON ��
h-Vr a3 '`
ARCHITECT _
I
a
HAS. CHARGED
ENGINEER
ASSMTPMM
HAS. CHARGED
INSPDATE OONTiiAf;tOR W ��.L0' lJ O- ( MIERAL � Jr. ltj(Aj�-e
t7
L+pY`PLGD W 'es'V{Y'j , A3A.9 (4 `4�> CSA jP
(ate -M Q Vis. 3 YXr' 3%-x
0
COPY SEDT TO Cl ENT ❑
CONTMU ON NIXT PAGE. 0.
PAGE OF
CERTIFICATION OF COMPLIANCE
1 HEREBY CERTIFY THAT I HAVE INSPECTED TO TiaE GEST ,OFAl_V
KNOWLEDGE ALL OF THE ABOVE.REPORTEDWORK.UNiESSOTHERWISE
NOTED. I HAVE FOUND THIS WORK TO' COMPEY'WITH-THE APPROVED
PLANS. SPECIFICATIONS AND APPUICABLE SECTIONS OF THE
r nVC RSI V r, am, nlnr,
SI NT11RE OF REGISTERED IN O
Pq 7 b 1::C- O 4.a-196-
JULTE! &F F PQRT RMSTER NUMAFR
Certificate.of Occupancy
City of La Quinta
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: 79-519 DANDELION DRIVE
Use Classification: SINGLE FAMILY -DWELLING Bldg. Permit No.: 0103-021
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: D F PARTNERS, LLC
Building Official
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