0103-022 (SFD)r
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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
74:867 ' 17,131/2(
Date � ,.7 w ff. Signature of Contractor ��' Ale
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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 9, Professionals
Code).
O I am exempt under -Section .B&P.0 or t isreason
Date �..ri '"� Signature 01.` Wner `
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:
Carrier Policy No.
S'�J.!`3'd+� FV N 9:`It3?►'3�'3-.��
(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 Califgmia, an�Onsr ree that if I should become
subject to the workers' compensation'p�ovisiof Section 3700 of the Labor
Code, I shall forthwith comply wilt. ose fovls.
Date: 'e_ !1_121 Applicant
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, an&State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property or iins+ectic . purposes.
Signature, (Owner/Agent) Date -'�✓�
BUILDING PERMIT PERM'T#''a F'
_
DATE VALUATION LOT
TRACT
$149,716 U
,1962
JOB SITE
ADDRESS
AP.N
"7945iy'AMMON DRIVE
604-0774X14
OWNER
CONTRACTOR/DESIGNER/EN INEER
I) r� :mrct rgas, LLC,
WORI'D : nvala-man, we
74-333HWY 3I1 VE IUD,
74-331 HWY I`11 ME:I03
5028
USE OF PERMIT
SDR3LEFA1N4MY.DW- MING
00 n +r IT 6r" PIAN IA�i Pa:RM T 6'A0AF-S WC11' I14('UJ)11; ,RLodt
hkLLSIOlVAAf%OtCH Jii'VrrWAY-73% P1sW "TiCK;09 RADUC91ON
X H15SUA'MWyyOFE ME CLAN d�,14,
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149,716120
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y •�,up ie��r�v ,�•;r {;.. �ry 77C,�
11.�.4:e7'Y.Pe'A9..d. It1.�.YiV: �'�1 �f.5iiaE7/1W�2kS YF
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C0144r"TRUC:' iOl F8X 101.-WO,418-011 98I4.59
5"
FfLAN CH EXE, `. 101, 000.4,19.3-18 $174.36
k
�i�:>;��•&�9��C�.[" �i�;1� IS�1 �t�00���1 �i3gGt r$ ': ��~3,:�
M,iY:.•',TR I"..L, tiI�..�', IC1k-p��-�•;2i)-s'3i?� �� ' �33�,�r
PLUMBING iw f
STR.ONO MOVOW ME v RESID 101 -t1tOL 24 r 000
OaLAM90 M 101-000-47M000"' $20,00
DZIUMIX) IRR,$M,PACT PEP �Iygt1'J.DU
SUB -TOTAL. CON;!Tk3't'9•CT109 AND PL C%HV iw"
RECEIPT
DATE f J
BY
DATE FINALED
INSPECTOR
14�.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL
APPROVALS
Set Backs
OPPUnderground
Ducts
Forms & Footings ` 19
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�2� ��
Exhaust Fans
O.K. to Wrap
I
36/�_
F.A.U.
Compressor
Framing
Insulation
��y�// G�
Vents
Fireplace P.L.
GGG/
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
_
Final
Final
_ .f% . _
POOLS - SPAS
BLOCKWALL APPROV/,LS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
3 L
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
1 t \
Pool Cover
Sewer Connection
_ _
S
Encapsulation
Gas Piping--_
Gas Test��
Appliances
Final
COMMENTS:
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)
AUG -10-2001 13:32 WESTERN INSULATION 909 686 8786 P.13i19
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (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 #: 6
SITE ADDRESS: 79523 DANDELION DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS- BATTS
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS:BATTS 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:
TITLE: P CTION MANAGER
DATE A GUST 10, 2001
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: 79-523 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: D F PARTNERS, LLC
Building Official
vni
Bldg. Permit No.: 0103-022
Land Use Zone: RL
Address: 74-333 HWY 111 STE 103
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.
Date: 9/27/01
POST IN A CONSPICUOUS PLACE