0103-016 (SFD)LICENSED CONTRACTOR DECLARATION PERMIT#
Thereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT TRACT
04 W Professionals Code, and my License is in full force. and effect.
C :) ch License # LIc. Class Exp. Date
ti d u7 JOB SITE APN
� JI).
f. yI� r. �� � ADDRESS79-526 �f �e � �` 4 604-07�i,`4M
cZ Date �`- '® Signature of ContractorOWNER CONTRACTOR/DESIGNER/EN IN�EER
O "�
1.-
0 OWNER -BUILDER DECLARATION D 1� k1 Ai�`i'1 fc S,1:LC DDEVELOPMENT, INC
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's 14-333 k1,WY 'I I I STS 103 74 - 33 i- WY 1 I 19f1l:10 3
~ U) License Law for the following reason: VALM. D s j',IRT CdA 92240 PA,TM 7.?M"IZr CA £D'' 60
Z ( ) 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 foru6.tf 5l�'t
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the ,property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business Professionals INGLY! FJA1i&LYDWEUWQ
Code).
( ) I am exempt.under Section �� B&P.C. f / thi reascfn ah J - Y,O'! f2, I�3 JUQ ;X53 + .Ft (B°f C2 Nal, 1�If;1at7I5 BI,U. ` I
N Date 1 ', J { # Signatur-e,•of Owner, . le`;�i;�z�rS�PtcroiO��t3i,�.e`�i�f;Zif�.tiCH DRIVEWAY - 75% PLAN 1,:13 CK �g �.&t?UCTION'
AHCE OF SM& PLA"
QWORKER'S COMPENSATION DECLARATION
CL
Z
p Z I hereby affirm under penalty of perjury one of the following declarations:
LO O O 1 have and will maintain a certificate of consent to self insure for workers' RAC! CONNSTA'1.G,DC9IUR .2,230,00 S? t,! 02 200'
X W compensation, as provided for by Section 3700 of the Labor Code, for the K.W.Ca}$>Mo 2.12.00 n
Om J Q performance of the work for which this permit is issued. 0Ak,%i3tX:A1ZP0RT (.qi°) 11%290100 =4" y�-- �,,, 1
L
Q U ( ) I have and will maintain workers' compensation insurance, as required byR
O CJ Q Section 3700 of the Labor Code, for the performance of the work for which this �.
li rn H permit is issued. My workers' compensation insurance carrier & policy no. are: '
�? Z Carrier Policy No. '
Q (This section need not be completed if the permit valuation is for $100.00 or less). P3v° {�.�'.E�',I!° �1.il��fARY
J ( ) I certify that in the performance of the work for which this permit is issued, t; ONSTRUCx3ag FIDE 101.000.418.000
1 shall not employ any person in any manner so as to become subject to the PLAN CHIMIK 11F19
workers' compensation laws of Californi , and agree that if I should become MECHANICAL T, L 14�. 101.000.421-000
3 subject to the workers' compensation ovisions of/Se tion 3700 of the Labor �'.LL',C�1'1kff A1, R'l 101 -000-420-000 SIVAS
Code, I shall forthwith comply with tho ✓ /p ;o�ir o�. o�� ly.�+UMBDIO pif, 101 N r ' 0tS0 I53 75
Date: �^� v) A licant 0
pP f STRO'NO MOT1014 VEE - kt'L.SID 101-00€2-241-000 51102
Warning: Failure to secure Workers' Compensation coverage is unlawful and MAIM() We 102:-000.423.000 $20,00
shall subject an employer to criminal penalties and civil fines up to $100,000, in OR's' El,;t PER IMIPAC.^! ITE2 "�9t907,t20
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to.sl:3:tri^TG`f3'.d'a5..!.;OMM17'C;'-110IbTA4 D PIAN i',I$£?.,M �a��7;�• }fl
�\ any permit issued as a result of this applicaton agrees to, & shall, indemnify 3:.2±5 3 FRE PAR> 5+F20 $0.00
& 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 'MAL IT'Y' .ITr"U'S DUE* WOW $3;273.50
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 complpwith -all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property f6r inspection purposes.
RECEIPT DATE BY DATE FINALED INSPECTOR
Signature (Owner/Agent) F f Date
'`'
INSPECTION RECORD
OPERATION
DATE I
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
`2� �_
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
`'�= ��–�'�
Exhaust Fans
O.K. to Wrap
3 ��
F.A.U.
Framing
_ _
_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
6r
Final
_ _
J
Final
POOLS - SPAS
BLOCKWALL AP�PROVA S
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
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 _
eVo
_
3/Final
/
COMMENTS:
Final
,G� o
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�U/
`'�—�G
Utility Notice (Perm)
2001 13:31 WESTERN INSULATION 909 686 8786 P.07i19
WESTERN INSULA'T'ION, L.P.
4211 Latham Sweet, 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 #: 12
SITE ADDRESS: 79526 DANDELION DR. LA QUINTA, CA
------------------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS (:::BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BATTS 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: PR U 10 MANAGER
DATE AUG ST 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: 79-526 DANDELION DR.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0103-016
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: 9/17/01
POST IN A CONSPICUOUS PLACE