0103-023 (SFD): P� Y perjury
LICENSED CONTRACTOR DECLARATION
• U) I herebyaffirm under penalty ofthat I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
nI W Professionals Code, and my License is in full force and effect.
OLicense # Lic. Class Exp. Date
�� ,e
oZ r- Date Signature of Contractor i 't tf�
O�
U C:) OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
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 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) f'
O I am�xeM, pt, u der Sebtion..• "� B&P:C rF � ~h's re4.,n.,,-
CY) N LO
Date�r'�. AWy"� Sign`'atu're.of w er a' f
Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of 'perjury one of the following declarations:
Cr
U-) � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
ED Q U ( ) I have and will maintain workers' compensation insurance, as required by
O L Q Section 3700 of the Labor Code, for the performance of the work for which this
d 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ob =) STAT 1r'Pa71+1.i7
d
Q , (This section need not be completed if the permit valuation is for $100.00 or less).
J () 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 O ree that if I should become
subject to the workers' compensation rovisioggs o Section 3700 of the Labor
3 Code, I 11 forthw'th com I with thou e v sio
P Y P '
Date: y Applicant i , __•
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• Correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby autho ,ize represerritatives of this City to enter upon
the above-mentioned property, or inspection purposes.
Signature (Owner/Agent
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ®$<jy.- TRACT
JOB SITE
APN
ADDRESS
79427 DANDMAON )MM
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
D I+' PAR 111 US, S.
tiFb'01 D DEN r1WNAKW, WC
74-333 I TTY I I I 9TE I T3
'14-333 ITWY 111 M 103
PAI.M D&URRk - CA 92,260
PAM Dmn-lr CA 92260
CBIA 502S
USE OF PERMIT
f,
S07.) w Yet,,lZ t aN:eAN 2M PERMIT OC.1ES :fdl:ET .iNC.-l:.ilDfp 81..S7O4,:.
'F`r AWAIM)TAPPR(AACH I)lt;`ii'j'?.WKY - 75% PLA 14 C.'I'IEd:C; YEZ R.12MOCTIO11'
FOR XS3UAQN0S OF SMS PLAN T VPF. MAR 022001
gg
.
Y
711ACw`T4ONST-RUC,TZON 4no*COW
L ,,��`
Ul— r� uuu
0ARA:MUCARR ORT (SM) ISMO.00
x9C°JibWOM CONT OF { 0XS1 ;1".��TCg10Fi
PERWfb'9'2 SUMMARY
CONSTRUCTION FrIf. 101,000-4) 8.000 V791
PLAN C30= MY, 101-.000-439-318 $16169
B%'fcC 1011;AL, VMS 101-000-421.000 j $98.50
fs`(XX,'TRTC'A:L 11 , 141-DOO-420-000.
P1..1,1�IBINO )TE 101-•000-419ptif7iY':'' $164,75
"k'aoA141m6;>'1< u)N z PX -Sm 101-€ 00-2A 1 „WO 13.92
GRADNO PER 101-000.423.000, $20.00
l�i�.'�Ilr�C1��R.I1�It�ACa' $2,4L�7.Of1
89B -TUM C{?WrRtTC 1ff0N' Aiv;O PLM' CHEMC
83,'27 i.5 0
LESS PRE -PAID FUM
$01,00
TOTAL PXAMM, b3as MY C11 NOW
tz;v&so
r
RECEIPT
DATE,
BY i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
Slab Grade
APPROVALS
_ _
`_ _
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
-� ���-
(((
��
/Z� _
Exhaust Fans
F.A. p
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath�d
_
Final ��%%�b
BLOCKWALL APPROVAL.
Final
POOLS -SPAS
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
Sewer Connection
_ �L
Pool Cover
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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:
79-527 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: D F PARTNERS, LLC
Building Official
Bldg. Permit No.:
VN Land Use. Zone
0103-023
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
AUG -10-2001 13:33 WESTERN INSULATION 909 686 8786 P.14i19
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 1!29623/PHASE 2
LOT JI: 5
SITE ADDRESS: 79527 DANDELION DR. LA QUINTA, CA
---------- -------------------------------------------------------
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTSc:
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BAITS 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: PRO ION MANAGER
DATE AUGAJST 10, 2001