0103-015 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
r1;hapter 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
4386 R �co 1213112(
Date -f `� 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. 7W,usiinesl & Professionals
Code).
I ani' xe pt der Section B&solh
Date #"M' Ia✓ Signature ofOwner
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.
STATS S 11`UND f �os�s-s►t)
(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
/66ree that if I, should become
_subject to the workers' compensatio, proyisiofis o Section 3700 of the Labor
Code, I, sh lI fl , hycomply with s�p.oyrisi s<
Date:'' '�� "` �,/ 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, and State laws relating to the building
construction, and hereby au' or'2e representatives of this City to enter upon
the above-mentioned property f r ins eotiog purposes.
f-,,.
Signature (Owner/Agent) t - - A�f" Date ��`- -e
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 010a -01.S TRACT
t$129,26.1. 0 13 29623
JOB SITE
ADDRESS
APN
79--530 DdilVD.0.10K MM
fill -077,4M
OWNER
CONTRACTOR/DESIGNER/EN INEER
D 7"' 1_xP,1.1qr1 ,, ,I 5..�:
WORLD !1T&M..OPME r, WC
74-33311WY 1 i X w tE 101
'74-333 HWY 11 I F17103
PALM I31?'.MMT CA 92260
PALM DESERT CA 31.2260
(760)56,6.295;5 CIBIA 5029
USE OF PERMIT
M701 E YA MILY f+i,�.Ra1U4Cr
C:
F M,,Ld.@'Oi'yVA.T PROACH DRIVEWAY -'751". KXrN MIECK hE Rift)Cj cTION
FOR dMU./ RCE OF SA?,94 P1.<.+A11 Mr. ®per
MAR
02 2001
TRACT CC5N5:1 TOC' ION 71100.00 5F •
PORCH/P.A.Tr0 :i•
c65M
0AR.AGE1C.�,R#1t')13.1' OF) 14, 366.1 _
a}.'1°F.m C1,1��: Or ci�1����. � +t n
��ii jftt_ {P1� ��J�LLqq,R(/A{ �1�:.'��C11
Pk 1r`].tl.�.�i�.j E IPJJ.98.efiW.30.RY
tiUN11TRUCTIM FEE, 103-000-418-000 $744.:60
PLA1q CHFIck, FE& 101-000.439-318 $1$3.010+
MECY144C L FFM 101.-000421-000 160.00
;`;UY,CTR,1CAJ,11% 101.-000.420-000 $121."
11�11�7 $S .�aJ 1b9
STf ONO IYIO7I' H FV, - .1:.x.911~4 101-000-241-€3001 $12.93
01141DINO FEY, 101-000-423-000 $20,00
;[bMs:LOPPIIR 3hiPt'..f T ilv I $1,907.00
9!.91_-'1`1MAx, CO3!3'11'tRT.K.1"TON "D PLAIT MEMI1,�
164.0
,CESS PREDpPAM N- i7 3
$0.00
WEAL PVI?1 f FEEN DU tNO'b`I+
RECEIPT
DATE-
Bx_.
DATE FINALED
INSPECTOR
/ 'J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _ _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_`� _
Return Air
Steel
Combustion Air
Roof Deck
(.�_ 8 ��
Exhaust Fans
O.K. to Wrap
-
y'L ����`
F.A.U.
Framing
36; (
Compressor
Insulation
�GJ//�� _
Vents
Fireplace P.L.
ll !
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lathj
Z3—o
po-1g4k 2
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
31 l2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_$ l
Pool Cover
Sewer Connection
(Y'
Encapsulation
as Test
RNr..
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)
v�
WESTERN INSULATION 909 6B6 8786 P.06i19 "I
WESTERN INSULATION, L.P.
4211 Latham street, Riversldc, C Vornia 92501
Td. (909) 686.8760 Pax (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 # :
13
SITE ADDRESS:
79530 DANDELION DR. LA OUINTA, CA
EXTER OR WALLS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS
BATTS BLO W
MANUFACTURER:
GREE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS:
S 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: PR U ION MANAGER
DATE At 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: 79-530 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 . Type of Construction:
Owner of Building: D F PARTNERS, LLC
Building Official
vti
Bldg. Permit No.: 0103-015
Land Use Zone: RL
Address: 74-333 HWY 111 STE 103
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.
Date: 9/10/01
POST IN A CONSPICUOUS PLACE
REGISTERED INSPECTOR'S MEEKLY REPORT
a-iwju mealow Ave.
Palm Desert, CA 92211
Office (760) 772-7192
'Fax. (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
D REINFORCED CONCMIE UCT. STEELASSMIXY Q s
0 POST TENSIORM.CONCREM 0 ASF44ALT R
D REINFORCED NIAS011" Q FIRE PROOFiIRG
JOB LOCATION n 9,530 VpgA e I t 4D JA IbR., LA 7`'Y! ^ � �
REPORT SEOUSNCE NO.
TYPE OF TRUCTURE
S a
PST BD:
DA
1-1
DAY OF WEEK
MAT RIAAL�� PTION .3
44
ARCHCCECT
INSPECTOR
Y
HRS. CHARGED
,1 C7
EUGINEER,
ASSISTANTS
NRS. CHARGED
DATEKTION ODNiRltCTDR' �i J ��{� CtBi(TFitCIOR
3 a7
ojog.sev-4afl w4ze�,p (a Cdr iP
t A 5 - 3 .a -x 3'a-xy9k C-oc-19
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COPY SENT TO CLIENT 0
t43AITHIUFD dAt NEXT 'PAGE d
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT i iHAV�E 'INSPECTEO TO THE BEST -Of NTV
KNOWLEDGE ALL OF THEABOVE REPORTED -WARN UNEE'SSOEHEMISE
NOTED. 1 HAVE FOUND THIS WORK TO COMPLYWITHTHEAPPROVEII
PLANS. SPECIFICATIONS, AND APPUCARLE SECTIONS OF THE
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=Sd -ruRE OF REi'm EREO iN O
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