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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
'd�•��d i� ice..,, 12fa"1/��
Date, 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. 7044, Business & Professionals
Code).
O I am exempt under Section B&P:G" r It is reason
Date •✓ . f " Signature of Owner
1 `•
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 performanceof the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier • Policy No.
F1#'ATZ FUND 15l15393.90
(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, andagree that if I should become
subject to the workers' compensatio provisions of Section 3700 of the Labor
Code, I shall forthwith comply wish se,p Vlsi r5's.,
Date: .." 4"1 Applicant A Zee- '
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 applicatt n 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 representatives of this City to enter upon
the above-mentioned property r inspection purposes.
Signature (Owner/Agent) Date '
BUILDING PERMIT PERMIT#
,
DATE VALUATION LOT �:�.�. •Oa�i TRA
U49,71620 1 29M
JOB SITE
APN
ADDRESS
°9-&14 DMIMM'.at.OiNDME
OWNER
CONTRACTOR/DESIGNER/EN IN;103 R
3?' �'d�}t.f.�IMS, LLC
WORLDT91~:%�s'4.C)1�Tvka-Z`y TNC
74 -329'3 .1:1?tl3�Y 1.1.1 M 11103
74.333 ��' W. 111 S11
PALI is T)M1X'1: CA 92260
.PMMA I3L%,'.kT CA, 92264
(76o)5E,8.2955 0;9141 5028
USE OF PERMIT
051O..: rA,MI,Y DW M,XWO
V0. 1.,0T 14„ PLAN 1A, PIDIZIMIT DOZS NOT 1WC1,€ IJX8.LJ"JCK i
'iitALi'.,. OOUAPP..ROA(`!i' DR.'V,,Y,WAY - 7.51M!#NCHECK FER PUBDUCTION ,'
VOR 13SUA11t,1f' OlrSf,MS PIM 71 PIL ®
M
R o 2 2001 .�
TRACT COE+ STRUC:i'ION Z31U,DO 3F,
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i�rrD�?:0,F1IPAT1CI 7100 SF .Y
i" LA
('MRAnF.lC;. r',PIJRT (s) 6744f1K.fit1
,Z+f�+. 5' D��':kE,:T`3I',D C':C3gs`�' GY (VI NSM�,+CN'1ION
149.71640 .
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PYLSYN'A4I��yn', S1�UJ.YYA/8A RY
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C-0140'1'RUC7'MN F1?is': 101.09003•-41 S-f1OU $914,AO
PUS CHWI K' RE 101.000-430-318 $;70.36
mg.al?(A,i1TCAL FEE 101 -OW-421 -000 193.50
1r.3X(:Y'R.i AJ,FEN, 101-000 4,20-000 3134.0')
PLITI+1 IDN4 0 FFIE 101 -113W -419 -ON 411,0175
:11'1?,ONG N4011101d 101-000-241-000 $14.w
O1'o z�,6DINO FEE 1091.000.42.3-00 820.00
,0EVZ3.,C?1?F,R.11Vd.PACT M 11,901409
0tl'.TBAXYCA7 C:OWGI'i`Rtl'C':1 ON A114D PLAN 't''" EC
$,4"423.15
t l•�4'i:�3y FRF -PAID 1M
$0t.00
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aSi7l�rnT'aJ t
RECEIPT
DATE
-•
BY
.J fry.
DATE FINALED
INSPECTOR
,:,
Yw I
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings
v
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
I �f'�-0X
Exhaust Fans
O.K. to Wrap
�� _ �—a�
F.A.U.
Framing
0 /
Compressor
Insulation
�p_c� �,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Finall/-`v�-��
/ _ _
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer ConnectionL5
Encapsulation
Gas Piping—J
d/Z7� 'XAppliances
Gas Test
/
Final
COMMENTS:
Final
Final
0g!_
/ /�,l/�
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
7
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:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
79-534 DANDELION DRIVE
R-3 Type of Construction: VN
Owner of Building: D F PARTNERS, LLC
Building Official
Bldg. Permit No.: 0103-014
Land Use Zone: RL
Address: 74-333 HWY 111 STE 103
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.
Date: 9/6/01
POST IN A CONSPICUOUS PLACE
AUG -10-2001 13:31 WESTERN INSULATION 909 686 8766 P.05i19
WESTERN INSULATION, Le P. -
4211 Latham Stmt, 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 #: 14
SITE ADDRESS: 79534 DANDELION DR. LA QUINTA, CA
EXT RIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKN /811 R -VALUE: R-13
CEILINGS: BATTS BLO
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: �BATTBLOW
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: RII(bqgCTION MANAGER
DATE AU UST 10, 2001