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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
;4'3867; f 121ti1i2t
Date "�'�! Signature of Contractor
. ' OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt rom 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).
( ) I am exempt under Section B&P. for this,eas 'n
..•
Date �ZIP �.r'%.N,•Signatu'e�,of%O ner� �r
WORKER'S COMPENSATION ECLARATION
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.
(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 a�tee that if I should become
subject to the workers' compensation provisions/of Seeetion 3700 of the Labor
Code, I shall forthwith comply with the proisions.4
Date:,5 ✓e_/) t • Applicant ��
7 G{
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 authorize repre ntatives of this City to enter upon.
the above-mentioned property f !r inspection purposes. / t
Signature (Owner/Agent) -„.f Date72
r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01613-W3 ki TRACT
U39,1915,60 3 29623
JOB SITE
APN
ADDRESS
V,535 DWMIJOINDIUM,
04-072-004
OWNER
CONTRACTOR/ DESIGNER/ EENIINEEER
^ibnALMS, IXC.
vOJJd ESd7O.Vd1"A, W.
74-333 H`Vd:tTP J IRTA 103
74-3,43 MY 113 91F, 103
.&''J^L.T1.M DnTf i' CA 922+.0
PALM DOW CA, 92260
(160)%6-2955 Ck 101 S02E
USE OF PERMIT
S03 ., B tai' I, PI..A:N iFit F'WMIT DOES NOT 11.4 161,r 111.,OC K
WA1,10001JAPPROACH DR1VOWAY - Fg% PL&H CRECK, FSE'RSDUC IOX
FOR yc.�rFr; o s1 R�1e1=t�,
E I
W 02 2001
TIR- ACP CONSTRUCT1014 2,LI&M By
y Uf_
1�ORC11i,i�,�a l IC1 31 .30 SI+
� �`i O1 8 U
CO T 11134' t ION fe& 141 - (t M,438.000 $'T74<SO
PI..A:14 C3fi€"(11 G IFFIE 1431-0C&4.`39-318 $163.
`MECHA1 ;C.I>LO'i?E 1431-000-421-040 99.50
kra.ECTR CAl, PEP 101.604-424-004 5137.15
P1.;E1MBiR O.VU' '101-I.00-419.4001 �4.63.i4
STRY.OAI(:Y MUTION TEE, • R=D 141-000-241.6300 X13.93
ORADI!NO FEE 101 -000 -423 -NO V0.00
Dh i!'iZOPIrJ, DAa ACT IVRe l,9ti S a13
X
8TYB-7t'YI"XL CO.N'V:EtT.i'MON AMyy,�If��yl�pI
y,'('�4�� g�::C�. y �
11MIS "NI)I.t�.1" i.S
'KXCAT, PKIMU FEES DUE NOW
RECEIPT
DATE +
BY
DATE FINALED
INSPECTOR
11 i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings t7p '
Underground Ducts
Ducts
Slab Grade
J
Return Air
Combustion Air
Steel
Roof Deck
O.K. to Wrap
Framing
S` 7L
Exhaust Fans
F.A.U.
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
_
Final 5�7 _
BLOCKWALL APPROVAL a
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
�' 1��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
_
q�(�/��lit_
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lary Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Certificate of Occupancy
City of La' Quinta I -
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 fo/lowing:
BUILDING ADDRESS 79-535 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0103-025
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: 9/25/01
POST IN A CONSPICUOUS PLACE
AUG -10-2001 13:33 WESTERN INSULATION 909 686 8786 P.16i19 ,
WESTERN INSULATION, L.P.
4211 Latham Street, Riversldc, California 92501
Tel. (909) 686-8760 Pax (909) 686.8780
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 #: 3
SITE ADDRESS: 79535 DANDELION DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS ��ow
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS: BATT BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 " R -VALUE: R-38
GENERAL CONTRAS WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: •794484
BY: >5�7
TITLE: PRO ON MANAGER
DATE AUGUtT 10, 2001