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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
-43567
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Date _11, fSi nature 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 structilre is not intended or offered for
sale (Sec. 7044, Business & Professionals Coda).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). !/. %
O l a exe t ur�de Section , B&P.CA' r tfii re ob
Date P'• Signature of Owner /eo
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. k 50930.0
nATF FUND
(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 Califo nia, acid agree that if I should become
subject to the workers' compensatio proviSio s of Section 3700 of the Labor
Code, I s all. fo h ith comply with os` ,•�BI��✓r.ro Ions.
Date: -��i" ApplicantG
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 rep7sentatives of this City to enter upon
the above-mentioned prop rt or' spectio purposes.
Signature (OwnedAgent, / '�' Date./-
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01 OQV 013 TRACT
W911.96,.60 is 29623
JOB SITE
APN
ADDRESS 4 pay�3 9�,��}�^ Are P�-{y�yy y�y ;/y
t`�'Z9-eWR t1.JJ66V.�.Tn�46Rd`.49 N.��`fJ.YN
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\�'✓4' --0 72-i1`/a 4
OWNER
CONTRACTOR ENNEER
r, �^^ (py ((.��y�� ��}} 77 pp //��
D F 1's°.7�,9�•L.L` ERS. LW,
y/DESIGNER/
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' OA.'i.7.D 11.7EV,O:�.WI.s};,mm , ,f.L c
74-33311WY 1)1 M, 103
74-a33 HWY 11A 1 EFIX 3U
PALM DEORT C& 92260
PALM 1YMR.T C6. 92260
(760)568-11955 L: 11111 Ras
USE OF PERMIT
01WOKi lWMRYLLyrO
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SPD -1,00 14 >i=i,AN.i.R,f1, AHF.;.f! IT DOES NOT INC'LL(D I�t'}C
''�JA&f.,iPC�f4'sY,.APP1?,0.ACH'
?i.TVYWAY
iFil+d71` CONSTRUCTION 4134,00 S1' i U
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P%illc,WF,A1'iO 71+2.00 SY
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'1WAIWD COS'f OF t';`O,RE'i`.WIF--MIq
1,39,1 A01
CONSTRUCTIC44 RE
P,LKNN'CP1'i&CK. FEE $654.69
Mf?CHAN?6'Lt,1.'PER, 101.000.421.000 $98.50
V,,1Z,C, TRJCA-L 9.47%, 101-000-420-000 $1 V,15
P1,1,iMB1140 ME 101-000-419-000 $163.73
S R.Op$O k'3fD3ION FSS n R.ESID 101-000-241-000 $13.92
s:16A3:alNO YXII 101-000.423.000 SAW
OXfMOPYPt IMPACT F90 $i,907-00
SUB-TMAL CO1~S'11TR1.1CT1014 AMD T+i.,AN ( 1, X
$3,764.31
LE33 F'7E'.E»P'.t' rD M32
$0.00
`1'Q2'TAI, PEUMT? y,S MY nowmar
!CA"sI
RECEIPT
DATE ��
B,Y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
' p
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
!�
Exhaust Fans
O.K. to Wrap
-��-
t�a"L .
F.A.U.
Framing
_
Z
Compressor
Insulation
adl
/ /
vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
9/��
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
__
—C-9-
Pool Cover
Sewer Connection
Encapsulation
Gas Piping-%
Gas Test
Appliances
Final
COMMENTS:
Final
if,-�{
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)
13:31 WESTERN INSULATION
909 686 8786 P.04/19
WESTERN INSULA'T'ION, L.P.
4211 Latham Street, Riverside, CoMfornla 92501
Tel. (909) 686.8760 Rax (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 #: 15
SITE ADDRESS: 79538 DANDELION DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTSBLOW.
MANUFACTURER: GREENSTONE THICKNESS: , 10.3 "
CEILINGS: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 "
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY: Xo
TITLE: P D,/ TION MANAGER
DATE AU UST 10, 2001
R -VALUE: R-38
R -VALUE: R-38
ii
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
ollowing:
BUILDING ADDRESS:
79-538 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: D F PARTNERS, LLC
e -w1
Building Official
Bldg. Permit No.: 0103-013
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