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LICENSED CONTRACTOR DECLARATION
1 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
Date Z 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). P;,t /
O Itam-exempt under Section B&P.C. for �fi"is-reason
'
DateSignature of Owner
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 VATH MD 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 agree that if I should become
subject to the workers' compensation provisigns of Section 3700 of the Labor
Code, I shall forthwith comply with th a provisiofis.
Date: &F-.4 Applicants'
A:
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 representatives of this City to enter upon
the above-mentioned propeinspection purposes.
Signature (Owner/Agent) . ^ r r"'' Dat "�-""�
_jr✓F IR
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Qa+ �i�. TRACT
16
29623
JOB SITE
APN
ADDRESS V e' .A2 pAppI ORI
y "072i4
OWNER
CONTRACTOR / DESIGNER /N (NEER604072—W4
14-333 EMWY 111 MY, 103
74.333 HWY 1 11 MT19103
P,b1IAA I:+E•a3ERT Cts 92260
PALM 17isa1Y.. Zf
CA 92260
(60)568,2955
CP11 t 5028
USE OF PERMIT
MOLE Fwmy 1yww2G11 o
sa
S - L,O:i 16, MAX n PU.M..I DOZ3NOT '04Cf.UOLT, fl -LOCK
j
VALLIP001J: PPROAC H D R1V.'&W r 3
4
T kACT COW;rf RUOTICH 5T MAR
0 2 2001.1
ETIMATED d �,p� y �L •g' •p� ,e1pY 17� 9�9,.v�t��+ r�'1491,716"
AFF.Dti �dL ATED h:0ti�.a `�.i.' CO NeE.�2.�U A.1011
y �q�^u 9 d rq,�r.
'1491,716"
3�a� NOWARY
KU
C:ONSTUCTiON F+ d 101x -000 -418 -„COC;' 5014,50
PLIKR CHECK FT12 tOl-Cr0043t 318 9681.45
MECi AS. 40.Ab FEL 101.000^421-000 S51&SO
F,LWTP;IrAI., i3WE 101-000-420-000 $134.07
PLUMBING PRE 101-000.419.000 $163.15
3`1'1v}:.i±NU MOTION FEE. - RES1I? 101 -000 -:241 -NO $14.I1
a., 1PLA.UMCf FER 101-000-423-000 $20.00
=if'9I.OPP.R.IMPACT F7±2, �l,latYlt+41
SUB -TOTAL C0t1° .P11TCr1i0N AND :i~IAH C11741C
$3,014.Vi.
110 PRE-P.AJD 1+TT3.1D
$0,00
TOTAL 11KRA'U' 1.+'E'ES ME NOW
WYj4`S 7i� Y
RECEIPT
DATE
B%DATE
FINALED
INSPECTOR
2. ! I4
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
7/ �� ����
Exhaust Fans
O.K. to Wrap% 4
F.A.L1,
,.
Framing
�F�(
Compressor
Insulation_
,� ) J �'�l/!
Vents
Fireplace P.L.
j
Grills
Fireplace T.O.
-
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
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 Lines3
l2 +��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
� �_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
�J
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
I
Certificate of.0ccupancy
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.-
.
ollowing.
. BUILDING ADDRESS: 79-542 DANDELION DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: D F PARTNERS, LLC
Building Official
vni
Bldg. Permit No.: 0103-012
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
INSULATION 909 686 8786 P.03i19
3
WESTERN INSULATION, L.P.
4211 Latham Street, Riverside, C.atlfbmta 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#: 16
SITE ADDRESS: 79542 DANDELION DR. LA QUINTA, CA
EZCTERIOR WALLS•
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS: BATTS Bt0
MANUFACTURER: GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13 R -VALUE: R-38
GENERAL CONTRA TOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PRPX6
TION MANAGER
DATE AU UST 10, 2001