0103-027 (SFD)U) N_ W
O :D M
I-- CY U.)
� W
oZ~
0000
(0
www
I-- (L
U)
Z
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
g`1431167 Y3 1 V31IPA(
Date ��'YSignature 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
lam em t u d r Section a ,`B&P.CA or(t.' %ea on - `I
Date , '' �'-Signature
of Owner " .r � �
r 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 performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
$TATSFWD 15W0193-0
(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 �s to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensatior,v,pr visions of Section 3700 of the Labor
Code, I i all forthwith comply with those py>�rsion-
Date: Applicant-21-
Warning:
pplicant 21•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 autho,r)''fe represeAtatives of this City to enter upon
the above-mentioned property Rr in-sp ctidin purposes.
Signature (Owner/Agent) �~� Date"' '
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
291523
JOB SITE
APN
ADDRESS
79-543 DAND EWOR DRYVE
604-072-004
OWNER
CONTRACTOR/DESIGNER/EN (NEER
D F PAllYppY-M."MI E, LLC
teagWok 31{iY�9VkU>!P(►MM4T1 NYC
y It
74-333 33 H Y 111 3111, b 03
/-7.333 I.J 4 111 ai�.r E S 03
MIA DFIID3r'.T CA 92.260
P,.AU4 ?DrJRWAr 92260
aW4 5028
USE OF PERMIT
aA M31ILTEe .l.As�t±pIL 7:" DWELUN •
F:v
WD - 1,0T T I, Me3N ZRO, P&MIT DL7Lr"S , ,)T i1vCl..i'I'M HIDICk. ...�
WAWF'OWAPP OACH laRTAM3NAY -75% FLAN CHECK FU dtEDUCY10N ,
VOR. IM -W 91<Ii' E' OP V� V.L I1' . T YF:ir.,
TRACT CONS RlIC' IOW 2.21010017;11 MA
02 2001 ;
I''I'3RCWPA a; IO :81 %.00 61' :
WthJA CARPORT (4F)
.
Eg.E.lmmrj) COST Oir col.m..%#UM. O
d.+J7q� boWcr °
�G��1'd3`6'�''4��"1'1P.�?~� 1'��1:• 1 �?i w?1�f(Da�•.4 �i•,�J�� S"�'F9,31�
�.
PL#►3KY�;H1tCFP';WY.
MECHA NTCAleFEE 101mQi�t-�1�1.Ot� �A� Sb
WIECTWCAL, 117., 101 _000-420-wo
PTIUMOIN0YU 101-000-419-000 $163,74
U.ROa+I O MOTION PER . MID 101-000-241-000 $1192
OR ALDINO ME 101.000.423-000 $20.00
!s)1'v+D"RLOP-R-It IMPACT FEE afor101.Ot!
R'•[Wl°Mr` , ("ONVM,01 fMMAIM, PLAN (111B CX
.Ya �t.5e3 PRE -1 IND Y,E:.1
$0.00
1'1 s�ML r A FIrEs AXTE now
T3 bo
RECEIPT
DATE p!
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs`
�C
Forms & Footings
Underground Ducts
Ducts
\2
V
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�_ e-1vZope-,
Exhaust Fans
O.K. to Wrap
Framing
I _�
5.
_ —
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines -
Party Wali Firewall
Exterior Lath
_
Drywall - Int, Lath
Final
Final
9% _
POOLS - SPAS
BLOCKWALL APPROVA�.S
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
Sewer Lateral
_
.s7 �i_ d�
O.K. for Finish Plaster
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
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)
(Certificate of Occupancy
City of La Quinta - g
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Const
Owner of Building
D F PARTNERS, LLC
Building Official
79-543 DANDELION DRIVE
Bldg. Permit No.: 0103-027
:tion: VN Land Use Zone: RL
Address: 74-333 HWY 111 STE 103
City: PALM DESERT, CA., 92260
By: DANIEL P. CRAWFORD JR.
.Date: 9/21/01
POST IN A CONSPICUOUS PLACE
AUG -1072001 13:33 WESTERN INSULATION 909 686 8786 P.18i19
WESTEDRN INSULATION, L.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 #29823/PHASE 2
LOT #:
1
SITE ADDRESS:
79543 DANDELION DR. LA QUINTA, CA
EXTERIOR WALLS:
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS cs�Low
MANUFACTURER:
GREENSTONE THICKNESS: 10.3 " R -VALUE: R-38
CEILINGS:
�SATTS BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13- R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT, INC.
BY:
TITLE:
DATE:
IRISULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484 ol
BY:
TITLE: P TION MANAGER
DATE AUGUST 10, 2001