0003-277 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
=) C) License # Lic. Class Exp. Date
,� wCi /43867I2f31d2i
r; Z r- -Date r� ^ wa Signature of Contractor J �"
O
co0r,�
J U C) OWNER -BUILDER DECLARATION
W WW r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
ON
rn
dQ WORKER'S COMPENSATION DECLARATION
C) (r I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L: compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q C) ( I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
IlLO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATES FNU, Policy No. 150"3-99
coo Q
J (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 provisions of'Section 3700 of the Labor
Core, I shall forthwith comply with thoselprrovisionss.
-,Date: V'2A "G'� Applicant _�
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. I!-
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
map & 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 aU6ve-mentioned property for -inspection purposes.
Signature (Owner/Agent) 1, Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0003-2771
TRACT
y�/c,li $1!.37,042.00 16
25691
JOB SITE y���rtq�
ADDRESS 9"51ar�1MFj.,o1lii.cY.a."72-5
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JIM DAN D LLC
WORLD D.L"4'IMOPM EN T, TRIC
74.333 HIGHWAY I 113T 103
74.333 HWY l l 1 fiil ' 103
PALM DEMT CA 92260
PALM D&SUT
CA
92260
(760)568.2955
CPU
5028
USE OF PERMIT
MWOLE IrAMILY DWEIM0
S1rD-LOT 16 PLAN 313 -PERMIT ;YOBS 1400 iAir;:f.,UDE .SL 0CKWA1,I,S OR
P001.75% PLAN CHECK FELE REDUCTION VOR NIULTIPI.i ISSUANCE OF
SAME ?LAN My—
TRACT CONSTRUCTION 2,230.00 SF
PORCWPATIO 50.00 SF
CiAi#AGEIC.,A.I'IPORT -ft 00 SY,
1
ESIMV.=ED CO.W OF CA31MUC'IION
I371012A)D ,
PEI?. Wf FTE SUAUURY
CONSTRUCTION FEE 101.000 418.000
PLAN CHECK NES: 101.000-439-318 $169.20
MFI12HANICALh 103-000.421-000 198,50
ELECTRICAL 179E 101.000-420-000 $142.15
PLUMBII1O FEE 101.000-4192000 1161.2$'
-
STRONG MOTION FEE - RESID 101-000-241-000
GR.ADMI13 FEE 101-000-423.000 $20.00
DIEVELOPER IMPACT iFEI: $1,90780
s
,„.
313ff -TOTAL. CONSTRUCTION ARID PLAN t:'fW_,CK.
$x3,278.30
MRS 7PR -P'AM 1,7373
$0:00
!,'O'1 Al, .f'M'NM,' F, 9 DUX NOW
S3a76-40
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
t�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
y—
Ducts
Slab Grade
crZo{
Return Air
Steel
. r —to
Combustion Air
Roof Deck-
�.p _
Exhaust Fans
O.K. to Wrap
_ _@®
F.A.U.
Framing
)
Compressor
Insulation
ayl
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
$• $
Final '
Final o
BLOCKWALL APPROVALS
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
$:
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Irj GO
Appliances
Final
Final
Utility Notice (Gas) Ip & �
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) OD
COMMENTS:
SEP -20-2000 14:16 WESTERN INRJLATION 909 686 8786 P.09/12
W TE 11 Ir SULATIC�N, THTC
4211 Latham Strcet. Riverside, Calilbrula 92501
Tel, (9091686-8760 Fax (909) 686.8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT i PHASE:
OWER - 25681
PHASE -1
LOT #
16
SITE ADDRESS:
8 DANDELION DRIVE, LA OUINTA, CA
-
------------------------------------------------------•--------
EXTfiINOR WALLS:
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 3 5/8 " R -VALUE: R-13
CEILINGS:
BATTS
SLOW
MANUFACTURER.
GREENSTONE
THICKNESS: 10,3" R -VALUE: R-38
CEIM
BATTS
BLOW
MANUFACTURER:
JOHNS MANVILLE
THICKNESS: 13" R -VALUE: R-38
- --------------------------------------
gEBIERAL CONTRACTOR: WORLD DEVELOPMENT
LICENSE NUIWB
BY: 1
TITLE:iC� 6 -'j -VA
�o.at
DATE: D
INSULATION C®NTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 4$
BY:
TITLE: OFFICE MANAGER--.
DATE SEPTEMBER 20, 2000
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:
79-598 DANDELION DRIVE
Use Classification: SFD Bldg. Permit No.: 0003-277
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D LLC
—7-&-04.x
Building Official
Address: 74-333 Highway 11.1 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 10-04-2000
POST IN A CONSPICUOUS PLACE