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t 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
Date ��� Signature of Contractor'•i?��c7�1
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).
( ) I am exempt under Section B&P.C. for this reason
Date Signature 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 STATg FUND Policy No. 1SOg343-99
(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
s sect to the workers' compensatit n�arovisions e'ctib "370V orfhe lab'o'r--
Code�l shall forthwith complq with ose provisfo s. }%%�
Dater ���� Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties acid 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, indemnity
& 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
�thh above-mentioned propertyy for inspe Iiora�eff�seS.
(Signature (Owner/ g�e�l� `°���`/�` Date v
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0006-087 TRACT
$337,042,00 2 25691
JOB SITE
APN
ADDRESS 79-613 DA."iL,IJOPT DF►IWE
604-072-"
OWNER
CONTRACTOR / DESIGNER / EN (NEER
WORM DEVELOPMEff, INC
WORLD DEVELOPMLW, ..C, WC
74 -33314 -WY 111 SM 103
74-333 YTWY 111 MT, 103
PAL YA DF=71 CIS,. 92260
PALM IYESM CA 92260
(760)568-2955 C13LO 5025
USE OF PERMIT
1NCiL}S 1Y'AbO-Y D`ti ELUNCT
SprJ-PL AN 3I2B LOT 02 - PERMIT DOLS NOT INCLUD9 kiLOCKIAFALLS OR. •.
POOL
TPACT C014STRUCTION 4230.00 SI?
PORCH/PATIO, 50.00 S.I'
GARACIFYCARPORU (9F) 15,288.00
ESMATED COST Off+' COPMUCITON
137A42.00
YERiVJICr FEE 9LIAM RY
CONSTRUCTION TIVE 101.000-418-000 $771.50
PLAN CHECK FI>Z $632.81
MECHANICAL FEE 101-000-421-000 $98.50
EIZCTRICAL ME 101-000-420-000 $142.15
PLUMB IC FEZ 101.000-419-400 $161,25
STRONO MOTION I?ZF - RESID 101-000-241-000 $13.70
ORADINO PIE 101-000.423-000 $20.00
DEVELOPER IMPACT 1�`la'1a
=T0rfAL CONI:1'I2Z.TJMON AND P) -.PN ClIFV, X
$3,767.91
TZ&4 PRE -PAID 17 .`3
$0.00
TOTAL 2'ERMIl '!F't..f`'CCS ME'
$0,767-91
RECEIPT
DATE
BY ` ti
DATE FINALED
INSPECTOR
iJ
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
14DATEINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
i
Ducts
Slab Grade
2
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
0. K. to Wrap
I p0
F.A.U.
Framing
Compressor
Insulation
2_3 Cat—
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
31 cc
Drywall - Int. Lath
Final
Final
tl $ C
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
4, _dI j
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
a lb Cote
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 1P
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 C, IS
OCT -25-2000 12:11 WESTERN INSULATION 909 686 $786 P.03/09
WESTERN, . I SULATION 9 INC*
4211 Latham street, i;uvnrslde, Caiiforala 92501
Tel, (909) 686-8760 Fax (909)686-8786
IWSULATWX UORTIFICATE
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: WILDFLOWER PH - 111 - 25681
LOT # : 2
SITE ADDRESS: 78613 DANDELION DRIVE, LA QUINTA; CA
..................... ..... ...........{".......................
EXTERIOR WALLS: r
MANUFACTURER: GREENSTONE THICKNESS: 10"ik R -VALUE: R-38
CEL GS• BATTS ALO
MANUFACTURER: Johns-Monvko THICKNESS: R•VALUE: R-38
CEI NGS: BATTS BLOW
mANUFACTURER: , Jo 'A4anvN/e THICKNESS: 3 518" R•VALUE: R-13
GENER-A C�� 'ACTOR: . WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
114SUL TION GONTiA9 : WESTERN INSULATION, INC.
LICENSE NUMBER: 461278
BY:
TITLE: PRODUCTION MANAGER
DATE OCTOBER 25, 2000
0
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 ADDRESS:
Use Classification: SFD
79-613 DANDELION DRIVE
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: JIM DAN D LLC
Building Official
Bldg. Permit No.: 0006-087
Land Use Zone: RL
Address: 74-333 Hiahwav 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 11-08-2000
POST IN A CONSPICUOUS PLACE