0003-276 (SFD)U)
F -
CV U)
W
OCY`M
W
o Z r
CZOOO
F-
LUa�
U)
Z
co
LO
N
ON
U am
CL Q
Z
`r Q0
O�Q
C0 _J
O
� 0)
11:r Z
cb::)
P-0
J
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
%743£367 13 I W 1120
yDate ��_�� Signature of Contractor C, t
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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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 $TATE FUND Policy No. ISO0393-99
(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
subject -to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forthwith comply with those provisions.
vEate: /.. 'r •z Applicant �1
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 ove-mentioned property for inspection.purposes.
1
Signature (Owner/Agent) '` ��% %"'-``"" Date r "0
BUILDING PERMIT PERMIT#
W03-276
DATE VALUATIONLOT
$3 0,t9�! 10 1.5
TRACT
25691
;,��
JOB SITE
ADDRESS -616 DA(".Xa$� DRIVE
APN
MM-077_EK��
OWNER
CONTRACTOR/DESIGNER/ENGINEER
HM i )AbT D LLC
WORLD DEVELOPMEM, WC
74.33:1 HIGHWAY 113 SAF 103
74.333 HW —1 I l ST:E 103
PALM X)EW tT CR 92260
PALM mr_;i2T
CSS.
92260
(160>568,2955
ML01
5028
USE OF PERMIT
MA1'C3u F-Pavoly IDWE"Li.J11IG
SF0.1,OT 15 PLN 48 -PERMIT IDOFS MOT INCLUiD1✓ B1,OCKWALL! 5 OR
POOL,15% PLAN CI•IECK FEE REDUCTION FOR iMULTIKE ISSUANCE E OF
SAME PLAI@ TYPE.
T&AXT CONSTRUCTION 2311,00 3F
Pt IZMPA.TIO 68.00 sr
O Aa13.Af1 CARPORT 06.00 SIS
ESMTAM) 1) C09r OF CONS'.P,,ftUC" ON
150,093,0
P:0'd' 11!6%; gU TMARY
C014STRLIC'.TION FEET? 101-000-418-000 $318.4A
PLAN CHECK FEE 101-000-439-319 $171.85
MECHA111CAL FEE 101.000.421-000 Sga,$0
EMC-TRI.C,AL FF„E 101-000-420-000
PLUMBING FEE 101.000.419.000 $161.25
S-TR.ONG MOTIUM PEE - RESID 101-000-241-000
ORAlINOTEE 101.000.4:3.000
AEVZLOPER IA#P.ACT FFY- $1,M.00
SUB -TOTAL C",OHSIRUCTIOR AND PLAN CIMC'T.0
X3;342.00
LESS MR -PAID =3
� L
$0.00
TQ' AL FMfff VMS IME 11 OW
&4,342.09
RECEIPT
DATE
B`(
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
.z pcaQ3
Ducts
Slab Grade
T.
Return Air
Steel
5 > 2
Combustion Air
Roof Deck
b, -.?-a - 00
Exhaust Fans
O.K to Wrap
1-10.00
F.A.U.
Framing
18 3
Compressor
Insulation
g
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathep
Drywall - Int. Lath
g •$•co CpFo
_
Final
BLOCKWALL APPROVALS
Final
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
5 - t -I - 00
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
1
Appliances
Final
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 t2A_
Final IJ ---
Utility Notice (Perm) �_�_
COMMENTS:
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 fallowing.-
BUILDING
ollowing.
BUILDING ADDRESS: 79-616 DANDELION DRIVE
Use Classification: SFD Bldg. Permit No.: 0003-276
Occupancy Group:
R-3
Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D LLC Address: 74-333 Highway 111 St. 103
Building Official
City: Palm Desert, CA 92260
By: Greg Fox
Date: 10-04-2000
POST IN A CONSPICUOUS PLACE
SEP -20-2000 14:15 WESTERN INSULATION 909 686 2786 P.08.i12
VT '� N I �..TI�ATI
4211 Latham street, Rivwside, CaLifom''a 92501
TeL (909) 686.8760 Fax (909) 686-8786
INISO ATION CERTIFICATT
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: ILD OWER - 25891 PHASE:1
LOT # : 7 5
SITE ADDRESS: B DANDELION DRIVE, LA QUINTA, CA
EXTERIQR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 35/8' R -VALUE: R-13
CEILINas: ATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3° R -VALUE: R-38
CE!� BATTS BLO W
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
GENgRAL CONTRACTOR.- WORLD DEVELOPMENT
LICENSE NUMBER: Q t%
<I A
BY:
TITLE: bea
DATE: O Ov 1
8NSUL►T[Ohl CON -TRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 46
BY:
TITLE: OFFICE MANA E-A'
DATE SEPTEMBER 20, 2000
a