0006-088 (SFD)Wiwi",
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. Classy Exp. Date
743867 �B___ t � � 12m1,7�
'ate �`> N Signature of Contractor j
. J
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 81 Professionals
Code).,
O I am exempeunder 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 STNTE FUND Policy No. 1509343 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,. anted 9r�e_ha .if I. should become
supject to the workers' compensation oFo IsiG ions.of Section 3700 of'the Labor
hC-ode,•I shall forthwith comply Withftho§ fpr visioocts'�^--�
ateb- t-,__2 k Applicant. f + `
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
constry. ction, and hereby authorize representatives of this City to enter upon
the above-mentioned pr�oplerty for -ins pteetion-p'urposes.
JSIg/nature (Owned gent) (1d
Date 6A
j1-ri -uo BUILDING PERMIT PERMIT#
OW6-m
DATE VALUATION LOT TRACT
$135,$26M 3 25691
JOB SITE
APN
"ADDRESS iA1��7s.r0��
604 -072 -OM
CONTRACTOR/DESIGNER/ENGINEER
WOR -M DENMOPMEW, INC
WORM r1E1Vh'L0PWH1V_1°, T90
74.333 HWY l 11 91B 103
74.333 HWY 117 UIE 103
PALM DESTRT CA 92260
PALM DRI'O'I' CA 92260
(760)560-2955 CBLff, 5028
USE OF PERMIT
S``71JOLE ITAMi1 Y 77VIELMINa3
5Fi9-PLAN 3KA 1XIT03 -PERMIT DOES NOT INCIMIDE 0LOCDCW,ALLS OR
P,001. 75 % PLAN CRECK FF FIF-D C TION FOR MULTIPLE ISSUA14CE OF,
SAIME PIAN TYPE
TRACT CIONSTRUC7:ION 2230.00 5F
PORCH/PATIO 30.00 SFS
OAIaAGE(C.ARPORT CdF) 14,072.80
Eb'FrLfttl'AT.W C.OS'r A>7 Co .KM.r,k'[ICMO,N
Y3+ �026.tt
P�FEE S iOit . Y
CONTSTRUCTION FXE 101-000=418.000 065,50
PIAN CHECK FU 101-000.489-318 $161.88
MECHA141CAL FEE 101.000-421.000 $98.50
,
IiJ=T1R.ICALFEE. .101-000-420-000 $190.91
PLUMBINGIM 101.000.419.000 $161.21
S'iP.UNO MOT1014 FEE. - RESIDE 101-000.241-000 $13.55
ORAD1140 FEE 101.000.423-000 $20.00
:
DLV ?J.OPER. IMPACT FEE •
� j^
V #
suB-J°oTAL oowraL7C'' ow AND PLAN G'Tmel.:
$3,268.62
LE B3 PRFs -PAID 1011, 3
$0.00
TOTAL, PKIP .1 T ! MIS li•LTE X0W
n )
RECEIPT
DATE BY'f,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
'�
Return Air
Steel
Combustion Air
Roof Deck
_ _
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
ap t.,jC40DL
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3)
Drywall - Int. Lath
CeV=CK
Final
Final 1��g (c:o G�DZ
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Cal. &-Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
1$ Oo
Pool Cover
Sewer Connection
Qj (8 pv Com(.
Encapsulation
Gas Piping
Gas Test
ci
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 1
Final L Cpm'
Utility Notice (Perm) a IR
COMMENTS:
F�
I
OCT -25-2000 12!11 WESTERN INSULATION 909 686 8786 P.04/09
W -ERN x1�L�PIi 9 YY�t
4211 Latham Street, Riverside, Calilbrrua 92501
Tel. (9D4) 686.8'760 Fax (909) 686,8786
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CAIV
LIFORNIA ADMINISTRATE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
Cell
t.
TRACT / PHASE: WILDFLOWER PH - 111 - 25891
LOT # 8
SITE ADDRESS: 79833 DANDELION DRIVE, LA QUINTA, CA
gKff pFt WALLS,
MANUFACTURER. GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
{
CEILINGS. BATTS 9LO�
MANUFACTURER: Johns -Manville THICKNESS: 1.3" R -VALUE: R-313
ILIN�S, BLOW
MANUFACTURER: Jo TICKNESS: 3 518" R -VALUES R-13
a����N°t'�(;T®� WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
,,,SSU LATI®N C®NTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MANA
DATE OCT08ER 25, 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 ADDRESS:
79-633 DANDELION DRIVE
Use Classification: SFD
Occupancy Group: R-3 Type of Construction:
Owner of Building: JIM DAN D LLC
Building Official
Bldg. Permit No.: 0006-088
VN Land Use Zone: RL
Address: 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 11-08-2000
POST IN A CONSPICUOUS PLACE