0003-275 (SFD)D
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
/ 74.3867 B 1 1213132(
VlDate ria Signature of Contractor
ti�
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 ISignature 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.
( ) 1 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 STATE MD Policy No. 160393-09
(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
subj�Ct to the workers' compensation provisions of Section 3700 of the Labor
Cede, I shall forthwith comply with those provisions
.Zate: < .;iU0 -Q Applicant—C.
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/above-mentioned property for inspection purposes.
Signature (Owner/Agent) - r !`" — Date2 V a4'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OW'; -27-S TRACT
$126,24,J..8()
91
1 r, l��p•� l� k��71
JOB SITL
APN
ADDRESS -79-63.
79- 3.8: 'ATWFL!0H.D1 .n . ..
W41-072-00
OWNER.
CONTRACTOR/DESIGNER/ENGINEER
AM DAN D LLC
WOPID DEVELOpivENT, INC
74.33:1 L11011WAY 111 ST 103
74-333 HWY I I 13'11;103
PALM DESERT CA 92260.
PAIM DE T C"At. 92260
,760)568-2955 CBL* 5028
USE OF PERMIT
MG7 E F"ILY 7YWRE LING
SISI?»IAT t4 PLAN 1RrPZRMIT HOES NOT INCLUDE SLOCKWALGS OR
POOL
TRACT C0113TRUC T I011 407$.00 SF
GA RAOTUCARPORT (S@) 13,406A0
l ti'T'Aa9".'ITE"D COST (UP' C014S'.I'.RUCTSON
126,241.80
I'E`R, n' k?IM ; UAMW" x
WNSTRUCTION FEN 101.000.413.000 "34.00
PLAN CHECK FEE 101-000-439-31€1 $6I0.66
MWHANICAL, FRE 101-000.421.000 $66.50
ELECTRICAL *E, 101-000-420.000 $134.91
PLUMBING FEE 101.000.419.000 $142.00
S'TRONO M0110N FEE • RESIN 101-000-241-000. $11.62
CtkADDIG FK9 101.0,00.423.000 $20.00
Di VZV OPER IMPACT IEP. $1,907.00
Ltio
3U'f3= r TAL C09954=MON AND PLAX C1ECk.
$3,627.69
LESS PR&PATD FFXS
$0.00
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
b'- z -Q®
Ducts
Slab Grade
S`�"i-S,c
Return Air
Steel-ZcQ-g�
_
_
Combustion Air
Roof Deck
(o • t4 - QQ)
Exhaust Fans
O.K. to Wrap
, %Z - p6
F.A.U.
Framing
_
8 1eo co F
Compressor
Insulation
Fireplace P.L.
$ �`� pJ (0 Fi
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
��) 1) �-�'
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
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
T I
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) It--t.wk Cz I
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) (lam, l8p
SEP -20-2000 14!15 WESTEP.N INSULATION 909 686 8786 P.97i12
i TE N INSuLATION, INC.
4211 Latham .Sheer, RW=gide, California 92601
Tel, (909) "6-8760 Fax (909) 686-6786
INSULATION LATION CEItTIFICAT�
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: LOWER - 25691 PHASE:1
LOT #: 14
SITE ADDRESS: 8 DANDELION DRIVE, LA QUINTA, CA
EXTIER_I_OR WALLS:
MANUFACTURER. JOHNS MANVILLE THICKNESS. 3518' R-VALUE:R-"13
QOLI9N6iS: <t�S SLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
CEILINGS: BATTS tie BLOW
MANUFACTURER: JOHNS MANVILLE T K NES S: 13" R -VALUE: R-38
GENERAL CONTRACTOR: WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATI NTRACT R: WESTERN INSULATION, INC.
LICENSE NUMBER•
BY:
TITLE: OFFICE MA
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:
Use Classification:
Occupancy Group:
SFD
R-3
79-638 DANDELION DRIVE
Bldg. Permit No.: 0003-275
Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D LLC
l 0't"l
Building Official
Address: 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 10-11-2000
POST IN A CONSPICUOUS PLACE