0006-089 (SFD)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
743867 B
Date — Signature of Contradtof �_ 1)
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that Iam 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:
CarrierSTATE MAID No. . 1509393-99
{
(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,.aad gree»that_if-I-should become
)s bject to the workers' compensatio rovislons of Section 3700 of the Labor
ode; I shall forthwith comply �with th - se provisions
Dater "� '` Applicant�•- _
Warning: Failure to secure Workers' Compensation coverage is unlawful'and
shall subject an employerto criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damage's 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 frepresentatives�of this City to enter upon
the above-mentioned pr rt Ifo•inspectlopurposes. '
nature (Owne /Anent' Date��
t '
` (`I' `J BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0006-0$9 TRACT
$126,241.0 4 25691 ,
JOB SITE
ADDRESS ISS- 153 DAM)MON DRIVE
APN
• 604-072-W5
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WORM DFV:OP:f�LC,1dT', WC
WO= DEV M- OPMQ4T, INC
74-333 HWY 111 0TL 103
74-333 HWIY 111 UrLe 103
PALM. DMM' CA. 92260
PALM DU i RT CA 92260
(760)568-2955 Gal4 502E
USE OF PERMIT
SINGLE. AM'.i:YMEM(Y'
S'FP_-PLAN JAaA. IDT 044 • PERM)T 0OPS NOT IMCL.UDE 11LOC:K:W.ALLS OR
FOUL:
TRACT CONSTO.UCTION 1,073.00 SIS
(1ARA0FJC,A,PJ7ORT (SP) 13,40ii.40
ESMIATFID COQ' OF COI4MUC;['LIONE
126,; 14150
PERMT In ER aiiT1MMY
COMSTRUCTION FEE )01<000»418.000 5'rWDO
BLAH CHECK PEE 101-000.439-318 $610.66
MECHAMCALME 101.000„421.000 X68.50
ELECTRICAL FEE 101-000-4MOW. $134.91
PLUMBINO?a 101-000-419-000 $14.2,011
STROND MOTION PPE a. RESID 101-OW241-000 $13.521
- f
ORADTNO FFE 101.000.42:3.000 120,00
17
DEVELOPER IMPACT ",Z $.1,907.000
SUB_UOTTALC0149tkti MOMA.1.3I;?PLM CIMCK
$3,621.69
LESS M -SPAM MS
$0,00
1'O'l;'A..L M2A+1 a F FEES DUE NOW
/?
RECEIPT
DATE
DATE FINALED
INSPECTOR
/ !
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms $ Footings
Ducts
Slab Grade
Lj
Return Air
Steel
Combustion Air
Roof Deck
pG
Exhaust Fans
O.K. to Wrap
it i 1 >"—il
F.A.U.
Framing
Compressor
Insulation
fir)
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1 aJ
Drywall - Int. Lath
Final
Final I 1 �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
to • 'LQ9 _@Qplk
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
p
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 o @
Final Tip -
Utility Notice (Perm) 10 2 0}4
COMMENTS:
NOU-09-2000 13:01 WESTERN INSULATION 909 686 8786 P.02/02
wr;STERN INSULATION, INC,
4211 Latter sit, Rivm side, California 92501
Tel. (909) 686.5760 Fax (909) 686-8786
INSUZATION CERTIFICATE
'THIS IS 1.O CERTIFY THAT IN 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: WILDFLOWER PH - 111 - 25691
LOT # 4
SITE ADDRESS: 79653 DANDELION DRIVE, LA QUINTA, CA
------------------- ---- ---- ---------------- ---------------------•-
EXTE IOR WALLS:
MANUFACTURER: GREENSTONETHICKNESS: 10.3" R -VALUE: R-38
CERT INGS; BATTS 73"-R-VALUE:
MANUFACTURER: Johns -Manville THICKNESS. R-38
CEILINGS: ATTS BLOW
MANUFACTURER:- ' Johns= - - -Ville THICKNESS_ - 35180 R -VALUE- -R-13- - - - - - - -
GENE ALCONTRACTOR: WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULA ION ONTRA TO : WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTN MA
IONA
a�
DATE OCTOBER 25, 2000
TOTAL P.02
Certificate of.O'ccupancy
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:
Occupancy Group:
SFD
79-653 DANDELION DRIVE
R-3 Type of Construction: VN
Owner of Building: JIM DAN D LLC
Building Official
Bldg. Permit No.
Land Use Zone
RL
Address: 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 11-09-2000
POST IN A CONSPICUOUS PLACE