0003-274 (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
;/-
43867
ate D - Signature of Contractor
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). L.
( ) 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. 7
( 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 FijNi3 Policy No. 1309393-09
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
2"de, I shall forthwith comply with those prf v&ssibns!"`1 y
Date: tee- ^ �' - 6; Applicant -
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.
ySignature (Owner/Agent) r � r` r"~ �-- Date L E----1>
t BUILDING PERMIT PERMIT#
DATE 1 VALUATION LOT OM-274VALUATION
,(c nth $150,993.3G1 13 25591
JOB bITEi APN
ADDRESS 79`61.58 D "PU''off DJUVE W4 -072_W.5
OWNER CONTRACTOR / DESIGNER / EN &NEER
JIM DM D 11C WORLD DEWELO:F'i EVr, 31`X
74.333 H10HWAY l 11 3'C 103 74.333 HWY 111 STE 103
PXM DEMMT CA 92260 PA1 M DESERT CA 922562
(760)568-2955 MI.<1f 5428
USE OF PERMIT
fflNIa1Zy?fiJALyDVW1M0
VID-LOT 1.3 PIAN 411B-PE12tAIT 11DES NOT 1NCLU DE BLOCICIMA113 OR
POOL,75% PLAN CHECK FEE RkDUC ri3ON FOR MULTIPLE t NUANCE OF
S,fAAl1L+ PLAN TYPE.
TRACT MINSTRUCT10N 2,511,00 8F
PORCHfPATIO 66.00 SF
UARAMUCARPORT 496.00 SF
BUJ s-TMA,L CONNRUCnON AND PL,f R CHECIC
1.1~ M PIRE-PAID F hw
RECEIPT I DATE
150X93.30
k
"I
$3,342.00
$0,00
'fff Mu FFMOT FEES DOE SNOW 1 $V42,00
DATE FINALED I INSPECTOR
PERMIT FER4 ;1€TdlGURY
C014STRUCTION FFE
101-000-418-000
$818.00
PLAN CHECK FLEE
101-000-439-31$
$171,$5
MF.CHANiCAL E
101.000.421.000
$93150
ELF..f`TRIC.A L FE1i
101-000-420'-000
$150.31.
PLUMBING FEE
101-000-419-100
$161,23
STRiSsdf. MOTION FEZ- RFZID
102-000 BIZ -000
$15.09
GRADINO FEE
1G1-000.423.000
$20.00
UFFV'EI.DP11'R IMPACT FRR
$1,907.00
BUJ s-TMA,L CONNRUCnON AND PL,f R CHECIC
1.1~ M PIRE-PAID F hw
RECEIPT I DATE
150X93.30
k
"I
$3,342.00
$0,00
'fff Mu FFMOT FEES DOE SNOW 1 $V42,00
DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
't _ 2.2 -6®
Ducts
Slab Grade
15, -7_46 --ft
Return Air
Steel
S - Z -t -w ACV
Combustion Air
Roof Deck
. -L0 _LIQ
Exhaust Fans
O.K to Wrap
{ • DO
F.A.U.
Framing
Compressor
Insulation
$ t.{ ��1--
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ICO
Drywall - Int. Lath
$
Final
Final I 'Coll C
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
-a. 0%
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
J
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 (� -
Final
Utility Notice (Perm) 21 "
COMMENTS:
SEP -20-2000 14!14 WESTERN I NSULRT I ON 'o9 GeG.e7rdG P.06/12
N INZJ °TIS , .
4211 Latham S=ct, riverside, Califoff la 92,501
Tcl. (909) W-8760 Fax (909) 686-8786
ERSULATION CERTIFICATE
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: /-W-100f LOWER - 25891 PHASE:1
LOT # 13
SITE ADDRESS; 58 DANDELION DRIVE, LA CUINTA, CA
- EXTE1490R 1A%"'
MANUFACTURER: JOHNS MANVILLE
Jill
ATTS
THICKNESS: 35/8- R -VALUE: R-13
BLOW
MANUFACTURER: GREENST®NE THICKNESS:
C 911ANG& BATTS BLOW
�;
MANUFACTURER:. JOHNS MANVILLE THI NESS:
GEI11@RAL COIILTRICTiIi /1NORLD DEVELOPMENT
LICENSE NUMB:
BY:
TITLE:
DATE:
LICENSE NUMBER: 4
BY:
TITLE: OFFICE MA
DATE SEPTEMBER 20, 2000
10.3" R -VALUE: R-38
13" R -VALUE: R48
: WESTERN INSULATION, INC.
Certificate of Occup, ancy
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
Occupancy Group: R-3
79-658 DANDELION DRIVE
Bldg. Permit No.: 0003-274
Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D LLC
Building Official
Address: 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 10-06-2000
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