0006-090 (SFD)6
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 }3. -� 1 12/311%C
Date %~ ��' Signature of Contractor ' w
,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 lh-`,S ,f.k. �) 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 STATE FUND- Policy No. 'W9393-"
(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 SecI'Q:3.7.00,of-tk�e-Labor -
Codel I shall forthwith comply with ,those provi ions '
Date:f L-� , "L -k3 Applicant -1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of, issuance of such
permit, or cessation of work for 180 days. will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property%for inspection`"1 poses�-"
1
Signature (Ow er/rf AgenfiT %� --- Date
!/ 1. P BUILDING PERMIT PERMIT#
90
DATE VALUATION LOT �•p TRACT
S150169330 5 25691
JOB SITE
ADDRESS 79_6,n DAzvri+rOl`d C3R1
APN
60-072-005
OWNER
CONTRACTOR / DESIGNER / EN (NEER
WORM DE'ZiF.U)PN IT, WC'WORM
DNVM. O.P.W— T, INC
74.33315WY 1 I l STE 103
74-333 I WY 111 MTl 103
PALM I3�.a�"ib'1•b.T CA 92260
PALIYI =MT C.A. 92260
(760)568.2.955 C13Lii 5028
USE OFF�PERMIT
VVGIZ, FA1-MptYHJLWG
SN:i�-PI.AAN 4!ZA LOT tl5 . PEY2M;T YJOI•+..S NOT Ii+IGI.t;TJ }TACT: ti9AI !S OR
POOL, 15 % PLAN CHECK FEE Rear UCTION FOR Iw ULTIPLA I,SUANC K OF
SAME PLAN 'I YPI
TRACE' CONSTRUCTION 2,3H.00 3F
PORCHIPA'T IO 6$.00 EF
QARAGrYCARPORT (9, F) 11641,60
EsTn"TE D COST OF.. i?0,N9MYJUn0.N
PER11W FEE 1xi3AOURY
COWSI'I'RIK.I` ION FRE 101.000.418-000. $8I8,0G
e
PIAN CHECK TPIFIC 101-000-439-3418 $1711.93
i...R
MECHANICALS FEE 101.000.4.21-000 $93,50
TiYd4,C` RICAL FEY, 101--000-420-000
PLUMBING FF.E 101.000.419.000 $161.25
STRONQ MOTION FEE - M10 101-1100-241-000 $15.09
;!
GRAWIIdG FEE 101.000-423-000 $20.00
£
;';v' �
TDLIVES:OPER IMPACT FEE
51JB-I CYI'd L 0.ONgrRCTC'710N AND PL.Alq CDEM-
$3,342XYJ
IMS PIS -PADS w
$0.00
TOTS -P-12 MKIF 1''ET"S D'0 A Q W
&3 2. 90 '.
RECEIPT
DATE
BY �
1 4�
DATE FINALED
INSPECTOR
Y t y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
'L
Return Air
Steel
Combustion Air
Roof Deck
_
(fes
Exhaust Fans
O.K. to Wrap
/If `�
F.A.U.
Framing
Compressor
Insulation
C�-e�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ofCP
Drywall - Int. Lath
�1
Final
Final 11�_1�,.oc? (�
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
(t. ` 1. �?d
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Stiower Pans
O.K. for Finish Plaster
Sewer Lateral
00
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
mLck
Appliances
Final
Final
Utility Notice (Gas) 44�
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 CQa
Final _ r e ��—
Utility Notice (Perm) p` &FF
COMMENTS:
'
OCT -2E-2000 12:12 WESTERN INSULATION
909 686 8786 P.06/09
WESTERN INSULATION' i e
4211 Latham stmet, Pivetaide, Cal anda 42501
1710). (909) 686.8760 Fax (909) 686-8786
219M ATION C 1ZT' ICATE
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: WILDFLOWER PH - 111 - 25691
LOT # 5
SITE ADDRESS: 79673 DANDELION DRIVE, LA allINTA, CA
]EXTERIOR WALLS,
MANUFACTURER: OREENSTONE THICKNESS: 10.3" R -VALUE: R-38
CRILINW, 6ATTS BLO
MANUFACTURER: Johns-Manvil/ HICKNES : 13" R -VALUE; R-38
CEILINGS: BA S SLOW
MANUFACTURER: Johns- a THICKNESS: 3 6/8" R -VALUE: R-13
GENERAL COINTR,,AsCTOR: WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSU A11O[11 CONTRACT R: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCTION MANA R
DATE 'OCTOBER 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:
Use Classification: SFD
Occupancy Group: R-3
79-673 DANDELION DRIVE
Bldg. Permit No.: 0006-090
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: 11-09-2000 -
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