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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
/te
74.38.7 B t� 12/31/2t
• -? `J`p Signature of Contractor C
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 -Signature of Owner
1.1161;-1244;1M91*11T1I:J41,116fi1111 111 W_1Jirr[ H
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.
(4 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 STATE1y 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
worke s'`compensation laws of California, and agree that if I should become
sub' ct to the workers' compensation provisi�s of Section 3700 of the Labor
C de, I shall forthwith comply with those pr visions..
►ate: `/• $ c� Applicant—
Warning:
pplicant _��
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 1 -have read this application and state that the above information is
correct.,agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
Zthe [&e -mentioned property for inspection -purposes.
ignature (Owner/Agent) �" ��`-f Date Y.
BUILDING PERMIT PERMIT#
DATE VALUATION '�27`�
LOT
17R42.00 12
TRACT
25691
JOB SITE
ADDRESS 7". 78 DAMUITON Dpaw.
APN
4504-072-00
OWNER
CONTRACTOR / DESIGNER / EN INEER
,TQM DAN D ILC
WORLD D DF1iELOPUEA? T, INC
74.333 i GHWAY 1 I I Si` 1013
74.333 RWY I I I SIM 103
PALM DEWRT CA 92260
PALM DE.SFa.T
CA
92260
(760)568-2955
C
IR 5028
USE OF PERMIT
SMO ,, FAWf-Y IJW'. TXNG
SFD-Lf)T 17 PLAN 3B -PERMIT DOft5 NOT INCLUDE 8LOCKW1A.1.1�S OR.
POOL
TRACT CONSTRUCTION 2,230.00 SF
POR.MPATIO 51.00 SF
GARAGEICARPORT 780,90 SF
lESTMA3fRD COS' OF C0NS'nZUC1TON
137,042.00
CONSTRUCTION FEE 101-000.418.000 $972150
PLAN MECX IEEE 101-000-439-318 $652.81
MECHANICAL TEE 101-000421.000 $98150
91 ?CTR1LA1,FEE 101-000.420-000 $1421 P-5
IPLUM8INC1 1''I�i 101.000.419.000 $161.25
STRO140 MOTION IEEE - REsln 101-000-24.1-.000 $13.1110
ORAOiNC FU 101-000.423-000 $a9.0A
.-r
c:x1•i
DFYEl..OPER IMPACT FBE $3,90.00
Sri
w�
OUB IOIAL cwOlrTS' RITC 100 :AND PLAN CHECK
$3,76-7.191
LESS YRE-P JD F
$0.00
'MIAL 1'EW&T Y"S D17,E .Now
t"dt5791
�k;it,•(�'�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-X-L - m@
Ducts
Slab Grade
Return Air
Steel
g _ Z4 -010
Combustion Air
Roof Deck
.-Lt -00 kR
Exhaust Fans
O.K. to Wrap
. E -"
F.A.U.
Framing—
Compressor
Insulation
Fireplace P.L.
8
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
0>7
Final
Final
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
I I
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
Gas Test
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 1
Utility Notice (Perm)
COMMENTS:
SEP -20-2000 14:14 WESTERN INSULATION 909 686 8786 P.05i12
Wmmlok'STERIK INSULATI , INC.
4211 Latham street, 7ivarside, California 02501
Tel. (909) 686.8760 Fax (909) 666-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVt CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT;
TRACT 1 PHASE: ILD LOWER - 25891 PHASE.1
LOT # : 12
SITE ADDRESS: 8 DANDELION DRIVE, LA OUINTA, CA
EXTERIOR WALLS:
MANUFACTURER:
CEILINGS;
JOHNS MANVILLE
BATT"
THICKNESS; 3 518 " R -VALUE: R•15
BLOW
MANUFACTURER: GREENSTONE THICKNESS:
E1LC NGS: BATTS 01N
MANUFACTURER: JOHNS MANVILLE T 'hCKNE88:
GENERAL CONTRACTOR' WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
10.3" R -VALUE: R-38
13" R -VALUE: R-38
INISULAIIQII CONTMCTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481"
BY:
TITLE: OFFICE MA
DATE SEPTEMBER 20, 2000
WCertific'ate 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 with the various ordinances
of the City regulating building construction or use. For the following:.
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
79-678 DANDELION DRIVE
SFD Bldg. Permit No.: 0003-273
R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D LLC
a'l"t
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