0003-272 (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 A I Z 12{3l ?E
LDate'1.2 "� 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).
( ) 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:
Carrier STATE IMMD Policy No. 1S093994y9
(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 ptro lisions�.of Section 3700 of the Labor
de, I hall forthwith comply with those provisions. -
ate: c1 % t' -'�� Applicant �• � ', _ N��"
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. -d agree to comply with all City, and State laws relating to the building
con)truction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection -purposes.
'Signature (Owner/Agent) `� v� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT W03-272
TRACT
1) S137M2.00 11
25691
JOB S119
ADDRESS
7 DA D1 ,10N D. TW
�INEER'f
0"72_
OWNER
CONTRACTOR/ DESIGNER/
Ji DA D JLC
WORLD DEVEi oPZv1MT,1NC
74-333 IRGHWAY 1 l 1 OF 103
74-333 HWY 111 WE 103
PAL�1M DESI W:r CA 92260
PALM DEQ d
CA
92260
(760)568.2955
CBL#
5028
USE OF PERMIT
SINGLE i?A1N J Y DVlMJ 399
SFD-1",r 1.1 PLAN 38-PEP.,IAIT DDES NOT INCLUDE SL.LCK'ti1CA, 1.3 OR
POOL
TRACT CONSTRUCTION 2,230.0 SF
PO,RCHPATiO 50.00 SF
GAP.ACIF#C ARPORT (SF) 19,238.00
E5Tn"T. D COSI Off+' CO;!@'S't'! UC 7ON
137,042.00
PERMT FEE SUMMARY
CONSTRUMION FEE 101 -000.41 ti -001) VrJ2.50
; "!
•
PLAU CHICK FEE 101-000-439-318 $163.20
" ;
-
MFCHANXCAL FRE 101.000.121.000 $98.50
r • r
F.3.,F,CTRICALFEE 101-000-420-000 $147.15
PLUMBING FEE 141.000.419.000 $161.25
STRONG MOTION FEE • RES1D 101-000-241-000 $13.70
43RADINO FEE. 101-000.423-000 $20,00
DEVELOPER IMPACT FEE $1,907.00
SU13-70TAL CONSTRUCrI14N AND PLAN CMC4K
$3,278.30
LEAS P:f R -)?AID FM
$0 00
! VIIAL P w r Ffilms DTUF NnW
�►;%'>1��
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR .
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Z5 -'L5 -06
Return Air
Steel
fi 0
Combustion Air
Roof Deck
•'19
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
$ Is
Compressor
Insulation
2; PS
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
I o0 R.o
Drywall - Int. Lath
$ D
Final
Final
!o_( .,�
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
Gas Test
Appliances
Final
COMMENTS:
'
Final loj9� oo CQ
Utility Notice (Gas) 7(0 ve --"
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
FinalCQ—
Utility Notice (Perm)
SEP -20-2000 14:13 WESTERN INSULATION 969 696 9786 P.04i12
did
4211 Latham Strect, Rivakde, C aLfornia 92601
Tek 1909) 686.8760 P= (909) 686-8785
INSULA'T'ION 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 TKE BUILDING LOCATED AT:
TRACT / PHASE: WIL LOWER - 25691 PHASE:1
LOT #
SITE ADDRESS: DANDELION DRIVE, LA QUINTA, CA
--------------------------------------------------------------------
EMT>"RIOR WALLs�:
MANUFACTURER:
CEILINGS:
JOHNS MANVILLE
BATT
THICKNESS: 3 518 " R•VALUE: R-13
BLOW
MANUFACTURER: GREENSTONE THICKNESS:
CEILIdd S: BATTS BLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS:
GENERAL O®NTRAOTOEL WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
10.3" Ft -VALUE: R-38
13" R•VALUE: R-38
IN IJLAIION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER:
BY:
BY:
S—)—
TITLE: OPPICE MAN
DATE SEPTEMBER 20, 2000
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 709 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: 79-698 DANDELION DRIVE
Use Classification: SFD Bldg. Permit No.
Occupancy Group: R-3 Type of Construction: VN Land Use Zone
Owner of Building: JIM DAN D LLC
Building Official
0003-272
RL
Address: 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 10-18-2000
POST IN A CONSPICUOUS PLACE