0006-092 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 CAI
Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class Exp. Date
r` C) U-) i
LU
oZ r— I/ate!"r /1 't Signature of Contractor, ✓° y--
CD 0 111
J U C OWNER -BUILDER DECLARATION
UJ W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ coco License Law for the following reason:
Z ( ) 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
Ncontractors to construct the project (Sec. 7044, Business & Professionals
', Code). -
M () I am exempt under Section B&P.C. for this reason
Ln
N Date Signature of Owner
ON
0)
Z WORKER'S COMPENSATION DECLARATION
0 2 I her
Z eby affirm under penalty of perjury one of the following declarations:
LO < O () I have and will maintain a certificate of consent to self -insure for workers'
X LL!- compensation, as provided for by Section 3700 of the Labor.Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUNDPolicy No. I3p931�9-99
ao 5
r- C)
J (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
Y
workers' compensation laws of Calif orniCa a, d.agree`thatif"I shoulld become
subject to the workers' compensatio ovlsions o • Section 3700 of the Labor
�C de, I shall forthwith complypyovisdn;
te -7112 043 Applicantf '
Will 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 applicaion 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 ree�prssetitafives of'this City to enter upon
[t/habove mentioned property tor'�>pection.pp�ses.
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Signature (Owne rge f c '-�--- �- Date` y—
'� G BUILDING PERMIT PERMIT/t
DATE VALUATION LOT TRACT
S1.�5,4x.i3 7 25691
JOB SITE TAT
ADDRESS '79-715 IaAND..,TON nZ►Q'tTLF
APN
60".72-M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WC1= I?1;'VE'L.C?phMa. INC
WORM 17E i I..OM"T, INC
74.333 I4WY• 111. Me 103
74-333 HWY I I I S-103
PALM DEISM CA 92.260
IPA M DESERT CA 92260
(760)5643.2955 IML4 5026
USE OF PERMIT
SIh G F-1?A.AXY MM. LWO
VD -PLAN 211B LAT 07 - PERMIT DOES 140'. rNCLUDE SIAXKWALLS OR .
PO01A 75 % PLAN 6°•`HFWK irEE RC?1 UCTION FOR MULTIPLE ISSUXKIC49 OF'
.,A.MZ PLAN TYPE
TRACT CONSTRUCTION 2,0'9 .00 3F
CfARAOWCARPORT (SIV') 1:4,406.40
FST- ATED CO's OF ICOXMUC' 70.14
126,247.M '
maor m siiva4ARY
CO7`STRUCT)O'NFEE 101-M-416=000
PLAN CHECK FEE 101-000-439-3418
MEf''HANICAL FM 101-000-421r,000
EUXTR1CAL F99 101-000-420-000
PLUMB1140 FEE 101-000.419000 ~ $142.00
j7I
STROND MOT1014 3FEE -1Lg SID 101-000-241. -000 $12.62
C1RADroo FRE, 101.000.423.000
1 E",L.OPER IMPACT FLY,$1,907.00
f
.� •
4.1^t
SUB -TOTAL COATS'I'RUCTIONAND PLAN CBF,C'4C
$3,169.70
LESS FR'E-.PATU 'IMS
$0.00
TO'N'AL RMr re'-ir.$ DIn NOW
',Y 691170
...
RECEIPT
DATE
BYZ
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�(�
Exhaust Fans
O.K. to Wrap
_
811-5- —'��
F.A.U.
Framing
.81 2
Compressor
Insulation
Fireplace P.L.
4053 �FQpC
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�_�'00
Final ' 1�_ �'�
BLOCKWALL A PROVALS
Final
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
U_ .QL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
g $oJ
O.K. for Finish Plaster
Pool Cover
Sewer Connection
jmfQ7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 11,�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles .
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 1i�Q f�0
Utility Notice (Perm) . 1
OCT -25-2000 12-'13 WESTERN INSULATION
909 686 8786 P.08/09.
WESTERN INSULATION, INC.
4211 Latbm Stmel, RveMU, CaWonga.92501
'Cel. (909) 685-V60 Pm (849) 686-8786
iY� THI N CEIZTIFiCA'i°
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT ! PHASE: WILDFLOWER PH - 111 - 26691
LOT # 7
SITE ADDRESS: 79713 DANDELION DRIVE, LA QUINTA, CA
9CERIOR WALLS:
MANUFACTURER: GREENS7'ONE THICKN5SS: 10.3" R -VALUE: R-38
CEILINGS, BATTS BLO
MANUFACTURER: Johns-meww"I1!e NESS: -13", R -VALUE: R-38
CEILINGS: ATTS BLOW
MANUFACTURER: Ahns- Ville THICKNESS: 3 6l8" R -VALUE: R-13
Of
IOIEM'rICTOF$� WORLD DEVELOPMENT
LICENSE NUMBER;
BY;
TITLE:
DATE:
INAULAI[i®N CONS AQ][QFi: WESTERN INSULATION, INC.
LICENSE NUMBER: 461278
BY;
TITLE: PRODUCTION MANAGER
DATE OCTOBER 26, 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
79-713 DANDELION DRIVE
Bldg. Permit No.
Type of Construction: VN Land Use Zone
Owner of Building: JIM DAN D LLC
Building Official
0006-092
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