0006-093 (SFD)U)
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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 prDate"
743€67 12/31/20
t
Datet Signature of Contracto
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). v
( ) 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 FUND' '. Policy No. 190939:3-99
(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
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Sectiorl„3.7A0-e1wthe-L-l:
Code, I shall forthwith comply With tose-provisi'r�S7'
Dated Applicant I«�-✓C '' '
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 3766
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, or Inspec ion -purposes:—
t i -
Signature (Ow er/Ag !+ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT f -093 TRACT
2,56+1
JOB SITE
APN
ADDRESS '19733 DmDb if}N Rf 1
'(04-072-M5
OWNER
CONTRACTOR / DESIGNER / EN (NEER
WORM reEvl~'.1;ciRI".IdT, IWC
W ORLT) Lt2v'vira OPmx1, RTC
74.333 RWY 1 I l W.I� 103
7d-3331 WY 111 UM -103
PALMDi:,SFkr CA 92260
PALM D ERT CA. 92260
('7a 60)561392955 CBII# 5028
USE OF PERMIT
t3I.� FATi�IL3f� i5i�?T�'.�.�25�3'
SM-PLANI 4RR LOT 08 « PERMIT DOES NOT INCLUDE BLOCKWALLS OR
POOL 15 °% PLAN CHECK FIEF, REDUCTION FOR MULTIPLE 18SUANCE OF
SAME PLAA TYPE
TRACT CONSTRUCTION XS11,0D V
PORCH/PATIO 68.00 SF
0ARA,O CARPORT (8F) 13,641.60
l A D COST QF 6ilJ.RV9rRUl..1.10.N
11.50093,30
! ,�aReSn
p f�y+�t/���1 SUMMARY
C01418TRUCTION FEE 101-000,418.000 $819.00
PLAN CHKK FEE 191-000-439-318 $171.85
MI CHANICAL, FFM 101-000421.000 198.50
ELECTRICAL FER 101.000420.000 $150.31
PLUMBING FEE 101.000.4419.000 $161.25
STrtONCi MOTION ISE « 1tI 5Iff 101-000-241-000 $15.09
` 1
J
GRA:��INO IEP 101-000.42.1.000 SX00
�
D_0,VZ .OPF_q IMPACT FEE $1,9117.00
..
`•�1
$'TJTt-T`Ca;l'Ai, COXSdRTJCMON AM') PLAN OMMK
$3,342.00
LM PRE -PAI) =
$0,00
11orrALPERNWHIMSDUENOW
$3,342.00
RECEIPT
DATE
BY `� DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
'L
Return Air
Steel
Combustion Air
Roof Deck
fk4P�
Exhaust Fans
O.K to Wrap
cot:�
F.A.U.
Framing
Compressor
Insulation
8 (
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
t2� CSC
_
Final ���$�.� CQ��-
BLOCKWALL APPROVALS
Final
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
t�e .-Ld
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
OD
Pool Cover
Sewer Connection
U(Qa
s?o CJI:i2N�
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 (p .o
Final oo _
Utility Notice (Perm)
COMMENTS:
OC'f-2S-2000 12:14 WESTERN INSULATION 909 686 8786 P.09./09
E�iTITI 1 I1TE' able
4711 Lath= 9t ftlt Ri sidc, Cslifo "a 92601
Tcl, (409) 686.8760 Fax (909) 6868785
-INSULATION CERTIFIC&TE
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 # 8
SITE ADDRESS: 78733 DANDELION DRIVE, LA OUINTA, CA
EXTgU®R VYA L
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
E�LIPJGS: BATTS SLO
MANUFACTURER: Johns -Manville THICKNESS: 13" R -VALUE: R•38
OUNM BATTS BLOW
MANUFACTURER:.
^ Jo✓9ns_Msnvill®THICKNESS; -3 5/8- R_VALUE:-R-13. - +. - - .
GEN ERAL-C-0-NIT-R&G-TA& WORLD DEVELOPMENT
LICENSE NUMBER:
BY:
TITLE:
DATE:
to : WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PR®DUCTION ASA
DATE OCTOBER 25, 2000
Y
TOTAL P.09
Certificate of Occupancy
City,of La Quinta
Building and Safety Department
WIN
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
ollowing.
BUILDING ADDRESS: 79-733 DANDELION DRIVE
Use Classification: SFD Bldg. Permit No.: 0006-093
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D LLC Address: 74-333 Highway 111 St. 103
City: Palm Desert, CA 92260
By: Greg Fox
Date: 11-08-2000
Building Official +
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