0003-263 (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
43867 B -, t-.� 12/31/2(
„Date 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
SZction 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 b -'MID Policy No. 1509393-99
(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 Section 3700 of the Labor
Code, I shall forthwith comply with those ro%fisioris. ),,
tDate: Applicant C
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify`that I have read this application and state that the above information is
correct: I agree to comply with all City, and State laws relating to the building
cons{ruction, and hereby authorize representatives of this City to enter upon
the/above-mentioned property for inspection purposes.
Signature (Owner/Agent) �� � 1 �- �•- Date !I1 O d
\J
BUILDING PERMIT PERMIT#
DATE l VALUATION . - LOT 0003-263 TRACT
.
�$ISQ,893,30 3 2Sb91
JOB SITO I
APN
ADDRESS 79 7M DANT MIPM DIM&
04.072AM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JIM DAN El .L 1.,C
WO=17I-WELOPi+AWT, INC
7.4.333 IiICUIMAY 711 ST 103
74.333 HWY 111 SILO 103
PALM DrSMr CA 92260
PALM E�M, RT CA 92260
(760)568-2355 CBL # 5026
USE OF PERMIT '
MNC3LE FAI4t#ILY MMilING
VD -IDT 9 PLAN 4RB=PERMIT DOES NOT 1NCI UDE BLOCK'WAI-LLS OR
1100L
IMACT CONSTRUCTION 21511.00 SF
PORCWPATIO 68.00 SF
GAi AMIC:ARPORT 6967.00 SF
RY- IMt TM COST OF COLTTSTRiYf,MIDI f
150,893.30
PERWrFEE 4(•1hD"RY
CONMUCTION FEE 191.000.418.000 S818100
PLAN CHECK PEP, 101-000-4339-218 W1.59
.,,
MIVWXTC.A.Lr RE 101.000.421.000 $98.50
9Lt;CTR.ICALFEE 101-000-420-000
}slvUMBINO FEE 101.000.419-000 S16I.2S
:.i f '
STRO140 MOTION FEE - RESID 101-000-241-000
f • .
ORADINO VEE 101.000-423.000 S200
r, • t 3',
DEVELOPER IMPACT P"'ra $1,907.00
SUB -,TOTAL CONST'.Rf7MON .AND PLAN CULEM
$3,857.:54
JM3 I RB—PAID VR
x+0.00
AL 1'URAM?rIPM DITE NOW
V'+,&57.53
�
1r
RECEIPT
DATE
By '
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
' OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
5 -28
Ducts
Slab Grade
y _ -L5 40 AD
Return Air
Steel
. 2 : Ot
Combustion Air
Roof Deck
4 .'L -t _
Exhaust Fans
O.K to Wrap
'Z ce
F.A.U.
Framing
EY •18,00
Compressor
Insulation
8•—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1 00
Drywall - Int. Lath
ap
_
Final ��� C
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 APPROVALSGas
"
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) e
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 I _
Utility Notice (Perm) ICL—
COMMENTS:
SEP -20-2000 14.12 WESTERN INSULATION 909 686 8786 P.02/12
vii 'TERN I SULA°TI , I .
4211 Lathain Strut, Riverside, California 92501
Tel (909) 686.8760 Fax (909) 686.8786
WESTERN INSULATION, INC.
LI.CFNSE NUMB 1278
BY:
TITLE: OFFI NAGER
DATE SEPTEMBER 20, 2000
INSULATION. 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 THE BUILDING LOCATED AT.-
T:TRACT
TRACT/ PHASE:
FLOWER - 25681 PHASE:1
LOT #
9
(t
SITE ADDRESS:
8 DANDELION DRIVE, 1A QUINTA, CA
MANUFACTURER:
JOHNS MANVILLE THICKNESS:` 3 518 " FI-VALUE:R-13
CEILINGS:
BATTS BLOW
MANUFACTURER:
GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
El~ IllMiiS:
BATTS BLOW
MANUFACTURER:
JOHNS MANVILLE THICKNESS: 13" R -VALUE: R-38
GENERAL QNTR
-----------------
WORLD DEVELOPMENT
LICENSE NU R:
BY:
TITLE: .'
DATE:
WESTERN INSULATION, INC.
LI.CFNSE NUMB 1278
BY:
TITLE: OFFI NAGER
DATE SEPTEMBER 20, 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
79-738 DANDELION DRIVE
Type of Construction: VN
Owner of Building: JIM DAN D LLC
Building Official
Bldg. Permit No.: 0003-263
Land Use Zone: RL
Address: 74-333 Hiahwav 111 St. 103
City:
Palm Desert, CA 92260
By:
Greg Fox
Date:
10-05-2000
POST IN A CONSPICUOUS PLACE