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0207-100 (SFD)U _N W O =) M r— d r` aZr�. O.o I— CID J LUWrla N Z co LO N ON �• Q Lo cc Q O X W OJQ mVU O CL U-) H _Z O 5 r` C7 LICENSED CONTRACTOR°DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisidns 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 760331.5 13 /,:� , 1. los ©ate ,�'� Signature of Contractor— / ontractor 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 STATEFUND Policy No. 1609301.012 (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 witfithose p ovisions. Date: ''Applicant Applicant Warning: allure to secure Workers' Compensationoverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety: for a permit subject to the conditions and restrictions set forth on his: application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of. La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date .of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation.' I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon, the above-mentioned proPerty for inspection purposes. f �; Signature (Owner/Agent) &Y t1 w Dat4 • ?{v' BUILDING PERMIT YPERMIT# 02.07"ll CK) . DATE VALUATION LOT TRACT *2221,157AD ,. ; `� 2914.7-1 JOB SITE ADDRESS �� �ei.�,u.:Iis��% APN OWNER CONTRACTOR/DESIGNER/EN INEER CAV G(i. F WEST, LP, AMIR ttOOK DEVELOPMENT COMPANY 514 0*'11`1147[DAM, C1WD 51.40.AOMAV-1 CININIG C':A1a�.: BAD CA Sg20Or$ CAM, -,S AD CA 9 2MR, USE OF PERMIT �:IV F..7 \aRr .L`d �.i''k73JS VtlVJ:K-V:t.6:.�F `i SK) ,1.01.88, PL,Ali %AR . 1PZ.CZ11 VP DOES NOT .114CLUDF, r1WClt;' i AL1.x% P004 SPA OR 15RWKWAY.APPROACH f1USTOM C'ONaYYRUCT.ION �,615.00 BF PORC;M010 5251.00 Fly Gmitt`r+CiUCAil PK31i`i,' R3xt.f14 X? ",I' '1.'�•+'�? COW OF GON61f1MM1 1703' 221,157.40 �'yyyyyyyq,,p��•�+ y';�'��� p, +�,p'�y ��..uS4.71/•T•�.i�,.yyi).E��[pR , - ' h�y,�fiO��^Y•.yY+rLf4A.G� ,ryt ,,�q p� ,y{p /�/�f-� Q! �S ,•� i:�q lYAi�J:S4��/r.I !411; T'dTrl:r �4Y J.''1���j °'d29�VYIV Wdi:+��,�N PLAN Olfi,W1; .ryre, I.C?wi�C ds�'-31£� $969.60+ MEC:E? ANIC,`AL YER 101-000-421>000 $111,00 91AXI'TRICAL F'Lb,; 101-OM420-000 $135,71 PLUMID X10 nF1 101■000.419-000 SOL% S7.'1tf5NO MOTION PIUS „ R ss 1!7 101-000-241--000 V2.11 (YRAADi"1~1O FEF 101.000-423.000 $20.04 1^. rFLOPRA IMPACT PEE, 0,40a,00 ART IN irF'OOLIC PLACES .1'dESIL 270-000.445^000 SUM i4 r : �•,tg y �, * ���y y ! a�,�y��w�•.y y�' gip• yy AVD �.OF�A�..d,,r S,a6.�+,Cvt�7,A YWQ .1..i,�) ii'l� D PJ,.cPfiV ��9.:.rt[i. OT qg i �IFy{iSAu. s • ® .' '�' ' ••�-� �� �yy ]y��yr� y iyg4y�,�y 2yg'^y(y /► ! � ?h.TsB-��Vil:.7.8,8»..L;.Fi..iiLY Y.i 1.�•Af �'W�� ;y,�-•A ��'F)8Y'9a� � SEP CITYOFL A QUIMTq FINANCE pEP RECEIPT DATES-: :: 0 K .. r'' v BY �°/ DAT IN ED Y/ I S TOR p 1 ,14, - INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade jf Return Air Steel Combustion Air Roof Deck xhaust Fans O.K. to Wrap Framing .A.U. Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final ff _ Final BLOCKWALL APPROVALSE Steel POOLS -SPAS 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 "Fr' Heater Final Water Piping /- Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection do f�� Encapsulation Gas Piping Gas Test3��—� Appliances _ _ Final Final _ Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fodures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 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: SINGLE FAMILY DWELLING Occupancy Group: R-3 57-530 BLACK DIAMOND Type of Construction: VN Owner of Building: CRV GOLF WEST, L.P. --I- --"S' /4-t-47 Building Official Bldg. Permit No.: 0207-100 Land Use Zone: RL Address: 5140 AVENIDA ENCIANS City: CARLSBAD, CA 92008 By: DANIEL P. CRAWFORD JR. Date: 6/11/03 POST IN A CONSPICUOUS PLACE