9901-130 (SFD)R 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
a �f,
F B 4j
Date '.�� f �I' + Signature of Contractor �� -'� ` �'�"'•
OWNER -BUILDER DECLARATION
t
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 Policy No.
(This sect onn need o be coOmpleted if the permit valuation pisor$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 foJrthwith comply with those provisions. i
Date: I h "I t' 1 Applicant—
Warning:
pplicant 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
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. j
Signature (Owner/Agent) `~�• -•-^' Date + X »`
r
BUILDING PERMIT PERMITk,,,
DATE VALUATION LOT TRACT
, -'G S336.679.20 1. 284444
JOB SITE `
APN
ADDRESS
80-355 W14JtSKOVII? ,
761 -oft -089
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CA.PS'LONES GOL "WEST I.;L.0
SHANNON COMMMITIES OF CALM,.rKC
200 E. WASHfN TON AVENUE, UE,
200 E. WASHfNCs"i ON AVE., #100 i
ESCONDIDO CA. 92025
ESCONDIDO CA 92025
(76Q)939 -K38 CEL # 5413
USE OF PERMIT
4�-Iwfm P 12n'AMY um T 1?.To
LOT 1, PLAN 2-1D - SFT) - PEIRWT DGF..S NOT INCLUDE BLOC—% WALLS
OR POOL,
CIUSTON1 CONS7"1tUC110N 4.000.00 SF
PP...tEtL RTATIO 1798.00 SF
CiARAZ'EICARPOR.T 738.00 SF
ES'I'I1Vwi.ATED COST OP CONSTRUCi4ON
336,678,20
rte RAUT FEE SUMMARY
C« NST UC310N FEe 101.000-118-000 $.1,449.00
PLAN (>LECK FU 10I. -OW -439-:318 SIA 87.3-4
141R04AMCAL fEEG 101-000-121-000 S114.0
ELECTRICAL RIC.AL FFE 101 -000 -420 -OW V-31".1115
P1.1'IRIF3tNC41"+ F, 101-000.419-000 $205.75
SMONG _tv.IOT 10N .FU, - RESII) 101-000-2.11.000 $13.67
CrRADINO F`EE 101-000.423-000 V0.0
INFRAST RUC",YURE FEC, 225-000443-342 56,000.00
Al2T 114 PUBLIC PLACES - RESU,' 701-000-25:5.0120 $591.70
F E DUPOSIT 101-000-439-318 41.00.00
SUB- CYrAL CONS"FRC.(MON AND PLAN C14ECI;
.LESS I"PX--I?!*ID IN'<L:;
-s1,1au().00
TOTAL PERMIT FEF.VS DUE, NOW
S8,849.72
i . q Ll"
RECEIPT V'
DATE
BYN i
DATE FINALED
INSPECTOR
'0 \'\ T
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings Ilia
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck r-
Exhaust Fans
O.K to Wrap
F.A.U.
Framing L
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
final S
BLOCKWALL APPROVA
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 APP OVALS
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
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
Final
Utility Notice (Perm)
COMMENTS'
"
i
Cerfiificate of Occupancy �—
City of La Quinta 0
Building and Safety Department OF °
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 Type of Construction: VN
80-355 WEISKOPF
Owner of Building: CAPSTONES GOLF WEST LLC
Building Official
Bldg. Permit No.: 9901-130
'Land Use Zone: RL
Address:
200 E. WASHINGTON AVE
City:
ESCONDIDO, CA., 92025
By:
DANIEL P. CRAWFORD JR.
Date:
5/10/2000
POST IN A CONSPICUOUS PLACE
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