9901-131 (SFD)LICENSED CONTRACTOR DECLARATION
I -.hereby affirm under penalty of perjury that I am licensed under provisions of
.F- ulapter 9 (commencing with Section 7000) of Division 3 of the Business and
64'LU ' Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
r� du7
t�Rf; 0 t is
41 "A
o -Z � Date t �1 f' Signature of Contractor �/1 ��yl 0 1 �
co 0 ' r
J U .C:) r 1 OWNER -BUILDER DECLARATION
UJ LU ,1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d 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
` contractors to construct the project (Sec. 7044, Business & Professionals
Code). `
Cl)O I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
O•. CJ
d Q WORKER'S COMPENSATION DECLARATION
C:) Cc I •Fie'reby affirm under penalty of perjury one of the following declarations:
r'.O () 1 have and will maintain a certificate of consent to self -insure for workers'
X,LLl LLcompensation, 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 IJ ( ) 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
d` F- permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
OD
Cf ' . "Li KITH INS, CO. 71)42394503
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
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.provisions.
Date:lJi'tlfk Applicant—/
• Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the -Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result.of this applicaton agrees to, & shall, indemnify
&.hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the' above-mentioned property for inspection purposes. f 1
i
( �_
Signature (Owner/Agent) Date ��� �. `L
BUILDING PERMIT PERMITJf
DATE VALUATIONLOT ' 9.901':!31 7TRACT
pg. 70 -P 28:.144
JOB SITE
ADDRESS
`$:37.5E,.ISKO-PF
76.1-080-089
OWNER - ' CONTRACTOR/DESIGNER/ENGINEER
CA;PS`I"ONES 010LF WEST 1,1,C SHANNONT CO P.4A'iT..l;RjMES OF CALIF., INr,,
200 E. WA.SH1NLt'T7:rN AVENUE, NUE, 200 EL WIV,SH.CNl"TON .AVE., #101)
ESCONDIDO CA. 92025 ESCONDIDO CA. 92025
(760)839$238 CBI.,: 5113
USE OF PERMIT
S4 I G- b i7 F A A.4 L <Y'9 41: 7' I.. 'f
LOT 'a. PIAN 3-2.A - SFO - RGR RT DOES NOT INC1.LUIDE U(30K WALLS
OR POOL.
,,'US'TOM CONSTRUCTION 4,621.00 S.F
PORCHiPATIO 890.00 SF
GARAGWCARPORT 7758.00 SF
L.S IMIA ED con OF CONSTt2.C1crioN
390,669.70
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 :$1,644.00
1'I.t1N CHECK KE 101-000-439-310 $11334.12
111Ii{;1-1A.ti1ICAL FMW 10140-421.000 5124.00
ELE.0 TRIC AIA FIKE 101-000-420-000 $253.40
PI.CN9Fe1NCI RX 101-000-419-000 $241.2a
STRONG MOTION FU - RESID 101-000-;241.000 $38.67
O AINNG Fa 101-000-x423-000 $140.00
1NFRAS*1"RUCTVRE EEC 1a.5-000-443-342 $6,000.00
kRT INPJJ. LICKA.CES - RESW;;' 701.-000-255-4100 $171.6.67
fEL .L%1a['tJSI'.0 101.000439-318 _$ 0M.00
SLrE3 TOTAL CONSIRUCT ON AND PLAN Ck(ECK
$10,:368.1 t
LESS PRI, -PAID FEES
=$i,a()ww
TOTAL PERMIT Fri ES OVE NOW
$9,368.11
t�V
REC€I,FS t e
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
° OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
•
Set Backs
Underground Ducts
Forms & Footings I A
Ducts
Slab Grade 431 IX
Return Air
Steel
Combustion Air
Roof Deck S
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
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 Q
j
Final
incl
BLOCKWA OVA
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 /
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
COMMENTS:
� S 3/f/99Al
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)
O
nil
communities
Januaty 31,2000
City of L& Quinta
Building and Safety Department
78495 Calle Tampico
La Quinta..CA
To whom it may concern,
We have supervised the installation of thirty-seven (37) of the 0' ' hagan cloaked
roof vents in Lot 2 at 80375 Weiskopf. We find them to be installed properly and
as per manufactures recommendations.
Thank You
R5 SnydWer��
Project Superintendent
200 E. Washington Ave., '�;Suite 100 Escondido, CA 92025 Ph: (760) 839-8238 Fax:
(760)'839-8246
(3ert6ficate 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 Type of Construction:
Owner of Building: CAPSTONES GOLF WEST LLC
Building Official
80-375 WEISKOPF
vti
Bldg. Permit No.: 9901-131
Land Use Zone: RL
Address:
200 E. WASHINGTON AVENUNE
City:
ESCONDIDO, CA., 92025
By:
DANIEL P. CRAWFORD JR.
Date:
2/1/2000
POST IN A CONSPICUOUS PLACE