9902-065 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N lw'.t 'Professionals Code, and my License is in full force and effect.
CV) License # Lic. Class Exp. Date
Lu
B 4/30100
oZ r- J'`'{ate �� r Signature of Contractor
(JD �. ♦`
J V ! OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ .a . 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).
`s () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
Os rn
d Q WORKER'S COMPENSATION DECLARATION
Cp _ ZI hereby affirm under penalty of perjury one of the following declarations:
Lo
- p () I have and will maintain a certificate of consent to self -insure for workers'
XW •LL compensation, as provided for by Section 3700 of the Labor Code, for the
O ' .Q performance of the work for which this permit is issued.
M: < U (�) I have and will maintain workers' compensation insurance, as required by
0 `U. Q Section 3700 of the Labor Code, for the performance of the work for which this
11 LOH permit 'is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
CO;; 5
r` qC3 TBDWi'H 'INS. CO. b)42194503
J(This section need not be completed if the permit valuation Is for $100.00 or less).
( ). I certify that imthe 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. y
�Date:r % j r f
Applicant—
X/ , r
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.
i 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
F{
DATE VALUATION LOT 9902.065 TRACT
/ &396.669.70 3 f 2A4,14
JOB SITE 7
APN
ADDRESS
SRU- SPis i��F,��3IsU.P.�'
761-080-089
OWNER — - -
CONTRACTOR / DESIGNER / ENGINEER
CAP.TrONES GOLF WEST LLC
SHANNON COMMUNITIES OF CALIF, 'INC
200 8'. WASE(Clvu-rON AVENUE
200& WAS I.11N0�1014 AVE.,. # 100
ESCONDIDO CA 92025
ESCONDIDO CA 92025
(700)839-8238 CSL- 5413
USE OF PERMIT
LOT 3, PLAN 3- iA, -SF D- PFRMTT TOES' OT INCLUM BLOCK WAL%.S
OR P001 -S,
C=USTOM CO•NSTRUCT10N 4,621.00 SF
PORCWPAT10 390.00 SF
GARAOWCARPORT 17M.00 SF
` E ST I NMA1ED COSY OF C O NSTRUCHON
386,669.70
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101.-000-418-000 $1,644.00
PLAN CMCK FEE 10.1-000-439-318 S.1,330.12
NW.CHAN'ICAL FF -6 101-000421-000 221.00
EIX-C.CR1CAi: FEE 1117.1. -OW -420.000 $253:40
PLUtvfBIN0 n'E 101. -000 -1119 -OW $241.25
STRONG 'MOTION FEE - RESID 101-000-241-000 838.67
GRADTNOr FEE 101-000423-000 $20.00
:F'F,1.? 222_ •000-043.342 16,000.170
ART :CN PML IC ..PLACT?8-RES11: '701-000.24 ±-000 871.6.67
SUE -TOTAL CONSTRUCTION _AND PLAN• CHECK
$10,3648.11
CESS PILE -PAID FEES
x;0.017
TOTAL, PERNIfT FEES DUE NOW
$10,368.1.1
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
Return Air
Steel A
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath d
-,/Pz
A= �_
f
j
Final
Final &W-4-0
BLOCKWALCA0ROVALS
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
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 0�
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:
Certificate, of Occupancy
Citybf,La Quinta
Buildihgand 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 comp/lance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 80-395 WEISKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-065
Occupancy Group: R-3 Type .of Construction: VN Land Use Zone: RL
Owner of Building: CAPSTONES GOLF WEST LLC
Building Official
Address: 200 E. WASHINGTON AVE
City: ESCONDIDO, CA., 92025
By: DANIEL P. CRAWFORD JR.
Date: 2/24/2000
POST IN A CONSPICUOUS PLACE