9902-070 (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
04 UJ Professionals Code, and my License is in full force and effect..
cy Lo License # Lic. Class Exp. Date
6W /at e Signature of ContBractor
r� I., C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
;4o) ~ �`~—L~~ for ^~'~~''g'~~~`':
Z ( ) |.aaowner ofthe property, mmyemployees with wages antheir sole
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Compensation, will dothe work, and the structure isnot intended o,offered for
sale (Goo.ro44.Business & Professionals oouo).
|, as owner of the property, am exclusively contracting with licensed
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contractors mconstruct the pm�o ��u� 7O44. Business & Professionals-
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(} Cf)|amoxamp vnuo oovnon______ ouPo xxmm�aoon_________
Uom Signature of Owner
' WORKER'S COMPENSATION DECLARATION
011 |xemuy am,m �nuo, nomuty of perjury one of the following uov|omnono:
L� �� (�|haveandwmm�mminaoon�|oo�o,00noemmoe�inou��r*nmon/
u- compensation, as 'provided for by Section ion oroummm
o �auo,Couo. ,o
C]' �� performance mthe work for which this permit |vissued.
'| have and will maintain workers' compensation insurance, aorequired by
Sdction 3700 of mfor ,tho performance for whichthis
ponnn is issued. my'wm,m,rs' compensation insurance oumo, a policy no. are:
�Carrier Policy No.
..,C�-'
4501
(This section need n�\�\���e�d��opam,xvo|u��1����0|00u,|esa.
| certify that inthe performance of the work for which this permit is issued,
l ahoU not employ any person in any manner ooaom become subject mthe
workers' compensation laws o/California, and agree that if | should become
s6bect to the workers' compensation provisions of Section 3700 of the Labor
,06e, I shall forthwith comply with those provisions2
Warning: Failure msecure Workers' Compensation coverage is unlawful and
shall subject an pmy ,mcrimimunonaltiooammm|nnesupto$1o0,000"m
additionx oo�ovcompensation, damages oopmm�
provided for
cxmoLauo,Code, interest and attorney's fees.
IMPORTANT Application iohereby made uothe Director o,Building and Safety
for 'a permit subject to the conditions and restrictions set forth on his
appnoa,ion.
����^ . 1'Each ponmnupon whose uexanmioepp|�aooniomade meach pomvnoo
. '~~ ^ whose request and for whose benefit work iaperformed under o,pursuant to
`
any permit issued as result o,this apnnoauon agrees to, u oxao. indemnify
u hold harmless the City of LaQumta. its officers, agents and employees.
` u. Any ponnn ioovou as result mthis application uovomao null and void if
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work is not commenced within 180 days from dam of ioouonoo of such
permit, o,cessation u,work for 1uodays will subject permit mcancellation.
~*
| certify that | have read this application and state that the above information io
ivnov. | agree mcomply with an oxu and State |owo relating mthe building
construction, and hereby authorize representatives ofthis City menter upon
the above-mentioned property for inspection purposes.
'' |,��ignsovm �}wno��onV �" oam��-�_��.�
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PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
1320,796.60
JOB SITe 25.
ADDRESS
904 0MY-1WO-Pil,
769-52"02
OWNER
CONTRACTOR / DESIGNER / ENGIN EER
ESCOND11Y) CA- 02025
ESCONDIDO CA 92025
USE OF PERMIT
LOT 67. PLAN -SFb- PEMYC DOES NOT YNCLURE BLOCK WALLS
COV(W*4 CQNSWRUCTION -4,796-00 SF
PORCOPATIO 7-".00 9F
VS11MATED CONT Of CUNSTRUCIION
320.786.60
PEMUT FEE SUMMARY
CONSTRLrCTIONFES 101-000-41.9-000 $1,413.00
PLAN CRECK'RE 101-000-439,�318 $286.38
NWHANICALFES 101-00"21-0100 $111.00
PLIMBYNG FEE 101-000419-000 SV.5.75
STRONG tv1(Xr10N FEE. - IRESM 1,131-000-241-000 $32.08
(JRADTNIG FEE 101-000-423-000 $20J)o
LESS PRE-PAWFEES
$1310)
RECEIPT"
l?ATE
5-5
DATE FINALED
INSPECTOR
INSPECTION RECORD
k
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs i A If
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap Q
F.A.U.
Framing
Compressor
Insulation Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath /
Drywpll- Int. Lath
A
Final
Final k
BLOCKWALL APPROVA S
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 LateralPool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test 2
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:
r rw
ri&VMcate of Occupancy
City of..La Qui nta
Buildingand Safety Department
a
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 bui/ding construction or use. For the fol%wing:
BUILDING .ADDRESS: 80-410 WEISKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-070
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CAPSTONES GOLF WEST LLC Address: 200 E. WASHINGTON AVE
Building Official
City: ESCONDIDO, CA., 92025
By: DANIEL P. CRAWFORD JR.
Date: 4/27/2000
POST IN A CONSPICUOUS PLACE