9902-067 (SFD)LICENSED CONTRACTOR DECLARATION
-1 hereby affirm under penalty of perjury that I am licensed under provisions of
'thapter 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
vDate y'� ! �r�f Signature of Contractor o -"
f
/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for theJollowing reason: '
( ) 1, 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, Busines§ & Professionals Code).
(.) I, as owner of the; property, am exclusively contracting with licensed
contractors to constructthe project (Sec. 7044, Business & Professionals
Code). .`
() I am exempt under Section , B&P.C. for this reason
Date 'Signature of Owner
'WORKER, COMPENSATION DECLARATION -
I, hereby affirm under penalty of perjury one of the following declarations:
( j• 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 section need not be completed if the permit valuation info $ 00.0 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
C.ode; I shall forthwith comply with those provisions.
Date: ~'=' / �rti �' Applicant I�/
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.
Signature (Owner/Agent)f '�---- Date
••l ii i
BUILDING PERMIT PERMIT#
DATE / ! VALUATION LOT _ '9'91)2'067 TRACT
/ $3861669.70
JOB SITE E
ADDRESS - `— ` -'
APN
3.S �WXIS OI!v
'761.080-089
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CAPSTONES GOLF WEST LLC
SH.A.MION CO1lff M, 1TIE S OF CALIF., INC
200 E, WASHINt-*M, N AVENUE
2013 E. WASHINGTON AN'E., 4100
ESCONDIllO CA 92025
ESCONDIDO CA 92025
1764)839-8239 . C'13L# 5113
USE OF PERMIT
11-NICILP M ,..... r1)"1211 INOt
LOT 5, FLAN 3-2AR, -SFD- PUMU `'DOGS NOT INCLUDE BLOCK WALLS
OR. 7'001.8. PI, AN CHEM F) R fS PLETWCED 75% FOR NTUC..T11'L
ISMANCE OF SAME PLAN 3^i PE.
CUSTOM (.,0NS'iRUC I'10N 4,621,00 SF
POF.Ci PATIO 890.011 Sr.
GARAQFJTARPCfR f 758.00 SF
ESTIAIXfEN) a),V ' OF CLAP STRU`MON'
:96,669.70
PERMIT PEE SUMMARY
CONSIRUCTR3N'F:EE 101-000-41.8-000
'PLAN CHECK FEE 10.1-000439-31.8 $332.53
NtECHA.''�TICAi.FEE 1.01-0€?(1 121-000 $1 24.00
ELECTi;UCAL FEE 101-000420-000 3253.40
PIAI4I131 NO FEE 101-000-419-M 8241.25
S1'3 MNG MOTION FUM-.RESfD 10:1-0004141-000 $38.67
Gi2ADIN NO FRE 1111-000-423-000 $2.0.00
rivekA3TWUC1JR91F 225-000-443-342 $6,000,ijr1
ART 1N PUBLIC PLACES - RESIC'70I-000-2.15-000 $7116.67
SUIS-'ral'AL C:ONS"IRUCTION AND PLAN CI: L
$9;3'10.5?
LESS .�l'.E PA.lI3 I�EES
$0.V0
TO' AL PERMIT FEE S DUE NOW
S9,370.52
RECEIPT
�y �.
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
e OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALSMECHANICAL
APPROVALS
Set Backs
Underground Ducts
Forms & Footings 1A11
Ducts
Slab Grade 114
Return Air
Steel
Combustion Air
Roof Deck
OX to Wrap
Exhaust Fans
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
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
s Piping
Appliances
Final
COMMENTS:
/
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 �G I
Ot ^i
' 1J,
c®mmuniles
January 31,:2000 {
City of La 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 O'hagan cloaked
roof vents in Lot 5 at 80435.Weiskopf. We find them to.'be installed properly and
as per manufactures recommendations.
Thank You
Rick Snyder
Project Superintendent
. fir:_
4.
E
200 E. Washington Ave., Suite 100 Escondido, CA 92025 9 Ph:(760) 839-8238 • Fax:_(.760)839-8246'
Certificate of Occupancy
City of La Qui. taSafety 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 th4, City regulating building construction or use. For the following:
BUILDING ADDRESS,:— 80-435 WEISKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-067
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 AVENUE
City: ESCONDIDO, CA., 92025
F
By: DANIEL P. CRAWFORD JR.
Date: 1/28/2000
POST IN A CONSPICUOUS PLACE