9902-068 (SFD)LICENSED CONTRACTOR DECLARATION
`l 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
_ i3 4130ivll01
ate ,y Signature of Contractor
OWNER -BUILDER DECLARATION'
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.
(r) 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.
'21'NITH INS. CO. Z042394503
(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 theworrkers' compensation provisions of Section 3700 of the Labor
Code, I sh II fo thwith comply with those provisions. /J
yf!ate• /'I Applicant G-�s'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 wor0or 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.
.7.. t
x/Signature (Owner/Agent) C' �� �'� �•% Date f
BUILDING PERMIT PERM T#
DATEJ t VALUATION LOT 9,4W-064 TRACT
JOB -SITE* APN
ADDRESS �...�- -- •,- ..,_
OWNER
CA:PSTONI S 0,01Y 41A'' . LLC:
2.001. WASHiNUPC?Iv AV1:NUE
ESCODIDIDO CA 92025
USE OF PERMIT
CONTRACTOR / DESIGNER / ENGINEER
SHANNON C OIA41!'1I.. NITIES OF CALIF„
200 E, WASKINIMJ N AVE, #100
ESCONDIDO CA 92025
(760)839-9238 sr BL # 5413
LOT 65, PLAN 2-2C., -SFD- PE1cTUI T DOES NOT INCLUDE f11..0CKW:+LLS
Mk POOLS.
CUSTOM CO'NSTRt CTION 3a`FJFi.i?f! SF
PORC111PATIO 798.00 SF
GARACiF)CARPORT 738.00 .SF'
ESTIMATED COST OF CONSTRUCTION
PERINII'f FEL SUMMARY
CON.VRIXTION .FFE
101-000-41.9-000
$1,413.00
PLAN (AfEC F -)-:E
101--000-439.319
$1,.145.51.
Fyak;CYi"i ICAL FEE
101-000-421.-(100
$111.00
ELE-C RI aAL FE
1.01-000-410-000
S224112
PLUNfBING FEE
101-000-419-000
&20.75
STRONG NAOTION:FEE - RESID
101-000-24.1-000
632.08
C"DINO 3161.
1U 1-000.423-000
$20.00
YNFfti' .STf2i arL1HE .F+-, ;225-060-443-3a
$6,000.00
ART 1N.V1BLIC PLtkC:VS-12iY=70.1-000.25540100
$551.9?
320,786;61111
S'trc3-TOTYU, CONSTRUC110N AND PLAN CHECK' $9,70143
LESS PRE—PAID FEES 50.00
TOTAL PERMIT FEES DUE NOW I x+9,703.43
REI �j,, 1,n, I� , E 1P� I B?" -, C� I 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
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
S
Final
Final 7s
BLOCKWALL APPROVAUi
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 nPool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test Z
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:
1T(-.
`
141
'T C,
i Oc
cuplancy
la Quinta
City of
Bufliding
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: 80-440 WIESKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-068
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CAPSTONES GOLF WEST LLC Address: 200 E. WASHINGTON AVE
City: ESCONDIDO, CA., 92025
By: DANIEL P. CRAWFORD JR.
Date: MAY 1, 2000
i
Building Official
POST IN A CONSPICUOUS PLACE
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