9902-071 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
F3 4/30100
VDate ! Signature of Contractor . , •f%t'�--r'" ,
.--
,OWNER-BUILDER DECLARATION
I'her eby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( .) l,'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
O 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.
( ) 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 ne'ed'no be completed if the permit valuations or $100.23S00 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 forthrith comply with those provisions.
„Date: / �J�1' Applicant—
Warning:
pplicant 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
ofthe 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
A 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
VSignature (Owner/Agent) f -� Date ��• r r
BUILDING PERMIT PERMITN
DATEVALUATION LOT TRACT
2iI44i
JOB SITE
ADDRESS �` !
X80-455_R,>I,QNk'
APN
76.141811-089
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CAPSTONES GOLD WEST LLC
SHANNON G"OMMUNITJES OF CALIF., INC
300 E. WASHINGTON AVENUE
2100.E. IVASIT[NGTON1 AVE.. 01.00
1s'SCONDRX) CA 92025
ESC;OND.TDO CA. 92025
(760i839-823€ C8L# 5413
USE OF PERMIT
LCAT 6, PLAN MA, -SFD- PERMri DOES NOT INCLUDE BLOCK WALLS
OR POOLS.'M.-W CEIECK FEE IS Ri:,iJLTt ED 7M/o.FOR rv.f0 .,T1.PLE
IRST IAS ary :. nF S AAJE _ AN TYPIE.
CUSTOi I CONS`i RUC1.70 i 4,621.00 31-
PORC"ATIO R".0 S>±
GAP.AG&CAR:P4.RT 751.09 SF
STI ATED WiT OF C,'t NSTRI3CF.10IN
386,669 710
)PERIWIT :FEE Stf11Ii1'IitiRY
CC+NS'`t' IXTtON:FEF 101-000418-000 S1.6411,00
PLAIN C_&fC:CK FW— 101-000439-318 5332.53
iM CH.rNNICAT.M, 101-000-42.1-000 $124.00
UECTRICA1. FRE 101-000-420-000 $253.40
PI1U'&9R:It4G FEE 101.-000-419.000 $111-11.25
STRe)NG :moT'IG)N FEE - RES;ID 101-000-,241-000 $38.67
GRADI140 FEE 101-000-4.23-000 $20.00
04FRAS'1'iti3t"i°URE FFR 225-5 i -443-34'x', $6.uu+)0i
AR*r IN J-' ALIC PLACERS - iRESX g01-000.25'5.0110
SUB-.ro(rAL CCIPFS'1'RUCTiON AND MiOl CHU, CK
$9,370.5'
LESS PRI&PAID TREES
50,03
TOTA.ra PERMff r! EPES DUE NOW
59,370.32
'RECEIPT�� 7r
DATE- e
BY! Z�.'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
. MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab GradeReturn
Air
Steel
Combustion Air
Roof Deck //
Exhaust Fans
0. K. to Wrap f
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
�J
S
Final
Final
POOLS - SPAS
BLOCKWALL APPROVAIS
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:
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
UU14 Notice (Perm)
Certificate 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: 80-455 WEISKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9902-07.1
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: 5/25/2000
POST IN A CONSPICUOUS PLACE