Loading...
9902-072 (SFD)LICENSED CONTRACTOR DECLARATION I aereby 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 13 4/30fo MOT ate T 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). 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. (X) 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 nee not'be completed if the permit valuations for�$100 00 or less). () I certify that in the performance c.f..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 provisi66s of Section 3700 of the Labor Cede, I shall forthwith comply with those provision ✓bas, r te:•Ate:.'-1-A'�� Applicant 'lis / , •- � f 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. �1 vSignature (Owner/Agent) t• "`--�f � +--� � Date � BUILDING PERMIT PERMIT# AWZ472 TRACT DATE ' VALUATION LOT_„_ �X M1 $336,67.20 -7 21444 JOB SIfE APN ADDRESS 180475 ATISKOPF 761-080-099 OWNER CONTRACTOR / DESIGNER / ENGINEER CAPSTONES O©LMEST LLC SHANNON COMNStf11ES OF CALM%, WC 200 F. WASHINGTON AVENIJE 200E. W LSHtNGrON .AVE..:. #1.00 ESCONDIDO CA 92025 ESCONDIDO CA 92025 (760P3 9-8238 t'M11 5,11.3 USE OF PERMIT LOT 7, PLAN 2-.1.8, -3FD- M73MT DOES h7f',`i” .INCLU�731w -1, K WALLS OR POOT.S, CUSTOM t-ON311IRIJC 1.10.N 4,000,00 Sli PORCit-Pl t tO 198.00 SF GARAGWCARPORT 7.38.00 8F %T4ibfA t+:ID Cr r or cOrrrUcr r<czN 336,678-20 PERIMT FEE SUMMARY CONSTRIJt:T ON FEE 101-000-418-000 $1,469.00 PLAN CHECK FM 10t -OW -439-315 $1,187.34 iLtWHANIC AL FER 10 It -000-421-WQ $111.00 1 LV,'C'J'R1C:AL FER 101-000-420=000 S?�1.2� P1„ U [NO FFF 101-000-419-000 $205.75 FROND .t�r.�7' LON F cE - ftE31D 10.1000-24.000 $33.67 C7RAC ING1'EE 10.1-000-423-400 $Moo f NPRASMUCi`URE l=FE 225-000-443.342 $6,000.w AR•r .tN PUBIX PLAC 1; - Rt✓MC ,701-000-255-000 SSai.70 SUB -TOTAL CO'NMRILIMON _kND PW, CHECK $9,849.12 .LESS PRE -PAID FEES $0,W1 TOTAL PERMIT FE'S DUE NOW $9,849.72 , /Y1{r� �.s,! % FiEC PaT/! � DATE,p.- BYf r.,{ DATEFINALED 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 B r3 Exhaust Fans 0. 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 Wall Firewall Exterior Lath Drywall - Int. Lath / Q Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Show O.K for Finish Plaster PdWer Lateral Pool Cover ewer Connection Encapsulation Gas Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring FMures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Ce'difi.catel'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: 80-475 WEISKOPF, Use Classification: SINGLE FAMILY DWELLING Bldg: Permit No.: 9902-072 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: 2/7/2000 Building Official If. POST IN A CONSPICUOUS PLACE r