9902-075 (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
fib$'! 4130�(ir3
ate+ ��l r Signature of Contractor j., : / �--''"r
I 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).
() 1 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.
(V) .I have and will maintain workers' compensation insurance, as required by
Seltion 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.
Z"131' 1N!;. Co. Z&1 2394-V,3
(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 the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Dx
,,ate: 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
fh¢/above mentioned property for inspection purposes.
`
Signature (Owner/Agent) (--- -�:{ j 7+ Date /
r r
w
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT _ 9"a'07.,5 TRACT �
{
. I:Z/� $3.20,796.60 - 6,—)
JOB SITE
APN �,
ADDRESS i31}-�90 �'7q:,�Slt,Ci�1H'
7f9-X21#-tlU2 ''
OWNER CONTRACTOR/DESIGNER/ENGINEER
CARS,Tt NES GOLF WES'1'L'LC SHANNON COMNTCiNrrIES OF CALIF., WC
200 E. WASIBINGTON AVENUM 200 F. 43 AS1.1.MITON AW., #100
ESCONDIDO CA 92025 CSCONDIDO CA 92025
(�i�0j :1_S^3i3 CBL# 5413
USE OF PERMIT
ray rs '>; ' 11 v
LOT 62, PLAN 2,213, -SFD- PER3VITT DOES NOT 1NCLUIX BLOCK W:�t .3
CR PCIOLS. PI AN CHECK fid IS REDUCED 75% FOR Nf RTL.T.LPLE
ISSU I CE. OF, SANfR rL€uhf TYPE.
CUSTOM CORT17RUCT10N 3, ", 96x00 SF
PORC"ATIO 798.00 31;
GARAOFI ARPORT 738.00 SF
\\-
Iffi l'IMATED COST OF CONS'.t RVC'F10't�
.201786.60
PURrUFf FEE SUMMARY
C;GNSTI21,f( TION x'FI: 101-60418-000 I,�113.04
PLAN CYICK .YEE 101-4)00•43)-118
l,f1"33CHIr'N`a'C,ini.
EI.EC'.I`.RICAI, :FW1, i 01-000-41120-1.100 321A. 12
PLUNII3TNICY FEF 1101 -Otto -119-000 $204,73
S` RC -11P3 NOTION !°'E - RE,%' 1J 1011-C►(10--241-000 $36.0
CRrAJ)'INt3.1:`1•,1,. 101-400-112:3-000 $20.00
1M:HRA,gTRUC"1'(Wi FLk 225-000.443-312 u,000.w
ARTI'N PUBLIC PLACES - RVSIr. 701-000-234-0W, W.i.97
SKID -TOTAL CONSIR ICTION AND PLAN CHECK
LESS }'.CCC PAID FEES
so.ou
TOTAL PERMIT FE&S DUE NOW
RECEIPTA,
DATE
BY ,T
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 1,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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 ,r
Drywall - Int. Lath
4AX
s
Final
Final
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
Finales
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines N
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
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
U014 Notice (Perm)
COMMENTS:
RANCROSS
RING cavm Dws
December 21, 1999
Innovative Communities
200 E. Washington Ave. #100
Escondido, Ca. 92025
Re: O'Hagen Vent Installation
Project: PGA West, La Qtuu'ta
To Whom it may concern:
•tate Cantto0t s
IJtlnso Pio. 631677
The specified arnount of O'Hagen vents were.installed correctly, per builders
calculations and manufachtrers recommendations.
Rick Pettit
Raibcross Contractors Inc.
VIV
0
6145 M"noUa Ave., 0334 • Riverside, C&tUo*njg 9ZSo6 909-423-0334 FAX 9o9 -4;3,0@s=
r
UAV*Qi�r��ticate'of Occupancy ,,a.7
city of La Quinta.1W
='
Building and Safety Department OFTME°`'
This Certificate issued pursuant tot 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: 80-490 WEISKOPF
Use Classification:. SINGLE FAMILY`'D. WELLING Bldg. Permit No.: 9902-075
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: 7/12/2000
Building Official
POST IN A CONSPICUOUS PLACE 1