9902-073 (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
• q$i1 0 Q 4130100
„Date 7% Signature of Contractor ✓ �;✓„' t -�”
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 i" not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
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.
(') 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.
dE1v`f .1.4 I;y1S, CO: Z041194543
(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,
1 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,'1 shall forthwith comply with those provisions. J
�ate:'a % `. ') Applicant
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 aabbove=mentioned property for inspection purposes./ l
VSig'nature (Owner/Agent) J� - �, fir_ �1 Date Ile rf
'' `^ ✓
BUILDING PERMIT PERMIT
DATE VALUATION LOT C 9902'0 3 TRACT
$386,669.70 &?' 21,414141
JOB SITE ' �
7N_,
ADDRESS
'W.�ISKOPF761-080-089
OWNER CONTRACTOR/DESIGNER/ENGINEER
CAPS"PONES GOLF y'En uc SH,AMNION COM'MLT IVES OF CALIF., INC
200 E. W'ASWNGTON AVENUE 200 E. WASHING TOW AVE., 0100
ESC4JNDIDO CA. 920:25 ESCONDIDO CA 92025
(760)839-82)38 C)7.L#1 5413
USE OF PERMIT
LOT 8, FLAN 3-2A„ -5%D- PERN'T i ORS', NOT INCIE.UDE BLOCK WALLS
OR POOLS, P1. AN CHECK T -W, M RE UCED 75°l FOR M111,TIPLE
ISSUjWCV OP SJN.fE PLAN TYPE.
A
CUSTO CONSTRUC'rM 4,621.00 $F
` ORMINk"II-0 840.00
GAPACPJCAR13ORT 753.00 SF
.Cf S'1':11%1.A` ED COST OF Z:daNS'1'1F2:i1L ION
x%,669. X0
P E8'I1 ff FEE yU11! NIUkRY
CONSTRULf ON.PEE 101.-000-41.8-000 $1,644.00
PL 14 Cf1i~C•,1ti f1^E 10117011-439-318 $332.53
I�MHA.NICAL FM .101-0.00,421-000 x 124.00
ELIS.C9`RWAL IEC 101-000.420-000 8253.40
P1 UNII3'INC1Fes? 101-000-419• X)O $241.124
STRONG r4= 014 FEE - RESID 101-000-241-000 $38.67
GRAWNG>F•I; , 101-000-1123-000 $20.00
iNF RA3'1R17C'.Pi;I"- F8E 2:13.000-;1113-3.42 $6,000100
ART 1N PUBLIC ;'LACES • RESIN 170.11 _000--:255.000 $716.67
S1 B-T(Y1*A1 CONti"'f1?t:.'•C"TION AND PLAN. CHECK
S%�,370,52
LESS Rfr M1) FUS
U11.13f3
TOT..Ai: P.ERNIIT FEES DUE NOW
$9,370.52
RECEIPT"
DATE ti
<�+C,�✓
BY/
^�}
DATE FINALED
INSPECTOR
l
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 MAVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BL0CKWALL APPROV S
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 14
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
UU14 Notice (Perm)
COMMENTS:
coknmunl les
July 12, 1999
City of La Quinta
Building & Safety Department
78-495 Calle Tampico
La Quinta, Ca. 92253
To Whom It. May Concern:
c
RE:. A plan change on lot 8 at Tract # 28444, 80-495 Weiskopf.
We deleted the wine room and relocated the wet bar per the buyers request. This will involve changes to
the foundation, framing, plumbing, electrical and HVAC. See attached plans and calculations.
Sincerely,
Fred Babineau
Project Manager
Innovative Resort Communities
200 E. Washington Ave.
Suite 100
Escondido, Ca. 92025
760/77
200 E: Washington Ave., Suite 100 Escondido, CA 92025 Ph: (760). 839-8238 Fax': (760)839-8246
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: CAPSTONES GOLF WEST LLC
Building Official
80-495 WEISKOPF
Bldg. Permit No.: . 9902-073
VN Land Use Zone: RL
Address: 200 E WASHINGTON AVE
City: ESCONDIDO, CA:, 92025
By: DANIEL P. CRAWFORD JR.
Date: 12/22/99
POST IN A CONSPICUOUS PLACE