0002-375 (SFD)LICENSED CONTRACTOR DECLARATION
11iereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O = CM License # Lic. Class Exp. Date
�Q'�
ti Z ti LU
9£te_____4__' Signature of Contractor // �+----
CS p ! /r
J U 0 OWNER -BUILDER DECLARATION
LU WW rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
cr) () I am exempt under Section , B&P.C. for this reason
LO
O N Date Signature of Owner
rn
0 Q WORKER'S COMPENSATION DECLARATION
o IM I hereby affirm under penalty of perjury one of the following declarations:
r � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q C) ( I have and will maintain workers' compensation insurance, as required by
O CU Q Sec ion 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:
Z Carrier 7 7 �� Policy No.
[1�t\'J•i 1. j1.�1. ��t-i. Inyl�_ CI•.i
(` C)
J (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 pr visions of Section_ 3700 of the Labor
�C de, I shall forthwith comply with tJ os provisions. r
te: !961 Ae 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 above -mentioned property for inspection purposes.
I
Pig -nature (Owner/Agent)/;i `�- s Date
BUILDING PERMIT
PERMITtI{'`/�
DATE f VALUATION 1i;1?0, %`�?g6,60 LOT
�.`? TRACT
JOB SITE
ADDRESS' -:) l� 1.�113i{
APN 761-lu44-ft;
OWNER
CONTRACTOR / DESIGNER / ENGINEER
0,141r `: lLl XjlrT' a 7
•.i1_1.1,.{.,
n.]�Y��//�V t'[ y11 n r, s.Y ir, lS t il' [4` "('Ir�C' eP((
17,41N ./ y A�, 1 E A.\.l.,')ER ..•�rii"!.s �IVU 1.:1y IAi1
_l?{1i✓. `r�e';�1'�I1`:i_xll,+l'•J !iti l'., l�iilL
:;l.lU i:. 1'V'.i\;�itil`1�_iJl.i14 ti1�1::. PF1�Ji3
USE OF PERMIT
:tli`'fdC.l' J'vssL,li(`.l.i
v► L.1 I LAI �:-.. - 1 i lti 311 i.sl?.!. a �lUT' fi�1C;GlJLL:15LlA+�;iti �A :\L L� +_!it
C.;,p"Ott,dCi'i{,i� i,,1;6.IJii
i,i_,,1 yi, i i<i 98.00 Sr
01,; r'ONSYR Tl.1d.YON
'Y2+lf '786.691
J1. AIy<V
) y jjyy r 33 g� C `n�, ♦�yg
Rxl'l/Lwi��l, 6 �;iLJI'l AYJ1�liFMelif•>wY
C;� �NSdT.RLIC t [ON I E' E f014M-418-0jfi
StA t cSKI,
f)r AN, iniIX
�j.�:ty -,}
u•L..._b,:S.�,ti•.:: �t ,. 1 Lx ; v, 'tnn •i� e niU �'.60l
i:l.x:4; t tttt'r1i, ii i� tc�i-xl6Ct-.i �tl-t)uG
,7�.`I, i.:
hf-t 4nlNti�;l.Y FEE
_ono
�_fl �,�i�l taC; ;'i"I: ' ft; -fJ0(i •�1',:':' -0�'f1
37rI,��l
_
dl�i Itr1;s"t'tt{a+=". iJIiL Fis l -(xiil ::l I=1-s +�.
ART IN P11131,11 70J-000-2554 t))
Sfy4I.y7
1"Af�'TW410:41'
�y)¢�t-"t'r1T'.��i_, /.'()A;�I'T`.,(.i{�'"T`((?1V .<��1;}}'f,,"�TV {�'}t}.<•f;
4i,rilfi,,t•q
C(YCAL PERM IT FFES' M)it, NOW
S4,99443
RECEIPT
DATE
BY' ''
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
11
Forms & Foot]nrgs aye
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
I
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. j
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firev.all
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCK Ai A PROVA S
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
to
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
Utility Notice (Perm)
F,:6-;F n,
State COntr"tajes
Lctna• NO. 631* 7
December 21, 1999
Innovative Communities
'00 E. Washington Ave. # l 00
Escondido, Ca, 92025
Re: O'Hagen Vent Installation
Project: PGA West, La Q«nita
To Whom it may concern
The specified amount of O'Hagen vents were installed correctly, per builders
calculations and manufacturers recommendations
Rick Pettit
Raincross Contractors Inc.
C,)",- /'� 0
6I43 Xagnolls Ave., i334 A!v*rs[d*, CstiiornJa 925a6 9"'423-0334 FA-1 904 ��3-o�sz
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
80-540 WIESKOPF
vti
Bldg. Permit No.: 0002-375
Land Use Zone: RL
Address: 200 E. WASHINGTON AVE #100
City: ESCONDIDO, CA., 92025
By: DANIEL P. CRAWFORD JR.
Date: 11/17/2000
POST IN A CONSPICUOUS PLACE