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0002-382 (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 /7631$7 .13 () Y3.1t24i te -;?' ® 6 Signature of Contractor 2 �,L 11 • 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). ( ) 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. (}cJ 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: Cartier Policy No. (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 su fect to the workers' compensation pp,,visions of Section 3700 of the Labor 96de, I shall forthwith comply with tf-o_s6-provisions . /+ + Date: ?x/00 Applicant— Warning: pplicant ! Warning: Failure to secure Workers' Compensation overage 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. vSignature (Owner/Agent) BUILDING PERMIT PERMIT# DATE VALUATION ?�,`3W,(Yif'M/© LOT TRACT 794ill1 r JOB 1M►53 �4 �1►�i .� 1tr APN 7. 61-6411.005 ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER &.11`. ��.�.+ �.=ili.i: �i7�: 1"r' s.�.�' ii`i �: r+1✓ i�t�'�,i�rl^ ?21:Vc%f)"r..:.i i�i�'t 'Ut9 L. 4M t1 }1lL�lf 1 Vi•1 li Y . !/ i UU GVi! L. VY tV�if I liV1 s 1 �JIVt AVE. Ei f 130 3y t (itVutlx.l CA 92025 E&: ;JNUHX) CA 92025 f7tir)1,�1it)-R3 3i VATJJ 5411 USE OF PERMIT 61NO'Lk, i -AI lL.1 1��J1 i.l.tivii it�.IJ- LuT t•j Y'Lr1N :-i-.a'LRWI l S'11JM NOT IIVC't,UOE i OCK WALLS t.11Z .F'uUL. J�;®t'I,At�I l:i1G�;lt!/iit; t>�f)Utr"3'ti.3�i F'C�< f�ii11: t'li'1.1a tSSI.+At+il;�: QF SAi\�ik PLAN TYPE. d.UJiI�^.JIV,IA CON?dlRVICTIO'N' 4.114HAt 11' POW"kN19-;I O 890.60 SF tJAt.AOEJ(AKKt 10! 755.0) Sr' E 1T MA 1`0 M311F OF CONS'iMUC710IN 31016,669.74) PERMIT IT FEE; SUMMARV C0N8'1XLTG:,".t 10N FEE I01 -W)-418.0(() Si CYN.W f Wt r,, F F. 9 1 @ T .!i(1f1-479-31 9 1%flZ 11tV1 C A1, n_13 S t if N) R;1..t t fT2IC�U F1;X S233.4o NLtlf4ti INC4 FhF 101414-419-OUt) 5211. �5 i ' TFdONG fiTfl'T(! �3J > f+f; _ Rt?StT� t(li.fH)f1-�41 llf}(1 $1R tiT ' t , f J GRAD, 17,11 101.000-123 GOO 3Ntk.ViT1ZLfC'iU12131;lir- .'2$-44th-1~1s3Ei2 S1,YOI.4 Ate'.i' 1N N1181AC 1%A0_-3 - RiSW 701-044-255-00() $716A7 t ; . j 't Sf r.B-'1'fyr'Ai, r rl`NsxR ()r10N ANN Pi,A_i r'FT%CK 5X77 S7 LESS' I'I:I:-PX'%,1D FAITS $C.^,0 1'U't'AllPERM i'1'PERSIA) ENOW SSX7.52 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings g- Ducts Slab Grade/ Return Air Steel IT06Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Q / 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 a Final Final d/ BLOCKWALL APPROVALS 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 Pool Cover Sewer Connection y 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 Utility Notice (Perm) COMMENTS: 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: 80-615 WIESKOPF VN Bldg. Permit No.: 0002-382 Land Use Zone: RL Owner of Building: CAPSTONES GOLF WEST LLC Address: 200 E WASHINGTON AVE 100 e -+n Building Official City: ESCONDIDO, CA., 92025 By: GARY HARTMAN Date: 3/29/01 POST IN A CONSPICUOUS PLACE