0002-385 (SFD)LICENSED CONTRACTOR DECLARATION,
U5 J- hereby affirm under penalty of perjury that I am licensed under provisions.of
1-- Ohapter 9 (commencing with Section 7000) of Division 3 ofthe Business and
U) 'Professionali- Code, and my License is in full force and nd effect..
C14 UJ
C,) License# 'LIc. Class Exp., Date
0 Lo 0515 ON
LU T
y 70-11 K
�teContractor
Z r-_✓Signature"of
ca O.
OWNER -BUILDER DECLARATION -
HLU I hereby affirm under penalty of perjury that I am. exemptrom
the Contractor's
C0 7 CL License Law for the following reason:
Z 1, 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).
1, as owner of the P-ropbrty*1 am'excliusively'c6ntracting, with licensed
contractors to construct the project (Seca .7044. -Business & Professionals
Code).
CO I Am exempt under Sedtion for-this'reaion
Lo B&P.C.
N Date §igAitLi(e of "Owner
0 C'J
< WORKER'S COMPENSATION DECLARATION
CL
It M -Z
0 1 hereby affirm. under penalty
Lo < [r I . _ y of ;.perjury one of 'the following declarations:
0 1 have and wi.11 maintain a certificate of consent to self -insure for workers .'
X LU compensation,
LIL -as provided for by Section 3700 of the' Labor Code', for the
—
..0 -J < -J performance of theworkfor which this permit is issued.
J
M < I have and will maintain workers' compensation insurance, as required by
d 0
Section 3700'of the Labor Code, for the' performance of the work for which this
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0) permit is issued. My workers"coriipensation insurance' carrier & policy. no. are:
'It z CarrierPolicy No.
Cb ZD
IN"'
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<(This section need not be completed if the permit valuation is for $100.00 or, less).
_J 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 3700,6f t.he Labor
Code shall forthwith comply'with thos(rprovisions.
Fate:
1 : Applicant
2 12.1 ne�
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 cobperisation; damages as provided for in Section 3706
of the LaborZode, 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 Quihta, 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
permit, or cessation of work. for 180'days will subject permit to cancellation.
1 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. .
re (Owner/Agen Date
PERMIT#
BUILDING PERMIT
DATE. VALUATION 4&33i6,67:8.'Z-6 LOT, Q=1-71an TAACT J
JOB SITtAPN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CAP91'0191.
INNIOVAIRVER
.200 E. WAS RING POINAVE. 100 - -
CA 920215
ESCONDIDO 92025
(700)939-8238 CU -0 444 i 3,
USE OF PERMIT
SINGLE 14A M I L Y D WE LL ING
SFD- LOT 17 PLAN 2-1 -,PWIIT DOPS NOri T1XLU1)E HLOCK INALLS
t:3 4:! 7!,'1/6 PLjW CRW_-'K FI -Y. REDIIJ(;TION FOR NAX-flPLIE, 1t;SUA, 14CE
Or, SAME PJLAN TYPE.
CUSITONI CONISTWUM1,011s, • 000100 5F
798.00 -Sill
I
GfUlAG&CARPDXV 738,00 SF
COST OF CO, VARUCTION
3
P E KNI I T 14
ME SUMMARV
C1Q'N3TRV'Cf,(C)N FEB $1,469.00
'INiM CHE MX�Flprl -1.01 -W-439-318
IME'04A'145CAL TFEAU
1M-,ECTRTC AL FEE lGi-000-4-20-000
PLUNIBING FID3 101 -000 -419 -OW $Z� 75
(A)) $13.x? )TT N q:.F
F,0N1QMC 0 -,RF�4
GIRAOTNIG IFE,137 $2001
INFYtA�SftlkUCTURIE FM, 225-000-443r34.2
AR'r YN mjnm d,ACI S RE= 701-0)-255-000
ISUMVIAL CON `rkT.JC;D0N AND PIAN CH ECK
6.22
LESS PRE
WrA§,ftA'MX FIENS DUNOW
S4.8,66-22'
At%
RECEIPT
By/
DATE FINA I LED
INSPECTOR
e
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 4Z
Underground Ducts
Forms & Footings awl
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck (�,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
3
or7
Final
Final /
BLOCKWALL APPROV LS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam-
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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 t
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: 80-675 WEISKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0002-385
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CAPSTONES GOLF WEST LLC Address: 200 E. WASHINGTON AVE #100
Tem
Building Official
City: ESCONDIDO, CA 92025
By: DANIEL P. CRAWFORD JR.
Date: 3/6/01
POST IN A CONSPICUOUS PLACE