0002-390 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
ChapUer 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
/ '!u_+iii i3 a311,34i21ui
�Olpate-��r �� Signature of Contractor
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct-: the project (Sec. 7044, Business & Professionals
Code). 1
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Perpalty 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.
(J I have and will maintain workers' compensation insurance, as required by
Sedtion 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 is S Policy No. ' � �
r�.i,+�`t.1 lYa,,. CO. Policy
(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 sh II forthwith comply with ingseprovisions'�`�,/
Date: vJ� Applicant—. ` ✓ l�1,_
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
thea bove-mentioned property for inspection purposes.
,Signature (Owner/Agent) �� 1 �' -:� Date !3h mn
BUILDING PERMIT
DATE l j VALUATION S.384,669.70 LOT
OWNER
PERMIT #_
i ,ijfl132�.3SN1
APN
TRACT 28M.1
ie-+�►su-�iG�i
CONTRACTOR/DESIGNER/ENGINEER
eCAP:;T.'; NES" CS - IX AVES a' LLC
2W E. � AS ifriUMN AVE. #100 4G0 E. WASHTNIGMN iXE. 4100
LSt. ONDIDO CA 9201.5 ESCOrl{ADO CA 92025
t7 1Ra9-�2 3. 0,111,9 5411
USE OF PERMIT
SIN(.—AX FAMIf,y .l'1iEiFLUNG
WD- LOT 1,2 PLAN 3-2- PGLINUT Dr -PE -S 40T DICLMR BLCkK WALLS tTR
11100L. 'TV/o PLAN 1*,-DUC_:1'j0N FOR MUL JI -ILL iS +U&NC,E O
;LAME PLAs�i 'i 1')%E.
CU i Oibi CONI STtRIIC iiON 4,621,00 SF
t JQitMPA:fTIG 890.00 IS
(;AAAJj1YQAtt110it1' 758.00 SH
E8TfNLA TE, 0 CONT OF CO}''4YA Ri:,tC" -1100N
PEIRM T }P;ii'.i'�:Siiii' MA11ty
CCINSTRUCrfON FEE 101-010,419-000 Sj,c►4<f:f)t)
PLAN c'w K vFF. iRi-f3f1(?-d i' _i1>i 't -q 5i
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$253.40
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$710.67
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RECEIPT DATE By ' " `I DATE FINALED IINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 5 ap
Ducts
Slab Grade SV
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap f�
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
Drywall - Int. Lath
� s
Final
Final
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
aev=4ateral
Pool Cover
Sewe onnection
Encapsulation
s 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:
A
r=
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
80-775 WIESKOPF
VN
Bldg. Permit No.: 0002-390
Land Use Zone: RL
Address: 200 E WASHINGTON AVF #1nn
City: ESCONDIDO, CA., 92025
By: DANIEL P. CRAWFORD JR.
Date: 1/18/01
POST IN A CONSPICUOUS PLACE