0204-211 (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
�rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date 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).
( ) 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.
�,4) 1 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 J M1 1N4t. Policy No. 7W,21k.394W
(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 shall•forthwith comply with those provisions!
Date: it ;X �fc v Applicant>Y
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.ll
'
tSignature (Owner/Agent) "d r Ya�� -Gj -IN Date
- BUILDING PERMIT PERMIT #
DATE VALUATION LOT '-�`= TRACT
.7' f / t ;,t t,2 ' 70 � 244 44
JOB SITE
ADDRESS -r-790 w%. ron,
APN
'7f24454)-01.2
OWNER
CONTRACTOR/ / EN INFER
CAPSTONES 001,1? WEST.
R040VATi; E RESORT C OMM(INITSl S, INC
200 N. WASHII01'ON AVE.
2(9) ,E. 'WASJ-Mx7tX)N1 AVE 4199
:%MOONTl ) CA 92025
FaCaNUM CA. 92025
(760)$3.M38 C.`.,€ IN 5413
USE OF PERMIT
9)NO, FAWYLY DWW-IJN(J
S33 - Uff 45, PJ AT'? 1.1B . 'PWo9r HOGS Wr H4C1XW*H3U),—K
WAT A FOOL, PA CRtkR4" FAFAY APPROACK -
CLISIDGM CONSIRMT ION 1.0%00 161T
FC?3tC13'liaAIM 594.00 S0
'
GARAMYCnARPMT (M.00 011
Ii5 91 RxY&.7'A�y(!_ D CV K_ Olt ( M1� �3trv� e.�.L�l
x7NMf7F it .'d 4,
/�}1yy ]�{;�'g'9y'Y y�.7/. WIRY '� $
P�d.'L3f.9nTY1..l F.l E, liPL7I'JN.%9�3':71.5�.$
CONMi.J "rioN WS si.,34.-mv
PL" t,.'IXECKFYPI 1.01 -OW -439-318 $1,M.26
1sM0HMCAT,VkH 101 -MD -421-0M $138.00
)
171MC;140 101 -000419 -WO $2)0.9)
O AMU M 161-Oi113-4713-ice moi➢ -00
1A V'OIX)1ER iMPAUr FIX, PX- 11.00
A11T W FS931aiS .1 ESIC 2'Y0.000 44S -Ml 'ttilt'sf3M
3- or.y CONSTRUCTION AND PLAN C`fIFC K
. � 3.XX8 PRA-PAD.17F1R1?9
.i !
�7C'A1`tMW ' A&INOS'
ClrroFQUily
sy FINANCEpEPT.
RECEIPT
DATE
BY
DA FD
IN PE R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
770t9'L-
Return Air
Steel
14
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Q
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
✓ �Z
IV
Final
Final
BLOCKWALL APPROVA S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING AP ROVA S/7
Gas Test
Electric Final
Waste Lines
�j�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
6 s 6 Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final �
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
�J
�$� /�L ?1le,
Certificate of Occupancy
T44f ot 4 Q"
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 80-790 WEISKOPF
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Type of Construction: VN
Owner of Building: CAPSTONES GOLF WEST, LLC
Building Official
POST IN A CONSPICUOUS PLACE
Building Permit No.: 0204-211
Land Use Zone: RL
Address: 200 E. WASHINGTON AVE.
City, ST, ZIP: ESCONDIDO, CA 92025
By: Daniel P. Crawford Jr.
Date: 6/13/03