00-2391 (SFD)'I LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of'perjury that'l 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
-7/63187
D531]20 i
%V/ate-�_ Signature of Contractor
f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.1 am exempt from the Contractor's
License Law for the following reason:
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
pale (Sec: 7044,Business & Professionals Code).
as owner er of the property, am exclusively contracting with licensed
contractors to.60nitruct the project 'ect (S6c..7044, , Business & Professionals.
Code).
O I am exempt under-Sbcti6n - 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:
.1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as- provided 'f6r by Section 3760'of,the Labor Code,., for the
performance of the work for which this permit is issued.,'
( �, I have.and will maintain workers'- compensati6fi insurance, as'required by
Se6iion 3700 of the Labor Code, the performance of the work for Which this
permit is issued. My workers' compeinsation . insurance .. carrier & policy, no. are:
Carrier Policy No.
Cmwrrl Y� "N' J. CO
(This section need not be completed if the permit valuation is for $100:00, or less).
I certify that in the performance 6f,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 withAhe provision
te: ;3 t7dAi!:L Applic nt V'.o, /!a��
V_
Warni6g: Failure to secure Workers Compensah�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 66ildin'g and Safety
for a,,permit subject, to the .conditions and,- restrictions set forth on his
application.
1. Each person' upon Whose behalf this applicatiori is made & each person at
whose re-quest.and for whose-bene'fit work is pe ' rformed 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 perm ' it issued as a result of this application becomes null and void if
work is not commenced Within 180 days from dat,e'of issuance of such
permit,
ermit, or.cessation of work.for 180 days will subject permit to cancellation.
I certify that I have -read this application and ita'te that the above information is
correctA agree to comply with all City, and State laws* relating -to the building
construction, and hereby authorize representitives of this City to enter upon
t above-mentioned property,for in pection purposes.
In' V I . I . .
71,1 X�: •• Date AA/4016
Signature (Owner/Ag6nt),_�2 - -
BUILDING PERMIT PERMIT-# --------
" a--�-
1
DATE VALUATION si- sop'.174). C_71 LOT TRACT `9444
lkl�o
JOB SITE I _4,W
ADDRESS
77—
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A Pil 117 S -V I f
&"4 0. '._ i
I MD.. At'
IN, ""A"""'
200 t. W!xSFfl1KqF0N.AVR ii -J.00
200JR. 'WASIENGTOR ekVE', Uiod_'
Lm?sicciwxbo CA 92025
ESCIC0401DO CA9202,,
C 4 54 QV
-8 1
USE OF PERMIT
SED -1 L01,23 PLAN 34 PE-WV1TD0FS NOT MCLUDEBLOCK WALLS
1-10 OL. 7�'M, MAIN C:' 4, Fl?)R RFA)LICTION F4.'_'JR NIVLTWLE� ISSU AI'lef,
Of,' SAMS'PLAN'TYPIS.
PORCHIMT 10 890.00 V
GARAQ&CARPOkIT 8F
'OW
ESTIMALTED -01r COMSTAUCIIONV
PEIRNM FEESUAIMM-kV
101 -OW -418-0M 51.644 tits
P -111 -AN 0-91lk, I.T.F. 101 -0 -Mc -43Q -31*8 "a32,53
U
MOMA:1141CAL rEU 101-0004121'4000
10 1 -GW420-000
PLUK,kING FEE .101-000-419-000 &24! 2g,
CVMOTIOV FEE— IRIEISP, -1}M-2111 1 -000 &3s,67
GIRtAOING VEE 101,-(10 423-Ou0
NFRAI.M. UCT101C' FELE 225.000-44-342 $1,907,00
A R: f rt 4 P 110 L I C PC ACER S R 0.4 1 D 70J. 000 -25 5-00 0
RIB -MM, C',CVST1FVCv1J0NTAND PLA1,J CHEICK
$5.3,52 1
LESS PRE-M.H., FEES
$7700,
RECEIPT _1
DATE'
BY
DATE FINALED
JINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
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
2
Drywall - Int. Lath
LZ
Final
Final /
BLOCKWALL APPROVA
Steel
POOLS - SPAS
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
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:
-
d
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
b
Tom-.
Building Official
80-795 WEISKOPF
VN
Bldg. Permit No.: 0002-391
Land Use Zone: RL
Address: 200 E. WASHINGTON AVE 100
City: ESCONDIDO, CA., 92025
By: DANIEL P. CRAWFORD JR.
Date: 6/1 /01
POST IN A CONSPICUOUS PLACE