0002-392 (SFD),.�• erg; ,'• :. :„ � •,. ,..,
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 #8 Lic. Class ` '. Exp., Date '
o
'0551 N 63171
^ spate. a Signature of Contractor'
y 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,tas owner,of the property, am exclusively contracting with licensed
contractors 'to *construct the :project'(Sec. 7044, Business & P-rofessiorials
Code).
O 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.
(� 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:
'No.
Carrier Polis �1'Ti1'I.td , r"CS.• Y. �I o9411
(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
�C dee, Ls all forthwith comply with't osorovisions.
te: Applicants V' - /4 E --
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer, to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code Interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to .the conditions and restrictions set forth on his .
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
permit issued as a result of this applicaton agrees to, &,shall,: indemnify
& hold harmless the. City of. La Quinta, its officers, agents and employees. '
2. Any permit issued as a result of this application becomes null and void if
work is not'comrrienced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property foynspection purposes. -
/J J
dS g ature (Owner/Agentq�'s_
BUILDING PERMIT PERMIT ,
DATE VALUATION8.LOT 4, TRACT '8444I
JOB SITE • ¢ A
J:L�Ss49
APN
-/-PD fib Ci ��
ADDRESS
j
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CA1'SMN:ESCQr"IF W E9. J'1,.t:C;
ININ1s;,IV A J,t!/l'RES;�11Tt"{.YK4j1i1F1rje`5"INC
2001 .. W LSJ- INR=J �N AVE. 9.10.0
200 E. 'vi AS-HINC_i rON.t AVE. HI
r<:SC0KiX1)0 CA 92025
JE C)ND100 t_':A 92f325
d 7� '39
USE OF PERMIT
Si•NOLE F1livi LY UVELLINOi
51,D- f,07"24 24 PLAN 3-1 - F RMIT DOES NOT IAicLUDE BI.00K 1)i.rW-3
OR. t.'/C?til:.. 7YN/o .PLAN i"..FlECK FM., 1t1 FXJCTIUN FOR S41UI.T.WL E ISSUANCE!
OF SAME PLAN '1 Y'11E,. y
CtISiGP�l Cvi�fS`fs.i�`C 1C?id 4,62:.00 5
y - '
Jas tRCf'v'I>6i,1'it"i 890.0 SIV
(_tARACUWCA11Lf'0Wf '758.00 SF
EN'.A ' T:1) C0.5►Tn OF CON S E'RLfCt'fO'N
s3€►, 69.0
P .r; f$ FEE SUNWWRY
;
C NS`ik?VC 1'K'):C,I FFE 01-000-418-00() $1,644.00
4wi',tlN C:}aT.;f;s.:rfyh t01-t�t1-439-:11.f.+ x,33?..5+
,
.t` 1 'e'Ir s1t '!! r. r_• 'i 115 f1{1� A•1f
.told-L�1V'"e/:G.!"1)t}0
f f f.f::1RICA"L PEE 1Qi-000-420-000 X253.40
1.�1.U1vt3Lt fEt l�E'E 101-000-419-000
't' t'SpJrt t s ► r ir�a�► s - i��? �4 1014)(M-241-000
tdiplDAt 4S9 i .L;.t: V=^+i7.3 -A3ltiJ
fNt icA,FRtJsv r s:f .t nT� 225-000-443-342
Aft'(' N PlJL AC— PLJ%eES - RE811: 701AW-255-000 $716.67
k
CC)�1S i'1F1 it.".f'IQ%l .'n P?,11 tiJF'l l
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S5,277.52. ,
RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
.4.�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings qa
Ducts
Slab Grade A
Return Air
Steel n
Combustion Air
Roof Deck Al Ll
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 /
Drywall - Int. Lath
di
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 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 A
Pool Cover
Sewer Connection i
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Certificate, o-f Occupancy
City of.'La.Quinta,
u
Building -anDepartmen.
d Safety t
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
t of the City regulating building construction or use., For.the fo/%wing:
BUILDING ADDRESS: 80-815 WEISKOPF
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0002-392'
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
City: ESCONDIDO, CA., 92025
` 7'"d 1, By: DANIEL P.'CRAWFORD JR.
Date: 5/24/01,
Building Official
. r
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