0204-214 (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
Professionals Code, and my License is in full force and effect.
License # LLic. Class Exp. Date tr,^} .
7 107 d 8 f .r;7 51.3 1103
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 ex,pmpt under Section B&P.C.-,for this reason
DateSignature of Owners
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:
Carrier KITH °D13. CO, Policy No. 2042394506
(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' compensationprovisions of Section 3700 of the Labor
Code, I shall, fort. comply with those provisions. �✓^
Date: Applicant
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 buiiding
construction, and hereby authorize representatives of this City to enter upon,
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) +%"-�' �Y�i i �`�-ii Date
PERMIT #
BUILDING PERMIT
tf2:iM-411
DATE VALUATION .A0 fi0 LOT 42 TRACT W44
,1
T"�t%es�ao!t�„ts>>P
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
(W`STO}PIS Gdl„r'i! r, Y. 1c,
TWl VATIVE RESORT COMMU fN .S,19C`,
200 !L WA.MMIR QV1't W ANT-
200 X `W:A2Hft4Q. 0X AVL, # 100
&XOk3D:C O CA 920.25
E C ONDI ✓`O CA 92025
USE OF PERMIT
: M.) , JXT 42,, PLAN 2.2B. PSMIT DOES 1400 Tt3CI..U1.7Y, YHX1C.K
WAL.IA P001, SPA OR DR3V'YWAY'.A.PPROACH, 16%R.Cf UCTION TO
Pt -KA CHI.'F.CK ComM., FOR MU1,71ME ISSUA14i;r OF SAML? Pl.,,a,14 TYPE.
CUSTOM C:Ci1d01'j UCTION : 06100 SP
POI?i;;'H41ATIIv7 1798100so,
QARAGTYQN,R?0RT 738,00 SF
WMA17D COST 01f C 0,1461M1'CI.'1rfM
6,60
320,796,60
P Zvmv Tilm 9UMM fwRY
COINSTMIC1)ON KE 101-000-416"600 . $1,413,00
PLAN CHECK FirX 11.71.000-439-.318 $796.1-49
NIEC ILA1v11d.'Ai, Ila 101 -OW -421-000 $111,01+
8i,'f+:C'3;UC'.1 L FRE, 101.1300.420"000 $224.12
P'L,tJlbil3.MO n't 101-000.,413.000 $205173
STR ONO M..071aN PEI ET,R? 31D 101 -00044 1-000 $32,08
1332ADDIG FRF 101-0 00-421-000 $20.00
Jl4PRAST -RUC:TtfiM. KE, $Ji,=J.00
ESM -TOTAL COMRIiL.€'b;ON AND PLAK MEff-K
$47401.:40
um nmr-PAID FiEm
$10.00
J_
---fid VIAL
IFINANCEDEPT TYOFLAQUINTA .y
z
RECEIPT
DATE ""' !,ABY
:;
DAT NAL
IN P C
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground. Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
7i
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
_
Drywall - Int. Lath
_
S
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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 Linest;
/�Z�T
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
!b2
Encapsulation
Gas Piping—
Gas Test
Appliances
Final
COMMENTS:
Final-
[�/ 2,011:1
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
3
Final
Utility Notice (Perm)
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
80-840 WEISKOPF
R-3 Type of Construction: VN
Owner of Building: CAPSTONES GOLF WEST, LLC
-7--4, /4 -u -
Building Official
Bldg. Permit No.: 0204-214
Land Use Zone: RL
Address: 200 E. WASHINGTON AVE.
City: ESCONDIDO, CA 92025
By: DANIEL P. CRAWFORD JR.
Date: 4/25/03
POST IN A CONSPICUOUS PLACE