0204-215 (SFD)LICENSED CONTRACTOR DECLARATION
5/•
I hereOAffirm 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 # Lic. Class Exp. Date
1763287 P. ' 5131A 13
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 exe ptu der Section , B&P.C. for this reason
Date `'S.s� 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.
(X 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 7'MITH INS, CO, Policy No. ZM231° 306
(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'fo5bwith comply with those provisions.
Date: 1141-0 Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his.
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a resultof this application becomes null and void if
work is not commenced within 180 days from date of issuance of such j
permit, or cessation of work for 180 days will subject permit to cancellations
I certify that I have read this application and state that the above information)
correct. I agree to comply with all City, and State laws relating to the buildin�
construction, and hereby authorize representatives of this City to enter upon:
the above-mentioned property for inspection purposes. `•
Signature (Owner/Agent) • •-.i�'�7 °f 'SX• Date ,1 �2
II
PERMIT#
- BUILDING PERMIT
()204-215i
DATE VALUATION �p��� LOT TRACT
S 42W.70 41' 2F44
JOB SITE
ADDRESS W-090 VVE iOK)
APN
7162-1.7i�-f3?;x
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CAPSM1102 0*CLV WEITL LLC
AMOVATIVR.FX8CiWP C-01Mrt' RTI IES, `�'�IC.
200 Y_WAV' k G' 011 AVE
Z00 7+', NWJfflRNGTQN V! 1 #100
FSCONJ: M0 CA. 92025
R."r.{.°�{ ND00CA 9202.5
USE OF PERMIT
.iiyLi - L.OT 41, I"LAN I -IAP,. Pk RMI T DOW NOT 1N2:1.,i VX f_t1AfaX
WALL% POOL, SPA, OR DRf :MAYAPPit1,'1ACM 75c/a k1EDOCTION TO
P1,,KJq CIxFZK. ;rte FOR M`U1,'r1PLF. ISSUANCE OF ?'AME P A14 TYPF.
CWIT:; M CONSTRUCTION V.".0@ 3F
PORCi-1113ATIC? 394.00 Sir
:IA.y3.Af$±t.�C'-ARFORT 0510012F
YSMWIM CCT OF C0.NS�.RT 9'11, ON
5001 00170
P YMI' 1 F'2 9U IARY
CONSTRi1CTION FEE :301.,000- 18.0011 $1,M3,.00
PLAN C:`ircle, ltEVE 101.000.439-319 tr/4,57
MY.CHAN 2CAt. FEr 1€f 1.000-4,21.000 $118,00
1'. P,L.1�:�;7:'1t1CAL, MILE '101-0001-420-000 $191.55
PLUMB1140 FEE 101-000-419-000 19.000 S210,;30
ST,RDHO MOTION A140 - RESID 101-000-241-000 $30,02
ORAOfNO E.EE? 102-00 Z3-0 0 $20.00
Z}EVZIA71!'YR.IMPACT PER, $,1,90740
ART 1N PUD3I.IC PLACES - R,EVIE 270 -NO -445i-000 9250,U
'S
$4,:113.16
i tl:
Cl C, QUIMA
FiNA
RECEIATE..
BY
DATE D
INSPE O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
I BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
,
Ducts
Slab Grade
_
pZ
Return Air
Steel
p
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
,Q
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
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 Lines
p Z
Heater Final
Water Piping
T
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
COMMENTS:
Final
Y; %zei 7h/-?"
Utility Notice (Gas)
/
ELECTRICAL APPROVALS
,Q /j
�D� `/ 716
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)
J
9
APR -17-2003 THU 03:51 PM IMPERIALPIPESERVICE FAX N0, 9096823406 P. 01/01
TRUSWEL, INC,
1400 F, Arrow Hwy. Upland, CA 91786 TEL.: (909) 920-4450 / Fox: (909) 920-5440
1�Zi o �NovdTieO
x'11- v2,
,Y� poef �►T
ate e?lnr-- cF F, -OP SAc*-
S
Exp. 6-30-03
No. C053621
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Ole,. _ILI;gp
Certificate of Occupancy
City of La Quintal
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
80-860 Weiskopf
Bldg. Permit No.:
VN Land Use Zone
0204-215
RL
Address:
200 E. Washington Ave.
City:
Escondido, CA 92025
By:
Daniel P. Crawford Jr.
Date:
4/18/03
POST IN A CONSPICUOUS PLACE