0010-012 (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 # Lic. Class Exp. Date
W Signature of Contractor r✓
.. ......�
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.
( ),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 Policy No.
(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.
Applicants ^•
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.
Signature (Owner/Agent) ^/ 1 'l'+ ✓ ' w Date-/
BUILDING PERMIT PERMIT#
DATE VALUATION LOT _ E}i}fY;a TRACT
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OWNER
CONTRACTOR/ SIGENE
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Ary MUL% INC.
200 gr WATAING70141.�,'VEHtJ:I
200 Z 'i MUN(.i•INDS AVE,0100
]", C0114:D100 CA 92025
IMfCONDIDO CA 92025
C760)839.8238 C.DZO 541.3
USE OF PERMIT
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VIA;I.C.d'PC OUAPPROACH DIUVFW V,Y PL+k°W CH. CK FEB. IdA'I31 MD, BY 75%
IfOR MULTIPLE tM.ANCZ
CUSTOM CONSTRUCTION 1o621,fv 8P
PORCIVRATIO Sian".00 ST:
GAIL&OFXARPORT (BY) 14,94640
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!:`aI<fS'k'RUCTI(N M.., `01.000-418.000 � siffi44M
PLAN CHECK FEE 101-000-43.9-318 03).03
MECHANICAL lh"I . 101-000-121-000 5124,00
LOLFCTRICAL IqW, 1901-000 420-000 $239.40
PI..UMBIN0 Y EF, 101.000-419.000 $241.25
STRr s MOTION fr FE w RE33l) 101 -000-24 1 -000 *38.0
(HWAING FELE 101-000-413-000 00 $20.00
WVMA)PBR IMPACT YZE $1,90?.W
~ART Y14 PUBLIC PLAWS - RE81%701-000455-000 MCC?
01)WfMAL C013;l R1JC'i'(01T.AWD Pi.AN' C Fi%:o"K
$5,002.02
1,M13 PRE -PAZ) ..P'.:1
59100
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'A•aifidR.a t`ial!'fi•
RECEIPT
DATE tt+
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
_
�_ _
/_?,���
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
O.K. to Wrap
_
/ �'a _
Combustion Air
Exhaust Fans
F.A.U.
Framing QV_ 7b�.�SrJi
Insulation ,
_
/7/dl
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
69-163- .
Final3�!/Q�' %31.G� G�d�De�1
Final
POOLS -SPAS'..
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bona Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines /Q�/7�a0 G
Gas Test
Electric Final s
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Pool Cover
Sewer Connection
_
p0 6d
Encapsulation
Gas Piping
Gas Test
Appliances
_
s�7�
Final
COMMENTS:
'
ar. -
.:'`} Ize
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 6*��
Utility Notice (Perm) / v`A
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 VIEW LLC
Building Official
80-895 WEISKOPF
Bldg. Permit No.: 0010-012
VN Land Use Zone: RL
Address: 200 E. WASHINGTON AVE
City: ESCONDIDO, CA., 92025
By: BILL GORDON
Date: 3/11/02
POST IN A CONSPICUOUS PLACE