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0010-014 (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 '763187 2) _ 04, 1 et2f . Date Signature of Contractor-�-x' - 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 ,1 Date ef 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. (,,o) 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. ZENITH IND. CO.Z0423INSM (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. e Date:. �Applicant , -:;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 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 p,4Fp6ses. Signature (Owner/Agenf��-� ��'' . • �A 4 DMate % BUILDING PERMIT PERMIT # DATE VALUATION LOT QDiD�,Ri-014 TRACT //,q ii,y� ,yy��??���� ��w,�,�yy� µq,��� yy �yy /� p,,qqpp j { j 8.RJ6i0rt11"' , NJay86.1669. to \�V; 210444 JOB SITE APN ADDRESS OWNER CONTRACTOR DESIGNER INEER CxPM&S, GCi1"..F aUM 1AX1 INNOVAi.N , • RESORT +COWAUNIT.f CMS, If 4C. 200 200 E, NVAII—M ON'.AV& #100 Wlelolq=o CA 92025 ESCONDWO CA 9 025 (-?W)8310-8Z38 t"BU 5413 USE OF PERMIT SAD - WT 30PLAN a"• 118RP3,11.I>"d1T DOES NOT INCL.Llwt `I9LOC K lYdAWWl'?+3:LdAPPROACH 1DRI ►EWAY PIAN C'HWX Fft li►EDUCtiD BY 'b% FOR. MU1171P'LE 1013U.&MC 1 CWWOM CORSTRUCTION 4.01,00 OF P014CH(PATIO 81110A .SYS 0111rtAWM:J R,PORT (OF) Z917aft, 7XD C`0ST OF CONURM',1: ON k&.70 NWhIMARY CONSTRUCTION FER 101.0090.416.000 11,64..4.00 MAN MCK M 101-000-439-318 MIA; MWHANiCALF"„ 101.000-421.000 UNA N.rZT-RtCAL FFYK C►1-000-420-MO Ki MBINO Mll! 101-0004-19.000 V:i4,�NO MOxFOW ice: » RMID 101 000-241-000 $38.67 MAN140 FBE 101.000-423-000 820,00 01VELOPIS,S�,;:1iilPACT Irate $1,9x,7.00 A3i.T ,1X PUBT.lC"' I'LACi,2 - USlt 701.000-255.000 5466,67 IYU.B-FOCAL CO `12LJCT10 1q\i7 PY-" CHI WK x5,(902.02, Imo; w YZIT-IMAM 1192.3 $0.00 LRECEIP.T DATE BY ,. DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ Forms & Footings 1�. 1 _ _ Slab Grade Underground Ducts Ducts Return Air Steel _ _ Combustion Air _ Roof Deck �- d] O.K. to Wrap �L� /J Exhaust Fans F.A.U. Framing 3� Compressor _ Insulation — 4' Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final ars lag Final POOLS - SPAS BLOCKWALL APPROVAL' steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines �0©9/� 0 Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection �b�9! _ Pool Cover Encapsulation Gas Piping _ Gas Test Appliances / Final COMMENTS: 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) ��� 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: Occupancy Group: SINGLE FAMILY DWELLING R-3 80-935 WEISKOPF Type of Construction: VN Bldg. Permit No.: Land Use Zone; 0010-014 RL Owner of Building: CAPSTONES GOLF VIEW LLC Address: 200 E WASHINGTON AVE Building Official City: ESCONDIDO, CA., 92025 By: DANIEL P: CRAWFORD JR. Date: 5/15/02 POST IN A CONSPICUOUS PLACE