0204-219 (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
76318"7 .1B 5i 1►r03
Date J / '//,):L Signature of Contractor'"'r 1 t' L
.. 1
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
pert rmance 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 MITH 1148, CO,*Policy No. %;042"4M6
(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 thos'provisions. '
Date: ` /31 r,4n V Applicant .; l ,
Warning: Failure to secure Works' 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'Iupon
the above-mentioned property for„inspection purposes.
Signature (Owner/Agent) IL +• Date
BUILDING PERMIT PERMIT#
7
DATE VALUATION LOT 37 ♦ TRACT 28444
JOB SITE
ADDRESS 71+ .'Ia7+p 0 .'13' fJ'
APN '162--1 % .011
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Cpj 4s 001s W+r,LW_
SNN9lKWa: kESOFTCCIMyV,WM{ S , INC .
200 R. r9A-%_ 3P14V1N7N AU,
200 R. NYA193MGT(YA AXE. It, 100
T'+ aCC)NI DX) Cry 92025
=XXIDID0 CA 92021
C';6f )839.8238 CIA41 5413
USE OF PERMIT
'a.Frd? ..IX'1't'' :I-7, 3"i'I.,AW 2,41. PD"1:t,1 UT MES NOT INCI,UDF, BI=K.
e ALL,8a TOOL, ORA OR DUdffrWA Y'APPROA.0 K 75% REDUCTION TO
PLAN CHECK VEF, FOR kfiULTIPLE ISSUA1,'NC F OF ,%". E: MAN TYPE,
CUSTOM 003OSTRVCTION 31706.09 WF
PORCHYPATIC 79&00 SE'
OAP.ACWYCARPORT "100 IS?
MiNATED COST OF &ONS:�77110H
320,786.W
FKSAXyI ny 9UA0L6R
CMS'i'RVCTICN 11LE 101 �0'tl0 4'18.000 $4413.900 .
PLAN CfP'uCK inti 101AXi0-439••318 $786.A
*HF,CPId's1,4t4 AL 101-000.421.000 $113,000
ELy. 'TR`IICA1, leJ?, '8101-006-420,000 $22ci.12
PTIUMBINQ FX9 101-000-4-19-000 $2.0317.4
STRONG MOT1014 TALK, R'„ S10 101-(W-211-000 $33.08
GRADi`l O FKY 101.000.1123.000 V40 00
INF'ii.t',S','t1:(:ft"7'i3RE ME 22.5-000-443-3342 3+12 $1,9 17.00
ART OT I;ijRUC 1'IACES • RESIE 270.000.445.000 VA1,97
a i,TO 'tAL �d)'�� ,'ITG' ;(C`I193�.r�;I D PI—A.11CW. .<Xw
9 4,501.:30
R,
I "� i , : k.� :i FRE-PKI)FRES
.., r.
.Otik
OTAL:fi'ERNUT DW'S I'.DVE NOW
1130
CITY0FLAQUIN TA
FINANCE DEPT.
a
RECEIPT
DATE. -S[BY
DAT FI E
INSP C OR
6+
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
d I A
Underground Ducts
4
Forms & Footings
Ducts
Slab Grade
um Air
Steel
_
mbustion Air
Roof Deck
���1
aust Fans
0. 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
�
3
Final
Final
1_
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
�
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice
(Gas)
C� 7 "o2oZ X02
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: SINGLE FAMILY DWELLING
Occupancy Group
80-940 WEISKOPF
R-3 Type of Construction: VN
Owner of Building: CAPSTONES GOLF WEST, LLC
Building Official
Bldg. Permit No.:
Land Use Zone
0204-219
RL
Address:
200 E. WASHINGTON AVE
City:
ESCONDIDO, CA 92025
By:
DANIEL P. CRAWFORD JR.
Date:
6/2/30
POST IN A CONSPICUOUS PLACE