0010-015 (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
•'! 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 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.
V.1 1 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.
;c. ITH P.4181'1 Ct.% %1114 394535
(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 Iaws'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,.
Date- /%�X'�^" 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 building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Pfgnature (Owner/Agentg°,r Dates
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/ / EN INEER
CA'I :VIS GC)UR VIE' T.,?C
S~imon commuNrnn I�IC.
200 F,WA M461TON AVrf KIK
201DX WARE GTOR AVE. 9, 10 0
!A 92025
V60)839-9238 M14 5413
USE OF PERMIT
HINGUI, FAWLY MOWING
SYD • L.1.7`,i' 11 PIAN 3, AI? PF_P. ,111 DOES NQT t'NC1,UVE .t L41IC K
`iAf'AWPC±WA'PRO.A.C14 DRIVEWAY. PLAN MIEC,K .PKE MUM BY 7M
FOR hCl.il,',1P1.Z ISSUANCE
CUSTOM CONSTRUCTION x,421;00 8F
1,L7.R.CI-iPMHO 990.00 V
GAR.;F INC,ARI ORT (SIS 14,854.90
R-MU�'T M Oowr a?, C,C)!@S Y'RUOMN
386,669.70
F*9fty
CONSTRUCTION ME 1 til •000 4161nV00 $1,644.00
PLAN ;i',I•IWK ME 101-000.439-319 $331,07
WCl'IdINJC1 ,i!'6, F22 101 -MO -421-000 MUM
&JIFM'%.lr.IAL YEE 1€11.000-420-000 x(09.40
PLC3MNA O Fisk: 101-000-419-000 $?A1.%5
STP14=0 MCIT10..0 IME - REBID 101-000-24i-000 $33.67
ORADIND SSBI; 101 q,00 -423.000 '4120.00
MOV1a1;14)IOMUMP'dsCT PEP, �1,907AO
ART 114 P'i3RUC .1?''L6ii F'S - 'RESIE 701.000-255-000 $46610
SM -TOTAL CONETIAMMON AWO MAN N C CK
$:5,0()2.02
IMS x''-P.AXi9 MO
$11.00
TMAL ' MES m7:1 Z`fiOIN
?�tPU 41.1
RECEIPT
DATED
II a i ;t,
1 BY A
ATE DATE FINALED
INSPECTOR
I f - '.. (1 U
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings �%�
���vr
Underground Ducts
Ducts
Slab Grade l'�
_
ll2g(TC�
Return Air
Steel
Combustion Air
Roof Deck
_
!/�6��! _
Exhaust.Fans
O.K. to Wrap
��
F.A.U.
Framing �LT1vl�!(�!D!
Compressor
Insulation �� t�
J'f/���
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall Int. Lath
�✓�(�D�!_� _ _
-
Final
�O�%�� 6�✓
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
/j
Electric Final
Waste Lines
/a���9�t//
Heater Final
Water Piping
r
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _
Pool Cover
Sewer Connection
�a����/�
Encapsulation
Gas Piping
-
Gas Test
i7L
Appliances
Final
COMMENTS:
r "
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)
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
80-955 WEISKOPF
Bldg. Permit No.: 0010-015
VN Land Use Zone: RL
Address: 200 E. WASHINGTON AVENUE
City: ESCONDIDO, CA., 92025
By: GARY HARTMAN
Date: 10/24/01
POST IN A CONSPICUOUS PLACE