0204-222 (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
5131103
Date �;r s� +� Signature of Contractor /r m `^
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 ISignature 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 Z9.J1I'f,4 IN& (.O, Policy No. Z042394SO6
(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.
Date: %-34-A, 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 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.
s.
Signature (Owner/Agent) (N Date
....;
BUILDING PERMIT PERMITf1 #JJtt��� ♦♦.q�yy
... i1r.�+.A1r•.b.fwL
DATE VALUATION 14*150 LOT 34 TRACT 78444
?
' 4JOB
SITE
ADDRESS, Y*
�7,
APN
6-t'I 4
OWNER
CONTRACTOR/DESIGNER/EN (NEER
06mmom,si (10LI.,`�Si',�3'�:,:I.:L:'
It3Ffi0VAT1VEKMJ0..T -M-MIAT-MMU, INC.
'200E i�•.�MM13TON EVE
.`aGt�N'f.'r1,fCl CA 9202:5
US -1` '14:CtI1 O 4,",.l',. 92025
P60)839.8238 3L0 5413
USE OF PERMIT
WNCYS-;I? ! � U�1J Z1NCf
SK) - LOT 34, I'LAW 1 -Wt, PPRMIT i ODS X OT 1NC ,UDZ Lt1.CJ(X
WALLS. POOL, SPA OR. lAfVEWA,i'"APPACIACH, %%UIJCJC ION TO
P'J.ANI CHECK 1E11±FOR ML11.,'17PIA ISSUt.11CF, OF S,psb9E PLAN T"YPF.
CUSTOM COWFRUC`iION 15' ID0 P
PORCi`IlMrIO 594.00 S?
0ARACik tCAUOFi'i' M7.00 Ni
ED lrog ii.Ce coffur..SLFGsY`Lr.E,boN.0
3094%1.1.50
�[�'�t(yy �p r�y5•� ,� �^� yp'�•y'ylyu�.)�,6di�md
Y. JL.['fi11YlF�,R. 31 ASti]. P9���, 3�Ji(iiTC Y
CONSTRUCTION FEE 101-000-418-000 $1,343.00
12L.AN C HWK MC 101>00.01 31,9-3I8 M59
MECHANICAL FI 101 -3i�0-42'1-t00 $1 f, OO
E°L:ECTRIC�rqL.�irE 101-000-420-000 qi JIM
F'I,'I3NF1=3IAICi I�� 1 Q1 aSfO(1n41 �-3i�t? �1#U.
S L RONO MOTION FEK . RRSID 101-000-241-000 X30.06
0-IRAD11AI VEM 101-W0- Z3-WJ u2D.a74
DLr F.LC1P1fV MPACT FEE $1,907,00
.ART IN PUBIAC MACHU - WHt 270.010-145-000 $251.40
•+�,�� � �1.i3- }'�"kbr ; k whz.**iTbrI��J2`�'.tf1iwp�,1!;%��" ".� a,
+
TIRS3 PRE -FIND PRU
$0.00
` IAL ;PrIk mI r FFIF-19 TWE NOW
$4,344A6
k
RECEIPT
DATEBY
DATE F ALE
INSPE R
A: r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
O
Ducts
Slab Grade
a2
Return Air
Steel
ip
Combustion Air
Roof Deck
_
Exhaust Fans
0. K. to WrapF.A.U.
s
Framing
D
Compressor
Insulation
/ Z
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
_W1
POOLS - SPAS
BLOCKWALL APPROVAL
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
Waste Lines�'�
-
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
J
Encapsulation
Gas Piping
Gas Test
6
Appliances
Final
COMMENTS:
Final
j zi-
Utility Notice (Gas)
ELECTRICAL APPROVALowe
rem—
. Pole
Temp P r Conduit
Underground
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
ffM
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: R-3 Type of Construction
Owner of Building: CAPSTONES GOLF WEST, LLC
-dry
Building Official
80-970 WEISKOPF
VN
Bldg. Permit No.: 0204-222
Land Use Zone: RL
Address: 200 E. WASHINGTON AVE.
City: ESCONDIDO, CA 92025
By: DANIEL P. CRAWFORD JR.
Date: 5/27/03
POST IN A CONSPICUOUS PLACE