0010-016 (SFD)f LICENSED. CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter, 91(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
37 6 It 8 1 r -
,Pate c-"Gf ✓ 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).
O I am exempt under Section B&RC. for this reason
Date ,Slgnature of Owner .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty - of perjury one of the following declarations: .
O 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.. •
(fie 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:
Cartier 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.
Date: / ,,. niApplicant r° �' ri! �!•� ��'
w•: •� ,W. � r• rtes "��� y„�
/,sWarninng::,Failure "to secure.Workers' Compensation coverage is unlawful avid
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.
r
Signature -(Owner/Agent)_,,,.•a A / �%�� Date
yf ?' . ,. Grrt � r✓��✓'� .-.,�..».:.�-`:.+,ter".. � `-
BUILDING PERMIT PERMIT q
M
DATE .),I VALUATION .. LOT . r� �D^Q,j'�. TRACT
».
+�C'1
.&4� s�� q
44
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER'
..
i 1's I, 'T AVEM'S
20 0 1K, WJ (r()N' Nq R, 100
R1111COMADO CA 9202S
Sca )r CA 9W-25
E4 AID )0
(-115"39-8238 5413
Y .
USE OF PERMIT
Sm .,1X. LOT32 Rt./�N 34A PERMIT DOES NOT s'NCLUEW 1f'A3CQC
WA1,1000UP1,.pPROACH DR14i: 9AV PL-A.N CHECK F?K'A I•Z:FDUO'ED &Y 7$0/0
FOR EbflY3L:F'F.&'!LE, ISSUANCE
C CJSTOM CCvNS°FRi CTI011 : -1621,m 3F
r OXB.CHIPATI lu9a.a0:
QATIAGIOCARPOR1 (SP)
P
.. '''d...t,' IED �:e�lST F� F C-014yTd,�Lii�.��.170I'1 ,
x9iV+cz1.90 i0�
C`Cr al tfll;`itf_� mak; )01-000-419-000 `$1,644.9101
PLAN CHIC >f EZ 101-W-439-318 $331.0.=
MECHANICAL ME, 1111«000•421.000 $124,00
'101-000-420-000 $ZZ)AD
F'i�C.fPr)£•F:",9i'!'k'.1.?' � 1'(fl'a�QC@Q�1.�'A1.1�Cfl' 1i�fl."a�
�v 1t:?3v0 Moll= ! 1T F: b ,��1 "sI i 01 000X33.&'1
6a1;.ialil�bCli�t�1+. ..
DFIVVLOPER IM PAVY x r,sos:ate
,`ATM PUWAC PLAW usir 01a000 -255-b 1 W&
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
:, BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs__
Forms & Footings PF%eli
Slab Grade llV��
_
_
12��
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
�_ , 6
�p
Exhaust Fans
F.A.U.
Framing
Compressor
Vents
Insulation a—, a t
Fireplace P.L. -
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath s��
_
Final
�fJ/i /�/ gyp.
Final
POOLS -SPAS
BLOCKWALL
APPROVALS
Std
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Waste Lines �d/Zs/�j��
Gas Test
Electric Final
Heater Final ,
Water Piping
i"�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
SewerDn ection
Cis Piping '
Gas Test
'/'f fG J�jjJ v
Pool Cover
Encapsulation
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)
6 rtifica te,of y Occu ancy.1� a�
•
City of La Quints
• r
Building.a n*d Safety Department,,�oFti
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
`y.of the City regulating building construction or use.. For the ,following:
BUILDING ADDRESS: 57-075 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLINGBldg. Permit No.: 0010-016
.•-Occupancy Group: R-3 Type of Construction: VN Land Use Zone:' RL
Owner of Building: CAPSTONES GOLF VIEW LLC Address: 200 3 WASHINGTON AVE,
}, , City: ESCONDIDO, CA., 92025 •