0211-210 (SFD)LICENSED CONTRACTOR DECLARATION
N I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cit w Professionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date
w � 78;4503 141 CIOIn : W3 1104
cZ rate ;� y ^'��- Signature of Contractor ��!�=' '=
�O� _.
J i. -
C CL
OWNER -BUILDER EARATION
LU W r*- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z_ ( ) 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
LO
N Date Signature of Owner
ON
Z WORKER'S COMPENSATION DECLARATION
C:) CL
Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the ,
m_ Q performance of the work for which this permit is issued.
QU ( I have and will maintain workers' compensation insurance, as required by
U
O Q Section 3700 of the Labor Code, for the performance of the work for which this
C 0) H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Carrier ' LL?NP'r Policy No.
ao 5
r-- CJ
J (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:
rovisionsDate: Pte—, �; ,� AppliFant_._
.'s•
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 heieby authorize representatives of this City to enter upon
the above-mentioned property.for inspection purposes. ,
l'
Signature (Owner/Agent �'!:''d^:�^9• Date
BUILDING PERMIT PERMIT#
• {i�i1.-�3�1.
1
DATE VALUATION � � LOT TRACT 29147JOB
SITE
ADDRESS .37-Giki�,3Jf,�`L�sOiCD2
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
80-ty70 MU?, ICU,R
78.,070 CADIZ, ....
LA QUINT.A CA 92.253
LA QM,,T.VA CA 92293
C?60,',5f4.4632 QW10 32,31
USE OF PERMIT
91.1GU F MNl Y MMOMM01
SPO -..'r 14.,PLAN 911 PITAMIT VOtS NOT t14CLU00'. bl.= VI.ALL%
POOL Oft DRIVEWAY APPROACH
C1JSTQ MI CONSTRUCTION 4.269,001DW
P011C;.W PATIO 1".156.06 SF'
0AWEICARt (Al 611160 S.F
C9FiS'1`q'UC:T1014 FIZ 101-417 0.418 000 $1,129,00
VILAX CHW,K P%r9 101--000-439-316 . $1,401.49
WCHAKICKIL FM 101.000.421.000 $49,50
F°1,Hf;TPJ CAL rEF 101-000-42"00 $:M&C4
PLUMBING FEE 1011.000.419m000 -. S20,73
STRONO MOTION ISE - R.F310 101-000-241-000 541.m
ORAD } 0FRE 101-000.423.000 SI. 06
Q}!VIU,AlPERL IMPACT YCE $2,40.5.0
ART IN PUBLIC FL CPS - .1RIUM[ 270.1300-445.0000 $526-41
86,7a75y.,CSy i
D �- .i..cC3A: n� �,�:•.�a.�.+'"�,%Eii.J'1S.'A:,+"'v'
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'1;o'3[`&14I .�:.�.V.F1,'�' �� 1JIJK Nt3`1+�°
Y7�.��
DEC 10 2002
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE •
BY
DATE NAL
INSP T R
'� r R
.l1 f �'
/�
INSPECTION RECORD
t OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
b
Ducts
Slab Grade
p n
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
3 Q3
F.A.U.
Framing
15W
Compressor
Insulation
j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
T
Final 3/�3
Final
7 3
POOLS -S . PAS
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
03
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
�3
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
_
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring J
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
_
Temp. Use of Power
Final
Utility Notice (Perm) jj
NO
- Certificate of Occupancy
U - -edf 4tiiGv . COPS'`
I�•caaaowrm�'� _.. ..
r
G� OF�w Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 57-600 Ballybunion
Use classification: Single Family Dwelling Building Permit No.: 0211-210
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: Weiskopf Partners, LLCQ Address: 80-070 Chanticleer
City, ST, ZIP: La Quinta, CA 92253
By: Daniel P. Crawford Jr.
Date: 7/31/03
Building Official
POST IN A CONSPICUOUS PLACE
L• Certificate of Occupancy
4
RATM
OF _ Building & Safety Department
This Certificate is issued pursuant to the requirements_ of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 57-600 Ballybunion
Use classification: Single Family Dwelling Building Permit No.: 0211-210
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: Weiskopf Partners, LLCQ Address: 80-070 Chanticleer
City, ST, ZIP: La Quinta, CA 92253
By: Daniel P. Crawford Jr.
Date: 7/31/03 ;. .
Building Official
POST IN A CONSPICUOUS PLACE