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0012-249 (SFD)`v _ LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of � H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and e WProfessionals Code, and my License is in full force and effect. O ch License # Lic. Class ' Exp^Date LLJ all Z r- Dae ./ /, Signature oo 00co � tbtf Cntractor _ U ( OWN ER-BUILDEIPIDECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's F-ILLicense Law for the following reason: Z ( ) I, as owner of the property; or my employees with wages astheir 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). C () I am exempt under Section B&P.C. for this reason, N O N Date Signature of Owner rn CL Q WORKER'S COMPENSATION DECLARATION �o � I hereby affirm under penalty of perjury .one of the following declarations: U-) F. O () 1 have and will maintain a certificate of consent to self -insure for workers' X,W L compensation, as provided for by Section- 37.00 of 'the Labor Code,. for the O- J Q performance of the work for which this permit is issued.- m' <.0 ( ) I have and will maintain workers' compensation insurance, as required by O U. Q Section 3700 of the Labor Code, for the performance of the work for which this rn H permit is issued. My workers' compensation insurance carrier & policy no..are: `t z Carrier Policy No. cob 5I�i1!t I� f Q (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 Californip�/, and agree that if I should become subject to the workers' compensation provisions oLSection 3700 of the Labor Code, I sFiall forthwith comply with those rovision ., Date: _fie/ Applicant / Warning: Failure to secure Workers' Compens10 coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, -damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth. onhis application. 1. Each person upon whose behalf this application is made & each person'at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City. of La Quinta, its officers, agents *and employees. 2. Any permit issued as .a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such ' permit, or cessation of work for 180 days will subject permit',to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorizz representatives of this'City to enter upon the above-mentioned property fo inspection purLoses. Signature (Owner/Agent)' �? Date ✓ .v ©, '. BUILDING PERMIT PERMIT# DATE VALUATION LOT . , -1 TRACT If ���t�� <-46 2.9147-I JOB SITE APN ADDRESS �7�i'I�."�%''Iti"",���!'tr?��P1`� ;it`a1•$I:�i)-�1Ci• OWNER CONTRACTOR/DESIGNER/ENGINEER IA Q-01WA CA 92233 1A Qgzra. CA 92153 Q60)56, -4837Mjj. 3237 USE OF PERMIT , , 7 o L 0T 46, PX..AN 38 - PEbtA91T 0 ES NOT 1NC 4U0r EfI )r..K CUSTOM C0148TRUC'! ION 4,824.00 N.1� 1x'STD/IATVJ> COW C7:V C-0- SrIV6CI-ION . 404,'° .IMA CONSTRUCTION F& 101-000-419-000 S I.11W, 00 PLAN t"HZCK VVX 1014'00-439••31S' $1,rXil MECHANICAL f<t+. E 101.000.421.000 X143.50 I, x �•n.Ir,Ai..I T� 101-17fJA- "1,11-CaOU fiA3t, % Puf"IJI13i w Fft 101.4100419-000 321,431". a ICGiIb? I�iG31 IpN N17F . I wlil� 101-000.241-000 $40.48 0f3.fi,DT.NG FEE 10"i-000.-423 00 $20A ART IN PUBLIC PLACE • .IZW3£: 701,•0004.55.000 $512.0.0 • /' UB11 TOTAL comr.iklMallfCJw MW PLAT C.a. OXX $6,1"$5.50 i i ;'7 � Art�'x'"FTtiS $0,00 dYJ'BAL pMM1,01"Y'S DMA NOW [RECEIPT DATE B� I DAT I LED INSPECTOR u r�it _ I/ D . k INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs_ Forms & Footings �� Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing i7� 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 3t o Final Final / d BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS s Gas Test Electric Final Waste Lines / / G/ Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final 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) COMMENTS: Coachella Valley Uo'V School District P.O. Box 847, The.lmal, CA 92274 (760) 399-5137, Ext. 235 This Box For District Use Onl DEVELOPER FEES PAID AREA: AMOUNT: RCPT M: CK A CASH: tNTTIAt.S: DATE: CERTIFICATE OF COMPLIANCE (California Education Code 1.7620) Project Name: Date: .Tan ,ate 1-2001 Owner's Name: Wi.eskopf Partners 1. -LLC Phone No. (760) 771-1761 Project Address: 57-575 Black Diamond, PGA West, La Quinta, . CA 92253 Project Description: Single Family Dwelling APN: 761 830 M6 Type of Lot #'s: Residential ' . gg Nommercial Industrial Total Square Feet of Building Area: 4.824 Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on jehalfpft%,owner/developer. Dated: 1-5h Signature: ..ws,t*...wtrs.t•.w,t...•.+ts....r,►r+r SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOW PROJECT HAVE BEEN OR WELL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement Note: Number of Sq.Ft. 4.824 Amount per Sq.Ft. s 3+ ?A Amount Collected $ 15, 796 96 Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis Assistant Superintendent Administrative Services Administrator in Charge Certificate issued by: Marcela Valdez Signature: Facilities Clerk Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees'% of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, In accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fen or the validity thereof; commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees Imposed Is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of Issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Cerdficate expires, If a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. Rev. 09/27/99 (COMMUNITY DEVELOPMENT PUBLIC WORKS FILE - City f oLa Quinta Developers Project Approval Form Prior to the issuance of Building Permits for'the project listed below, the following Departmental clearances must be obtained. Please return this form to the Building and Safety Department only after approval. Contact applicant for resolution of conditions preventing or delaying approval. Project: SFD-PLAN 3 LOT 46 - CUSTOM RESIDENCE 57-575 BLACK DIAMOND Applicant Contact: JIM AVENELL- 760 771-3148 Application / Circulation Date: 12/29/2000 JGJ Date Community IDevelopment Department Christine di Iorio, Planning Manager Date Public Works Department Steve Speer, Senior Engineer Date Building and Safety Department Greg Butler, Building and Safety Department Manager Health Department Fire Department Schools Fees Paid Date Date Date Date 22 � ,[ j IC'OMMUNITY DEVELOPMENT PUBLIC WORKS FILE City of La Quinta Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to the Building and Safety Department only after approval. Contact applicant for resolution of conditions preventing or delaying approval. Project: SFD-PLAN 3 LOT 46 - CUSTOM RESIDENCE 57-575 BLACK DIAMOND �a °l L+1 C 4S - 50 Applicant Contact: JIM AVENELL- 760 771-3148 Application / Circulation Date: Community Development Department Christine di Iorio, Planning Manager Public Works Department C Steve Speer, Se for Engine Building and Safety Department 12/29/2000 JGJ Date Date 3 v� ate Greg Butler, Building and Safety Department. Manager Date Health Department Fire Department Schools Fees Paid Date Date Date ......... ............ ....... ..................... . .... ............... ... . . . . ........ ................. . .. . . . .. . .... ............. City of LaQuinta .... . . ................. ...... . . .. ....... ..... . . .. . . ........... ....... .. ..... .. ... . ... ..... ...... ......... ........... ...................... ........ .......... . .. .. ..................... Building 81 Saf&y Division . . . . . ..... .... ............ P.O. Box 1504 .... ......... 78-495 Calle Tampico ...... ... ... La Quinta, CA 92253 . ........... . ................. .. .. .. Building Permit Application and Tracking Sheet Project Address: 51-5750 X494,0AM4PJP Owner's Name: PAkrAgA-S 17/0 A. P. Number: Address: 6 16 0- 14/ SA4 01I RA wo z I f Legal Description: kar4 lkuvr giloO-1 Ciry,ST, Zip: 444*40-A eA. IPZZS-,Y Contractor:#A�IMJUA 4WOWAIrrI4W (44 Telephone: -140 -7 ?/- qlw4s Address: 78-070 CALLS 4CAPi -A Project Description: 501-4 F.4AA 11. City.ST, Zip: IA 4w+4 i -A, 4M. 9Jz63 el -A kJ 3 B .............. .. ....... ....... Te le hone: .................. .. ......... . .... .... ........ ..... . ...... ..... . ........ . ... ... . C -44R. SAT09 *(Akr Construction Type: WA. FRAPAIC, OccupancySIAM& &MILIf ........... .......... Project type (circle one) t**Te�w Add'n Alter Repair Demo Sq. Ft.:"4. #Stories: # Units: Estimated Value of Project: .ciy Bus Worker plannin. FireMs M, Dept Title. 24 tai :..:::: . . . ....... ..... ................ :--%-- ....... . .... K. : : % : : , , * ::: :- - - - - - ............. ..... .... ... * : .. .............. ..... . :,ons., .0 .... : : X. ..... % X........ cm........... ...... ......... ........... .. ... .... .. I ........... ... . ....... . ..... ......... d eh o S.. ................. .. ..... ... ......... . . ....... . . . :re itt ...... .... ... ............. ... .. ..... ........ ........ ............... ............ ... ...... .... ..... .... ........ ......... :.:. X X -X .. .... Subs :AXX d, . ....... ....44 0000Pia:.:;.;;:;.;:.;.::::...;;::.:.... .:ii ............... .ciy Bus Worker plannin. FireMs M, Dept z2aAZ wt "I 1t 5"tiff i i A i We -7-1" ' V�lEr5Kc1'F ���ric'i�5�� L.L. 53- /hl SoraT+l ERrl N►LLS L � „a to 4*4. �ta7s3 Lot # gess 1 81-010 2 81-020 3 81-030 4 81-040 5 81-050 6 81-060 �7 81-070 8 81-080 9 81-090 10 81-100 11 81-110 12 81-120 13 81-130 14 81-140 15 81-150 16 81-145 <B) 81-135 Shinnecock Hills 81-125 81 81-115 20 81-105 ' a 81-095 22 81-085 23 81-075 24 81-065 25 57-570 26 57-600 27 57-630 ® 57-660 57-690 30 57-720 31 57-750 32 57-780 33 57-810 34 57-840 ® 57-870 61) 57-900 57-930 i` 38 ,; 57-960 57-990 40 57-665 41 57-635 42 57-605 43 57-565 44 57-515 ® 57-545 -ps%tom .46 57-575 5 57-605 4 57-035 Shinnecock Hills 57-665 �� ►� �,.. 5 57-695 Tract No. 29147-1 PGA WEST, La Quinta, Ca. 92253 EALS h(.,4l S AFdr&j&ff .T., c A'J'FdE -L 771-3e14g 7-725 Black Diamond -755 Black Diamond 7-785 Black Diamond 7-815 Black Diamond 7-845 Black Diamond 7-875 Black Diamond - -100 Chanticleer _, ... -090 Chanticleer -080 Chanticleer -070 Chanticleer -015 Shinnecock Hills -155 Shinnecock Hills -060 Chanticleer 0/0+_0'� I% Shinnecock HMIs Shinnecock Hills Shinnecock Hills Ballybunion Ballybunion Ballybunion Ballybunion Ballybunion Ballybunion Troon Way Troon Way Troon Way Troon Wpy Troon Way Troon Way Troon Way Troon Way Troon Way Ballybunion Ballybunion Ballybunion Ballybunion Black Diamond Black Diamond m wC{SgFoPF 2d�� Black Diamond Black Diamond A.P PEL Via; Black Diamond -. , PF - JA Black Diamond .�15E,pF .lgR Black Diamond-.�$E�cPF_ 3,g %,, &/-O woIZ ?9 Shinnecock Hillsi 5 Shinnecock HillsZ49 57 Shinnecock Hills 53 5 Shinnecock Hills 54 5 Shinnecock Hills 55 5 Shinnecock Hills 56 5 Shinnecock Hills 57 81 Shinnecock Hills 58 81 Shinnecock Hills 59 81 Shinnecock Hills 60 89 Shinnecock Hills 63 81 Shinnecock Hills 65 81 Shinnecock Hills W 81 Shinnecock Hills Shinnecock Hills Shinnecock Hills Shinnecock Hills Shinnecock Hills Shinnecock Hills - I?KAi2 Shinnecock Hills Shinnecock Hills EALS h(.,4l S AFdr&j&ff .T., c A'J'FdE -L 771-3e14g 7-725 Black Diamond -755 Black Diamond 7-785 Black Diamond 7-815 Black Diamond 7-845 Black Diamond 7-875 Black Diamond - -100 Chanticleer _, ... -090 Chanticleer -080 Chanticleer -070 Chanticleer -015 Shinnecock Hills -155 Shinnecock Hills -060 Chanticleer 0/0+_0'� I% Shinnecock HMIs Shinnecock Hills Shinnecock Hills Ballybunion Ballybunion Ballybunion Ballybunion Ballybunion Ballybunion Troon Way Troon Way Troon Way Troon Wpy Troon Way Troon Way Troon Way Troon Way Troon Way Ballybunion Ballybunion Ballybunion Ballybunion Black Diamond Black Diamond m wC{SgFoPF 2d�� Black Diamond Black Diamond A.P PEL Via; Black Diamond -. , PF - JA Black Diamond .�15E,pF .lgR Black Diamond-.�$E�cPF_ 3,g %,, &/-O woIZ ?9 0/0+_0'� I% Shinnecock HMIs Shinnecock Hills Shinnecock Hills Ballybunion Ballybunion Ballybunion Ballybunion Ballybunion Ballybunion Troon Way Troon Way Troon Way Troon Wpy Troon Way Troon Way Troon Way Troon Way Troon Way Ballybunion Ballybunion Ballybunion Ballybunion Black Diamond Black Diamond m wC{SgFoPF 2d�� Black Diamond Black Diamond A.P PEL Via; Black Diamond -. , PF - JA Black Diamond .�15E,pF .lgR Black Diamond-.�$E�cPF_ 3,g %,, &/-O woIZ ?9 talEo�t�P�: �srala-�S�', Lls�. ti h(®$C AS- Apt Hca ss r-►+&jza N e G -t- , �`� � �ei���t,t, L A414vaeA of Address 1 81-010 2 81-020 S8 /3 .G--: 81-030 81-440 5 81-050 6 81-064 7 81-070 8 81-080 9 81-090 10. 81-100 11 81-110 12 81-120 13 81-130 14 81-140 57 131-150 3-� 81-145 �- 58 81-135 18 81-125 Cp 51-115 20 81-105 CO 81-495 /22 81-085 4•23 81-075 24 81-065 25 57-570 26 57-600 27 57-630 2$ 57-660 ® §7-690 30 • 57-720 31 57-750 32 57-780 33 57-810 34 57-840 ( 57-870 57-900 Shinnecock Hills 57-930 S8 57-96+0 ( 57-990 40 57-665 41 X57-635 42 57-605 43 57-565 44 57-595 <q�) 57-545 46 57-575 „�--� 57-605 57-635 �..aGV 57-665 ., 57--W5 Tract No. 29147-1 PGA WEST, La Quinta, Ca. 92253 Shinnecock Hills Shinnecock Hills Shinnecock Hills �L Shinnecock Hills Shinnecock Hills Shinnecock Hills 2 Shinnecock Hill!� Ballybunion Ballybunion Ballybunion t 3 Ballybunion 1 06 Ballybunion Ballybunion , 5 8 113 �lz Troon Way Troon Way Troon Way Troon W,@y Troon Way Troon Way Troon Way Troon Way Troon Way Ballybunion Ballybunion Balounion Baliyion Black Diamond Black Diamond—' Black Diamond Black Diamond Black Diamond MAIW5 4 9A Black Diamond Wjsgrof�: m lig Black Diamond Shinn ecock /74�llS SA in r] cccc% bwl r Shinnecock Hills 1 57-725 Black Diamond Shinnecock Hills 52 57-755 Black Diamond Shinnecock Hills 53 57-785 Black Diamond Shinnecock Hills 54 57-815 Black Diamond Shinnecock Hills p. 5 57-845 Black Diamond Shinnecock Hills 56 57-875 Black Diamond Shinnecock Hills 57 81-100 Chanticleer Shinnecock Hills �- 58 81-094 Chanticleer Shinnecock Hills )�59 81-080 Chanticleer Shinnecock Hills 60 81-070 Chanticleer Shinnecock Hills 63 81-015 Shinnecock Huts Shinnecock Hills 65 81-155 Shinnecock Hills Shinnecock Hills W 81-060 Chanticleer Shinnecock Hills Shinnecock Hills Shinnecock Hills Shinnecock Hills ` W6 6T 33 2 � r!� /ZI?�'r� IT ////'' 11.f / Shinnecock Hills Shinnecock Hills Shinnecock Hills �L Shinnecock Hills Shinnecock Hills Shinnecock Hills 2 Shinnecock Hill!� Ballybunion Ballybunion Ballybunion t 3 Ballybunion 1 06 Ballybunion Ballybunion , 5 8 113 �lz Troon Way Troon Way Troon Way Troon W,@y Troon Way Troon Way Troon Way Troon Way Troon Way Ballybunion Ballybunion Balounion Baliyion Black Diamond Black Diamond—' Black Diamond Black Diamond Black Diamond MAIW5 4 9A Black Diamond Wjsgrof�: m lig Black Diamond Shinn ecock /74�llS SA in r] cccc% bwl r 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 Cassification: SINGLE FAMILY DWELLING 57-57.5 BLACK DIAMOND Occupancy Group: R-3 Type of Construction Owner of Buiading: WEISKOPF PARTNERS, LLC —r —.4, /4-% Building Official V Iu Bldg. Permit No.: 0012-249 Land Use Zone: RL Address: 55-161 SOUTHERN HILLS City: LA QUINTA, CA„ 92253 By, GARY HARTMAN Date: 11 /30/01 POST IN A CONSPICUOUS'PLACE