0010-288 (SFD)U)
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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
Date 7 !! 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.
( ) 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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(vy 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 provlsions of Section 3700 of the Labor
Code, I shall fort] with comply with those p oovisionsy�� 3
Date: 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 inspectionur�osess'.'.r;+
g ature (Owner/Agent) 4' �' Date .^r`
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ���•i� TRACT
� 29147-1
JOB SITE /
APN
ADDRESS -
5 'fly
OWNER
CONTRACTOR/DESIGNER/EN INFER
1,1..%C
KAIiE"i47 LIA CORMOCTION 1t4Cr
55.16100ViT N'I .,21
PO BOX 366
1.,11% WMA. t'MA. I 922.53
1.4"a Qi;fINT& CSA 922.E 3
C160)564.4832 C:Blif. 3231
USE OF PERMIT
s:FYI - LOT 49, PLAN I flit - P>m.kM1T DOES 1, OT INIC'•1tAIDE iJLDCK
WAWPOOUAPPROACH Dd?W W'AY. Re.i. IT FEF INC.Li D93 PLAN CHECK
WIP£} IT OF $60,
CUSTOM CONSTRUCTION 14,364,00 8F
PORCHIPATTO 59ll.ft0 SP
0ARAGMARPORrc (0w H -1032A .
I..:
99MATED 0'05T Ole W11MUC7101i
r.s rr•,,. ...
CONSI UCT ION FEE 101-000-4361000 51,863, rD
PLANi";HEK."K kIE'' 1,;11-000-439-318 �t,d6i.9i
� r �
tJ�ECHA'NtCAI<PRE 101.000- 21.-Uf}1� �130.'ak1
t �:
ELECTRICAL FRF, $221.6
:"!
PTAIMO C1?k� 1O1•i3C3*J• i�>tFOO 322.i:'i�
ST RO140 MOTION M RESID 101-000-241-00
ORADfNG FVE 101 -NO -423-000
1D]?, irM,_,L3F';rRAMPACT "Z �,9iFRttf)
ART I:N.PUBLIC PLACES - MWE 701 i -000-255,=M) WP,f>~4
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RECEIPT
DATE { j
BY,
D FI h INSPECTOR
(
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & FootingsDucts
`2
Slab Grade
v
��/�_ /��
Return Air
Steel
Combustion Air
Roof Deck
_ _
Exhaust Fans
F.A.U.
Framing
dr
Compressor
nsu a ion /
p/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party:Wall Insulation
Condensate Lines
Party Wall Firewall
n
Exterior Lath
Drywall -Int. Lathe��-�/�
Finaleess%����L
a�?oALPOOLS
Final
- SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
�?i//%
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
j/�6-� ///
Electric Final
Heater Final
Water Piping
/�!/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
��/��j�
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
/J
Final
COMMENTS:
C/ _IV >�X�����
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
r� /
Utility Notice (Perm)
APR -8-2002 01:20P FROM:
� 4 CITY f` LA QUINTA
T BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REOUEST LINE
777-7153
�1- AVI
Owner WE1SKOPF PARTNERS T., LLC;
Contractor i
Permit Numb"► 0010-2801 •K yr- LA
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIrN ALL APPLICABLE SPACES
JOB ADDRESS 57-665 BLACK DIAMOND .
Sr D - LOT 4% PLAN IRR - PERMIT DOES
NOT INCLUDE DLOC'K
TYPE OF INSPECTION 1 DATE I INSP.
FOUNDATION A SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUN0 PLUMBING
PRE-GUNITE
DO NOT POUT: CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CbNCRETE SLAB j
JOISTS & GIRDERS
ELECTRICAL GROUNO WORK
DO NOT POUR'CONCRETE UNTIL ALLABOVE HAS 13EEN SIGNEO
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT • A/O
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT J 4' 0 8,
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK Uh
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER _
FOOL FENCE & GATE
�EWE? SEPTIC TANK
ELECTRICAL
L ABOVE HAS BEEN SIGNED
FINALS
PLUMBING
FINAL GAS TEST
HEATING -A/C
F7 40- 1,
HOUSE NUMBERS I 1
, JOB CO�
MPLETED•-ey,
_
TE1s�4>r
MP POWER —�
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: 57-665 BLACK DIAMOND
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
R-3 Type of Construction: VN
Bldg. Permit No.: 0010=288
Land Use Zone: RL
Owner of Building: WEISKOPF PARTNERS, LLC Address: 55-161 SOUTHERN HILLS
Building Official
City: LA QUINTA, CA., 92253
By: BILL GORDON
Date: 4/8/02
POST IN A CONSPICUOUS PLACE