0010-289 (SFD),C/)
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LICENSED CONTRACTOR DECLARATION.'
I hereby affirm undeF penalty of perjury that I am IicenSed under' pr'6isions 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
pate I ,I, Signature. of Contractor'_, r .
t 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).
(10) /1 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 Californias and agree that if I should become
subject to the workers' compensation pr visions ;f "Section 3700 of the Labor
Code, I shall forthwith comply with thoswprovisionse,�
Datelf 0.0 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
& holdharmless 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 authorizrepresentaibes of this City to enter upon
the above-mentioned property for Inspectiof ppurposes.
Signature (Owner/.Agent) t` Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
7 (4147.1
JOB SITEI
APN
ADDRESS
�`V� f-"l.�':7e?:7-•y.6,ni'A�.a!'d�.�l,.ITl.Vfl.L!!Ff,Fl � 4
1 ��E •'l� .N^Y�d.M1I
OWNER
CONTRACTOR/DESIGNER/EN INEER
PO Bux 366
C& 92253
1A Qpwu. CA 922S3
(/60)564-4832 C:JVI#1 3.237
USE OF PER�{MI�T
MI ML]N
fiA 7a » 1., n' %, N"Id 3BA . PERMIT DO 'S 3JiO'.f iN'P.;LLiDE F. LOC r,
WA1,310-001ZAPPROACH D1111V WAY, PIK.RiVdA, RV, WC110 QRS PLAN CH40K
Ots'P03 s' OF $600,
CUSTOM CONSTRUC:TIM4 4,824,00 OF
POIZMUP.-kriO 996.00 SF
0AR.AMUC.,jB.,'>t�PORY r;101T� 15,1893,00
l�i`IQ7:�7'. $ Jon"
�yy�99��%.)r��
��,t�,,r�vV.�tU
t��+ ,FEE 1101-000-418-0100 ,r�r�
PLAN 4H�w<IN: VEE, 01"000- 39-318 �Ity,F 7'i.. 1i�
•� 4„-- �_ ^
Mcka.WCAL Fit 101-000-421,-000 $1431S0
Y,O1XV:o9'R1Cw'AI. FEZ 1 �t ^€itlt r•ao2-t?tlii $3'� i. Ft
t k I:
P1.,UMi11NO FEW Z 01-000-419-000
3T1ZC3NQ &flO'Ji`ION M. - REOID 10114)(A-241-000 U0.43
EV21OnLkIMPACT 1PN:t
ART M PUI A.0 P.LAC U — RB&M i0I-?007,55-CO, WIN
71?1?',tf��t31'7 tp1»f)C �,-.1>6fifJ.4tiFl
Ti. -TOTAL i.OMACrfMiNN AND PL AW C'`IV;C5t
$6,91s.so
LE, 53 FREAPAM FUM
-$600.00
TCYTAL PXMI f VVEN DUs: NOW'�5,57f,!60
RECEIPT
j
BY
DgTfe
INSPECTOR
D+��)
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILD NG
APPROVALS
MECHANICAL APPROVALS
Set Backs �j– _
Forms & Footi g
_ �fDj—
Unci>rground Ducts
Slab Grade
��/�d%
Ketum Air J
Steel
Roof Deck
_ _ _
�fi/�
Combustion Air
Exhaust Fans
O.K. to Wrap
'S ' D/
F.A.U.
Framing
/ _
Compressor
Insulation
( N
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath S
Dru+nrall - Int. Lath _
F0 A; -
[
Final
�/d G �d�6tI
NMI
POOLS -SPAS
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
Waste Lines
/�/6/�
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
Encapsulation
Encapsulation
Gas Piping
Gas Test
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
_
—40 _
Final
Utility Notice (Perm)
Certificate of Occupancy
City of La Quinta
Building and Safety Department
r�Noe-�� 11�-'
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
57-695 BLACK DIAMOND
Occupancy Group: R-3 Type of Construction:
Owner of Building: WEISKOPF PARTNERS, LLC
Building Official
VN
Bldg. Permit No.: 0010-289
Land Use Zone: RL
Address: 55-161 SOUTHERN HILLS
City: LA QUINTA, CA., 92253
By: BILL GORDON
Date: 4/8/02
POST IN A CONSPICUOUS PLACE
TO:7777011 P:2/2
' CITY OF LA OUINTA
iEhGP BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-71S3 .
Owner 'WEISIf.OPF PAIZ'1 NER,W1, LLC
Contractor KAH(TTLLA CONSTRUCTION IrS!Q_
Permit Number (J010 -2R.50-1 v
r LA
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 57-695 BLACK DIAMOND
SFD - LOT 50, PLAN 3RR - PERMIT DUES
NOT INCLUDE BLOCK
TYPE OF INSFECTIgN DATL INSP.
FOUNDATION & SETBACK
FOOTING STEEL a { ,•
MAIN GROUND SYSTEM
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL AB VE HAS H EN SIGNED
CONCRETE SLAB
JOISTS A GIRDERS
ELEC�TRICAAL— GROUND WORK
DO NOT POUR CONCRETE UNTIL A L ABOVE HAS BEEN SIGNE
I,
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
80ND BEAM
O.K. TO WRAP
GROUT CI d' r! S'
FRAMING
INSULATION
PRE -ROOF
COVER NO'O
WR U
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER _
POOL. FENCE & GATE
EWER�SEPTIC TANK
5 • �9. J ��_7.r_
HAS BEEN SIGNED
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C J
HOUSE NUMBE
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