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0401-066 (AR)- 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 74-060 )3 111C 03/3132( � " I/Signature of Contractor Date'/-� 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 licen§ed 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. (Y)• -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 STATE FU14D . Policy No. .1$4248@-13 (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 sh II forthwith comply with those provisions. '.,^�� Date:,2670/©VA licant PP - Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection, -purposes. Signature (Owner/Agent), �-� ��, DateL BUILDING PERMIT PERMIT# Chi-0Gci VALUATIONLOT i .$ �� LOT TRACT DATE //�� P/ / �� ,, Ag0 � P JOB SfTE ADDRES '�d�,V1 APN Tr -t OWNER CONTRACTOR / DESIGNER / EN (NEER 590 AN? rE. OAKLEY .Ci fid) 77.6618 C Al,19 CH-11TLTA,iAMN . W. DD E NHI1..X.3 CA 91302 s.At;)tT 4iA, G111.1 X253 C160)837-5478. CDTJ1- 5941 USE OF PERMIT KIESI 3F. N JW. A1D1.9IMMIT A)O49.9.F. `t'OKITCHr1,NP.kF' AI.L.UNDFdi IOX1.S"rJNQP.0,001JNA ;. .ADD OU T DOP,R BUILT-IN R13Q9 :REW K)Ti;13E'1`l' TRACT CONSTRUCTION 44.00 6'E CONTMI.CT AMOU11T :t7',3,�9.Otf I�4�'., T0.) COST OF O'O:�'iS`:iC�€.b.T(,"i'lON f e�cfq�,yy q•ATEVS� •1��rx�p�t�«� PK 3,"".�.wFf..1tlJ.Y.&.� .kT � KIR i➢ LVSC.LY.dk'(:. X .sy CaNSTRUCT€C)Ai HE 301-000-418-000 $349.60+ ,PLAN CHECK g 101-000-439-318 $7771.82 MECi±tAMCAL [EE, 101.00021.000 $26.00 ELECTE.1C;AL FEE 101-000.420-000 $1(1r4 PLU M B1140 FEE, 101 _000.419.000 $45.00 STRONO NOT1014 OZY - .FINS)D 101- 000-241-000 $4.00 � � D FEB 2 0 2004 CITY OF LA QUINTA FINANCE DEPT. P1,13K CT-WC°K. " "I.3.04 LIM PRE -PAW I'B'S $0100 .XM4YY, ?'E;T'r.148.8'i''z';'WKS DUE NOW X713.04 RECEIPT DATEBY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing 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 Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 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: INSPECTION RECORD COPY f OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings / p _ Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation 9 o Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Sl o Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 Top Out Plumbing Final 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: At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to in the amount of X 49 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now. be issued. Fees Paid By Exempt - Mr & Mrs Kramer -Check No. Name on the check Telephone 818.702.8810 Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MC ilvrey Payment Recd $0.00 / Over/Under Signature c NOTICE: Pursuant to Government Code Section 66020(d)(1);•this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE J1F>Ens� Desert Sands Unified School District �o 47950 Dune Palms Road >4� r • 1/23/04 La Quinta CA 92253 Q BERMUDA DUNES CIO RANCHO MIRAGE C7 No. 25408 (760) 771-8515 �+ INDIAN WELLS PALM PDESERT y „O IN INDIO b Owner Mr & Mrs Jerry Kramer APN # 762-023-003 Address 56626 Riviera Drive Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 56626 Riviera Drive 49 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to in the amount of X 49 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now. be issued. Fees Paid By Exempt - Mr & Mrs Kramer -Check No. Name on the check Telephone 818.702.8810 Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MC ilvrey Payment Recd $0.00 / Over/Under Signature c NOTICE: Pursuant to Government Code Section 66020(d)(1);•this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting J J.CM Inspections 39725 Garand Lane Suite F L.L Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS EPDXY INSPECTION REPORT Date: 0 Proj ct Name: h p Project No: Na_V"eV' UWt Q C c2S kL n Cb Project Address: City: Title 24 AWS UBC Other: S��a�� �UK'tr� f • ��� .� a �a File# f D1.1 App# F D 1.4 Client: Sub -Contractor: Other General Contractor: Architect: Structural Engineer: t,�1 Sa�t��'S R Anchor Bolts 0 Rebar Weather: ` � ' Epoxy Type: `.)�MC)St�n �Ts'o��ri \ �a.t�a\ s ttr�n Unresolved ems: Epoxy Shelf Life: Q ����£� ono 5None Hole Cleaning Method(s):Qom` p� \� �'♦ S Co r,os c c�,� tlrtia �nie t c C t E] See Below Description of Work Inspected:'�j roc o-� �S�\ � 'C t \( 0 u iu c a {��]n � /• n♦n rr- Ci`7 A1!\f n t (1 CN tom\\ T ♦.. • ii . Oe n ( A q Lr A ♦ r \ f � . n . �I♦ W P ON SVC e-,.1 Wt �ii� C) iJ'A � (� ^, 3— �.. cAAr tN f 1' 3[ .on(�i ♦. e+..f\ f.1.r. a i J Sn C (i ('a•.\ i n Cn 1z W ,lit �A p.n �+`� Cd r W . ' _W pp (� S S 1� .� cx,� n ♦\ �' o v 3 b.. C.. -�t•-N c 42LA r, --,-- A--,- .A . n r .o.Q h J o n S I . c �S �✓ cel a t�� C,1CC\e We/ Tc- Cn tom n� f « �r>. �{e�r ,rte SI\A; n'�' _ Le— rao'x t ^c.. ..7 f� Q.a e" \N c :\ .r♦.. C A ..vim n ..a.. 4 ck4z G.l� V Work complie"ith written approval from Structural Engineer and ICBO Evaluation Report # I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications applicable building laws. Final report issued at project completion. Inspector°`Jack C. Millin,) ICO edification No: 0842216-49 Contractor's`Rep+esentative: C_ ..... ...... .... Copy 1__ _61M Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of 1 J JCM Inspectioris 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 I N S P E C T I &N V EPDXY INSPECTION REPORT Date:3-3o;c)q Project Name: Project No: b+nne r' �StrQ Qnr s.� Project Address: City: t Title 24 AWS 'UBq Other: File# �D1.1 % %AI'A GCl App# O D 1.4 Client:,4', Sub -Contractor: Other General'Contractor: Architect: Structural ngineer: � � �SOCtQ14S �. *C f1S F� a Y-A� s'', � � Anchor Bolts F-1Rebar Weather: 11 F ` EpoxyTYpe:. L t`� 5ot1 JfF7�c I e_ ` annul `ItCems: Unresof—vee Epoxy Shelf Life�c Y.��o r .t �j ©None ^ Hole Cleaning Method(s). . n w r, C p o n f i c- Co rr fCS4nr ok,1.- .� W�' fy L r 1 See Below (� Description of Work Inspected: i5Q OX u T1­�c CA. 1 l FotW .n Q T U m fN'k r\ o `S we 1]r ..) A% P q a -,e C �.n 1 n. F"s J ;1'0 ._ O ("V11 Z��, ft^+ _ i� ,., j�yga M.1 a y r r\ .,Je� e �O �Ja °� �% < oQ�4 ( O W s C_ 1vt' 0 � VNra'1` _ 04. , a1 f "4 '" ;•?,., 1 n C \A n Y,1 n / Y1 �� � O .,A :>.'J\ C -on y 1 r C 1 ' Z h ^� h (-� of 1 5v'1 C -C. rs r ren 4-%CC�L`NM, t-_*%w�1 Gt r c� a rw ..• G r, c"OriV,II.J a �� o. C_ lrffia �Y�3�tn� ��rtCn r? 5'r.sl� �r r .�.. '1 A*) f'Y i i rc],n r 0�-1 ', e� ,.e� � �/a Ar I"r � � r � t ` , 9 rt ��•a [�.-- '�'Q .. ^, r\ ''Cl ,rlc \(1� � r � �J �e � A i�nd Y" (0�1. /��, Q i� n W� t�'-1 .� 1 r, A C •?n r Cn...' Sf 2 � e+ r, <r—' \ �.� 4 40 n\11 C Z vt� ( n ir (40 %4js f J'c L... iX o wy t5 • r Work complies with written approval from Structural Engineer and ICBG Evaluation Report # hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications _applicable building laws. Final report issued at project completion. , Inspect r: Jack C. Milli ICB i No: 0842216-49 Contractor's Representative: Ication i r Copy 1 CM -Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page _J_ of CV © -a D 2 r r KI V I r AT OPENING ch W Q D r � lO (f) 4x8 POST Q A00 (N) SIMPS0N HD 5-A W/5/5'0 THREADED ROD EMBED �'bIIK. INTO EXISTING f7G. DRILL 3/4'0 HOLE & FILLED W/HILTI HJT HY-- 150 EPDXY. V FINISH FL. - a (M) 4.4 POST 05 (N) SIMPSON H05A H0LOOWN W/SST816 ANCh'OR BOLT. O (N) 3- MUDSILL O (ro) 12" WIDE FTG. Q (%I) 2'-2'*. DE FTG. Q9 (N) 2—#4 TAB. (4—TOTAL) OR 4—:#3 T.&B (8—T0Ts1L) 10 (N) 2-#4 DOWELS MIAL 4) DRILL 5/8"o HOLE INN EXIST FTG- PAD & FILLED Wl HILTI- HIT W-150 EPDXY. OR 4-#3 DOWELS (TOTAL 8) DRILL 1/2"Ia HOLE IN EXIST FTG- PAD do FILLELi W/ HILTI KT HY-150 EPDXY. i11 (E)PAO FTG. 2'-2'x2'-2" 112 (E) 2. P- FLAT DETAIL D ETAI L i