AR (9710-176)52430 Avenida Martinez
9710-176
LICENSED CONTRACTOR 'DECIARATION
I hereby affirm under penalty of perjury that leam"Ikensed 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
Dater,
Signature of Contracto
9
OWNER-BUILDERDEC ILARATION
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).
. ( ) 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 agiee that if I should become
subject to the Workers' compensation provisions(of Section 3700 of the Labor
lode, I shall forthwith comply with those provisions.
/Date:';Y r, APpli til
Warning: Failure to secure Workers' Copensati coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all, City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyafor inss pectionfpurposes. t
/Signature (Owner/Agent). T_' 'Y Date tFl t e_) q 7
4
PERM';" °°NTR°`
BUILDING PERMIT
, 1tr<-i ►
DATE VALUATION s. .d. LOT TRACT 62.26 .
/y
JOB SITE, t
ADDRESS .4$- i30 A ' ENIDA cii' 'jtNEZ
APN773-27.024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ADAM MARSHU0,14y
AFTH.J.")s ('ta1Nr,I'llt11:''1' ON
3ZJ30 AAVEM..A. MAJI 'i t M
nmi<-tti (Jayi II'Lo
LA QUWA t'A 412'0
I.Jt ('*lwrA CA 9.)1S 3
USE OF PERMIT
i4t/fJY 1 e.t.+.4' i `Y.trtr .ai
!{ » i ,11 1 t .$%4A , ? 6 #'J(•` F. l+4 w' 1 R'U'R.i.l'i l l.I l
y,Elli .fi
P1,A1,4 (.1 VK I -'Fr 101-0 M-4314 118 l.b ;fit►
o(1Nfi tt("rl 33 R{lw
((w raii4v t f ff!m- .f({1 ' l1t a qry ti
,t.+ .. i ll.f •.. ry f, t'.L';;I,S 'd "' -MM..kl'0(Jv4.1 aie.M '.N
'i T" ':tiN0 MOTION FIX, - R SID, 31.09 s.t.., o?
NOV 2 5 1997
` OffYOFLAO-1-101TA
d
• u1". ti 1. 1tr •k"1 3 #'K . ,
,f}3ti
1€,T.1A4., Pi+;RtMI t'YE S IME, NO% V
t
RECEIPT
DATE
BY
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 4
Combustion Air
Roof Deck Wd VO,409L114
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation Asgw
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
P rewall
Exterior L
Drywall - Int. Lath /
Final
Final
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
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
COMMENTS: h
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 10/31/97 APN # 773-272-024
No. 16219 Jurisdiction La Quinta
Owner NameAdam Marshall
No. 52430 Street Avenida Martinez
City La Quinta
Tract #
Type of Development
Comments
Lot #
Single Family Residence
Permit #
Log #
zip 92253 Study Area
Square Footage
No. of Units 1
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 or replacement mobilehomes-
It has been determined the above-named owner is exempt from paying school fees at this time due to,,tlie,,fO'1lowing"
reason:��-...rr
Residential Addition 500 Sq Feet or Less w rr
w
EXEMPT r, ✓'�' `�
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X or $ 0.00 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 Blaine R. Grimes Telephone (760) 564-4854
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Exempt $0.00
Check No. 0
Signature
NOTICE: Pursuant of As embly Bill 3081 (CHAP 549, STATS. 1996) 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 fr m the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy -'Accounting
• PREoR D's 4N
REVIEW ONLY
--. - E K
CASS ROGERS
t Cr%M ENGINEER: CONSULTANT JC B R
PLANNING DEVELOPMENT
• CONSTRUCTION PLANS • BUILDING • GRADING • STREET
SEWER • WATER
• STRUCTURAL CALCULATIONS • WOOD • MASONRY
CONCRETE • STEEL • RETAINING WALLS • SIGNS
i • ELEVATION CERTIFICATES • DRAINAGE 8 FLOOD STUDIES
• FOUNDATION CERTIFICATIONS
Phone (760) 7795075
73533 JAMESON ROAD Pager (760) 8624030
t PALM DESERT, CA 92260 Fax (760) 7795076
WB -1 2 EACH 1 3/4 x 7
1/4 MICRO -LAM BEAM
SIMPLE -UNIFORM LOAD
( 3.5 x
7.25 NET SIZE)
OVERHANG SUPPORT
- MARSHALL
i
LOADS: ITEM
LIVE LOAD DEAD LOAD WIDTH/HGT'
COMP
ROOF
20.0 PSF 10.0, -PSF 2.50
FT
SPAN =
12.00 FT
SEC MODULUS= 30.66 -IN-3
LL DEFL
= 0.10 IN
UNIF LL =
50 PLF
MOM OF INER= 111.15 IN -4
Allowable
= 0.40 IN
UNIF DL =
25 PLF
MOD OF ELAS= 2.0 E-6 PSI
Ratio
= L/%1372
BEAM WGT =
6.2 PLF
MOMENT = 1,461 FT -LBS
DL DEFL
= 0.07 IN
TOT LOAD =
81 PLF
BENDING FS = 572 PSI
LL+DL DEFL
= 0.17 IN
H SHEAR =
26 PSI
Allowable = 2,600 PSI
Allowable
= 0.60 IN
Allow
285 PSI
R-1 = R-2 = 48.7 LBS
Ratio
= L/845 '
.
I
• PREoR D's 4N
REVIEW ONLY
--. - E K
CASS ROGERS
t Cr%M ENGINEER: CONSULTANT JC B R
PLANNING DEVELOPMENT
• CONSTRUCTION PLANS • BUILDING • GRADING • STREET
SEWER • WATER
• STRUCTURAL CALCULATIONS • WOOD • MASONRY
CONCRETE • STEEL • RETAINING WALLS • SIGNS
i • ELEVATION CERTIFICATES • DRAINAGE 8 FLOOD STUDIES
• FOUNDATION CERTIFICATIONS
Phone (760) 7795075
73533 JAMESON ROAD Pager (760) 8624030
t PALM DESERT, CA 92260 Fax (760) 7795076
i,
WB -1 2 EACH 1 3/4 x 7
1/4 MICRO -LAM BEAM
SIMPLE -UNIFORM LOAD
( 3.5 x
7.25 NET SIZE)
OVERHANG SUPPORT
- MARSHALL
LOADS: ITEM
LIVE:LOAD DEAD LOAD WIDTH/HGT
COMP ROOF
20.0 PSF 10.0 PSF 2.50
FT
SPAN = 12.00 FT
SEC MODULUS= 30.66 IN -3
LL DEFL =
0.10 IN
UNIF LL = 50 PLF
MOM OF INER= 111.15 IN -4
Allowable =
0.40 IN
UNIF DL = 25 PLF
MOD OF ELAS= 2.0 E-6 PSI
Ratio =
L/%1372
BEAM WGT = 6.2 PLF
MOMENT = 1,461 FT -LBS
DL DEFL =
0.07 IN
TOT LOAD = 81 PLF
BENDING FS = 572 PSI
LL+DL DEFL =
0.17 IN
H SHEAR = 26 PSI
Allowable = 2,600 PSI
Allowable =
0.60 IN
Allow = 2.85 PSI
R-1 = R-2 = 487 LBS
Ratio =
L/845
pRE . l1 [ A
FOR DcS!N
REVIEW ONLY
DATE 1✓!3
r
CASSEEROGERS CM R: CONSULTANT ICBR-1.
• PLANNING DEVELOPMENT
• CONSTRUCTION PLANS • BUILDING • GRADING • STREET
SEWER • WATER
• STRUCTURAL CALCULATIONS • WOOD • MASONRY
CONCRETE • STEEL • RETAINING WALLS • SIGNS
• ELEVATION CERTIFICATES • DRAINAGE & FLOOD STUDIES
• FOUNDATION CERTIFICATIONS
Phone (760) 779.5075
73533 JAMESON ROAD Pager (760) 862-4030
PALM DESERT. CA 92260 Fax (760) 779-5076
PRFOR DF -SIGN
B
REVIEW ONLY
DATE f- /3-•..1-
0
WB -2 2 EACH
1 3/4 x 5
1/2 MICRO -LAM BEAM
SIMPLE -UNIFORM LOAD
( 3.5 x
5.5 NET SIZE)
11
ROOF
SUPPORT BEAM
- FAM RM/LIV
RM - MARSHALL
LOADS: ITEM
LIVE LOAD DEAD LOAD WIDTH/HGT
t
COMP
ROOF
20.0 PSF 15.0.PSF 1.00
FT
SPAN =
17.0.0 FT
SEC MODULUS=
17.65 IN -3
LL DEFL
= 0.39
IN
UNIF LL =
20 PLF
MOM OF.INER=
48.53 IN -4
Allowable
= 0.57
IN
UNIF DL =
15 PLF
MOD OF ELAS=
2.0 E-6 PSI
Ratio
= L/527
BEAM WGT =
4.7 PLF
MOMENT =
1,433 FT -LBS
DL DEFL
= 0.38
IN
TOT LOAD =
40 PLF
BENDING FS =
975 PSI
LL+DL DEFL
= 0.77
IN
H SHEAR. =
25 PSI
Allowable =
2,600 PSI
Allowable
= 0.85
IN
Allow =
285 PSI
R-1 = R-2 =
337 LBS
Ratio
= L/266
CASSEEROGERS CM R: CONSULTANT ICBR-1.
• PLANNING DEVELOPMENT
• CONSTRUCTION PLANS • BUILDING • GRADING • STREET
SEWER • WATER
• STRUCTURAL CALCULATIONS • WOOD • MASONRY
CONCRETE • STEEL • RETAINING WALLS • SIGNS
• ELEVATION CERTIFICATES • DRAINAGE & FLOOD STUDIES
• FOUNDATION CERTIFICATIONS
Phone (760) 779.5075
73533 JAMESON ROAD Pager (760) 862-4030
PALM DESERT. CA 92260 Fax (760) 779-5076
PRFOR DF -SIGN
B
REVIEW ONLY
DATE f- /3-•..1-
0
WB -2 2 EACH 1 3/4 x 5
1/2 MICRO -LAM BEAM
SIMPLE -UNIFORM LOAD
( 3.5 x
5.5 NET SIZE)
ROOF
SUPPORT BEAM
- FAM RM/LIV
RM —MARSHALL
LOADS: ITEM
LIVE LOAD DEAD LOAD WIDTH/HGT
COMP
ROOF
20.0 PSF 15.0 PSF 1.00
FT
SPAN =
17.00 FT
SEC MODULUS=
17.65 IN -3
LL DEFL
= 0.39
IN
UNIF LL =
20 PLF
MOM OF INER=
48.53 IN -4
Allowable
= 0.57
IN
UNIF DL =
15 PLF
MOD OF ELAS=
2.0 E-6 PSI
Ratio
= L/527
BEAM WGT =
4.7 PLF
MOMENT =
1,433 FT -LBS
DL DEFL
= 0.38
IN
TOT LOAD =
40 PLF
BENDING FS =
975 PSI
LL+DL DEFL
= 0.77
IN
H SHEAR =
25 PSI
Allowable =
2,600 PSI
Allowable
= 0.85
IN
Allow =
285 PSI
R-1 = R-2 =
337 LBS
Ratio
= L/266
PRFOR DV
EGN
REVIEW ONLY
L)ATE