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0101-004 (AR)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•- ,:/ Datj�, Z- '9 'L.. Signature of Contractor OWNER -BUILDER dECLARATION I horeby 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, ain exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals (1,5 1 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. n�� k'i i+ ����uai 14241246.00 (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 beeecome� subject' to the workers' compensation provisionsp�fl Section 3700 of the •L bor Code, I shall forthwith comply with those provisidns.% ,Date: + _ Applicant Warning: Failure to secure Workers'Compensatior overage 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. a' 1. Each person upon whose behalf this application is made & each person�pt whose request and for whose benefit work is performed under or pursuantfq 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 correct. I agree to comply with all City, and State laws relating -1 construction, and hereby authorize representatives of -this City the above-mentioned property for winspection,purposes Sig ature (Owner/Agent) %%I +' ,' �' Date ormation is ho building enter upon PERMIT# i BUILDING PERMIT / e e DATE VALUATION LOT QSi {��. ,{ TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER'/ EN (NEER I..AQ1'3IN.�'.�, 3 1110UAiAWD PA.. X3 CA 92276 X3 3 �• 17 5 C7BV. f• 5137 USE OF PERMIT PATIO I Ab1Dl'fION 147,00 OF �5:��,Ct•Iir���b'S.f,� ��.ta0 S�, iwJ�P lr02•'K:'F.�.Ns4.�+�vry.�l,bt/.f.V .yy� Mgf�r�yy��h,p��ccpp ��vV �'e��ggp•�.+Fy�.�6yTAI.E7Yy(•IT.-DC.708M fy ,r.IC:.[dAAU1�a.1l5:� AYJ.�1.d915�•k1.�i�s . PIAN''t:HY.CM JIM 101-000.439-318 $1.90 CO'Pf'4MUC' 014 i<EES�1�tkS?t�43R�,C�iy $126,00 M.ECHEN vIJ�LFEB 101-000.421.0Uig $19.St1 FILWI cRY. LM, RIZ 101-000-420-000 $15.75 STROM MOTION PER - RESID 101,000-2,41-000 11101" fFtiaN q' G ayftL y� F, l.�y,� V�.l�y Y�r�f``1 ,A �, y1 q' �`}����� P/� 65 L/.6:P•sIX)T =LGA �:h. X1,9.7.d�T I.:.L,10 N ll�i. D ✓'yi at'�l/.R I.rAS'J.,E;,y.+K yn� y.�.. �) 4 4. ,16 112M � ?�P 'E1 i9.t3q JAN 04 2DOI (. - R C IPT DATE7i taBY� a j f �/ 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 I 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: 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 713168 B 10/31/2( Date _ 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 (SBC. /U44, Business & Nrofessionais Code). p 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 t. • Policy No. dVD 14S9iiV-tMV (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 shall forthwith comply with those provisions. Date: Aoolicant 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. BUILDING PERMIT PERMIT# SrAZI- FC5Z71S - DATE VALUATION LOT 0101-004 TRACT JOBSITE APN ADDRESS 54-700 AVENMA RUDIO .774-272-010 IOWNER IRV RISLEY 54-700 AV_F.14Z)A R[TBIO LA QUINTA I USE UP PEHMPr RESIDENTIAL ADDITION. ROOM ADDITION AND PATIO ADDITION PORCH/PATIO CONTRACTOR/DESIGNER/ SO -CAL BUILDERS 31300 DESERT P —I MDR CA 92253 THOUSAND PALA>-IS CA 92275 (760)343-1134 CBL -9 5737 147, 00 31? 159.00 SF ESTZSATED COSI OF CONSTRUCTION 10,096,80 PERDAH FEE SU34UA RY PLAN CHECK FEE 101-000.439-318 an1,90 CONSTRUCTION FEE 101-000-418-000 $126.00 MECHANICAL FEE 101-000-421-000 $119,50 ELECTRICAL FEE 101-000-420-000 $15.75 STRON(J MOTION FEE - RESID 101-000.241-000 $1,01 SUB -TOTAL CONS`I` UCTION AND PLAIT CIIDCK LESS PPE -PAID FEES I RECEIPT I DATE TOTAT, 1PFRM1 T' FFF.S T)ITF AVOW DATE FINALED I INSPECTOR r $244..16 $0.00 $244.1 F Signature (Owner/Agent) Date- I I I I I Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 1/2/01 API # 774-272-010 No. 21427 Jurisdiction La Quinta Owner NameIry Risley Permit #0101-004 No. 54-700 Street Avenida Rubio Log # City La Quinta zip. 92253 Study Area Tract # . Lot # Square Footage 147 Type of Development Residential Addition No. of Units 1 Comments is a bedroom. At the present time, the Desert Sands Unified School District does not collect fees on ga_ages/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 they following reason: Residential Addition 500 Sq Feet or Less EXEMPT ' This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 X 147 or $ 0.00 the property listed above and that Gilding �. Permits and/or Certificates of Occupancy for this square footage in this proposed project m.a,,n.,.owhe issued Fees Paid By N/A - Mike Roberts Te iplione:✓ DESERT_ SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 t Document Cannot Be Duplicated (619) 347-8631 Date 110/16/90-1 Type of Permit La Quinta No. 110203 Permit # 08475 Log # Owner Name Shirley Stephan No. 54700 street Rubio city La Quinta zip 92253 Study Area 110 APN # Tract # Lot # Square Footage 11466 Type of Development Single Family Residence No. of units 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 or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This .certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X 1466 or $ 2,31628 have been paid to W&U.SM. for the property listed above and that building permits and/or Certificates of Oocu a�ync for this square refoo in this ProPProJe_ct may now be issued Fees Paid By Shirley Stephan Tele p}n Ile Name on the check r� + By Richard M. Beck r M• Director, Facilities Planning & Development 4 u.' Fee collected /exempted by Marcia Ewart Payment Received Signature jVI &A, Check No. 1240 Collector: Attach a copy of County or City plan check application form to District copy. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accountin; w Cr 01, JAMES O. WALLACE AgrWhrral Commissioner Director of Weights .& Measures OFFICE OF AGRICULTURAL COMMISSIONER AND WEIGHTS & MEASURES CALVIN C. KAMINSKAS. 4080 LEMON STREET, ROOM 19 Assistant Commissioner RIVERSIDE, CALIFORNIA 925011 CLEMENT BENVENISTE. Sealer (7114) 787-25611 - 49613 Highway 86, suite B12 Coachella, Ca. 92236 '2A'l CASE NO. X8132; o,4- DATE DEVELOPER'S NAME: Ca' ADDRESS TELEPHONE: (61f 7 7. I C ti ,fir 'gym..a.zrxtt!'q'1`iT,�"°�.;;r3'�e.,.iJ�[��r'Y�y��.Alikp(Ir."skk't'p4Etrr��r?'.��' oS JOB NO. Buena Engineers, Inc.. /3,.'7,,2 7 %(,F 79-811B Country Club Drivel TEST LOCATION'- Bermuda Dunes, CA 92201 - (6',19) 345-1588' V `�� Az V/ Client Name A ce MAXIMUM Client Client Phone fi DATE JOB NO. FIELD TESTING /3,.'7,,2 7 %(,F PROJECT TEST LOCATION'- LOT LOCATION DRY A ce MAXIMUM CONTRACTOR— NUMBER OWNER WEATHER TEMP. 0 at AM CONTENT 0 at PM PRESENT AT SITE DRY MOISTURE % lbs./Cu. 0. DENSITY CILIENT%REPRESENTATIVE SIGNATURE i. FIELD REPORT TECHNICIA SIGNATURE v 15367 FIELD TESTING REFERENCE CURVE TEST TEST LOCATION'- LOT MOISTURE DRY MAXIMUM MAXIMUM OPTIMUM NUMBER - NO. ELEVATION CONTENT DENSITY DRY DRY MOISTURE % lbs./Cu. 0. DENSITY DENSITY CONTENT Ibs./cu. ft. % 7 4 J T;T -A --- - - ----- S- 5 A z CILIENT%REPRESENTATIVE SIGNATURE i. FIELD REPORT TECHNICIA SIGNATURE v 15367 - r PLAN CHECK CORRECTIONS - DATE.- 11/3/2000 PEF'MIT # TBD JOB ADDRESS: 54-700 Avenida Rubio CONTRACTOR:, Mike Roberts , PLAN CHECKED BY: Daniel P. Crawford Jr. Dear Mr. Roberts, , ' The plan review for the room addition and patio proposed has been completed.. Please address the following corrections to approve your plans and permit construction: • 1 '`Please provide schoo fee exemption letter:% �2. Please.provide verificationlofStateLContractor-s Licen 3. Provide verification of.City Business -License` 4.,P.rovide.Certificate;of Workers's Compensation orprovide'a'list ofSub-Conaractors._Please j•icku Ci s,:5ub=List- rovided:-' I a licab'le P P t1'' P - (f- PP ) ; Please specify on plans that all construction shall comply with the 1998 California Building,1. mbing, Mechanical. and Electrical Code. ' lease provide a means of emergency escape from master bedroom. The removal of the ` ('evt�e� : ting 6068 french door and replacing it in -the sunroom addition affects the rainimum Op-� requirements of the code for both light and ventilation and egress. There- is an exception to allow for your proposal if the opening.between the sunroom and master bedroom is a minimum . of 50% of the 16'4" overall dimension. This exception would consider, the sunroom as an addition to the master bedroom, remaining one room. OR Provide minimum egress for master bedroom. , 2: lease provide minimum light (10%) & ventilation (one twentieth) for master,bedroom. (Noted 6yo,�'e e tion may be applied above, correction.6) A_Pilo o t- . lease note to provide a smoke detector in the sunroom. y r1l _1 9i ase provide;"attic.ventilation_calculations,(1/300)-'and provide details for. viiplian`ce,,,ssize and number of vents. `7CM , A, KA Roo -(- lease specify 28 gauge inimum galvanized valley flashin Please prokide ICBO report number for proposed roof tile. - X12.7,lease note minimum required attic, access. r c0 �`a'elease revise plans to reflect Title 24, current version, in effect.is CALRES2 version 2T -Revise • L' p o,reflect minimum requirements.%2, x 0W. 16 0. C. with R-21.insulatior.`:?"Revise section to reflec evisea' Title�24 .Please note size of HVAC register in sunroom.i -.d ".. 6 ei entify existing electrical service size and location. Plan note is general and.indicates e replacement may be required. Verify plan and construction intent. 16. e building as submitted 'does not.meet the prescriptive provisionsof the '998 California , '•' r► _ B Code section 2320 for light frame construction, therefore, a design in accordance with CBC se 'on 1605.2 must be provided. Please note Seismic Zone 4, exposure' (7, 70 mph wind. Please feel free to contact me to discuss any question you may have concerning this correction,` J proposed addition and patio. (Afternoons work best, I am in the field in the mornings) Please respond in writing -to each comment/correction above. This will assist -n a quick back ' check of your plans as to the location and action taken to address the correction requested. Additional corrections may be requested upon further review. If I may be any further assistance 4 l please contact me at,777;7027, thank you..' y` _ Sincerely, uildingInspecto II i Bin City of La Quinta Building 81 Safety Division P.O. Box 1504 Perrnk # 78-495 Calle Tampico La Quinta, CA 92253 Building Permit Application and Tracking Sheet Project Address:- 70 i] U Owner's Name: �} S A. P. Number: —,7 --2-7 2 .- el_�) l Address: C 7� c) `7 LJ L Legal Description: City,ST, Zip:zct v� Contractor: 1 kle n�� S Telephone: Address: 0 b - u Project Description: Cit}'.ST, Zip:� ©d P l 0 fV Telephone:770 —r vG'CJd t_�' `T9d State Lic. # : City Lic. #: _ !� Arch.. Ener.. Designer: Address: 7 U City. ST. Zip: Telephone: r- 5 Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone 4 of Contact Person: Estimated Value of Project: APPLICANT DQ;NQT WRITE BELOW THIS LINE ..... # Submittal <:. Re Id Recd TBACIjCIlVG Plan Sets plaa Checksuhmttted Item Atnoaof: .. Struetural Csles Revtewed seai7 for correctiaas +. „Pistt:GltckDepostt;. > ... Truss Calcs: GtltedCaittactFeisen L►laa:GJ t.Balaacr Title 24 Cales _ Plazas }ticked u�r.: _ Ceasisat[ioza • Grant DeeYl': Eltta3 seohitmrfled3j� Mechaemak Sehool.Eew REViClYtth`ret}ilY t0 gitt4 Eleettscid: • Subcontattnr lyjst l alkd Cotttatct i r an Plumb ' Contractor>Infn 4` 0. ;, $;iiLL CiyBusiaesa Lic. 0M; Vl+orkers' Corep.pt Izifra�tsactase Plaetuug Apprmsl ;:. Pub. VVks.;gppr ; H..O:A Agpranttt Fire Mar. Aper ; H. Dept. Apprev=l Ag. Approval . :..: Dateatiiiisl.ligpetttot:.: Tgt;lPermlEFecs :;:; N C. - A QUALITY CONTROL LUMBER INSPECTION SERVICE SUPERVISORY FIELD INSPECTION REPORT Licensed Plant: - !-';r., i t'. Date of Inspection Q.C. Inspector: G'.r t- Arrival r % Departed ..j ' .1 NON-SCHEDULED IN -PLANT WOOD TRUSS INSPECTION As per Uniform Building Codes Standards Sec. 2311.6 and Sec. 2343.7 in accordance with engineered plan specifications. In Accordance Lumber Grade & Storage Connector. Plates i 0�1 Workmanship Accuracy of wood cuts x. Bearing of wood joints Knots in plate area Split limitation h Position of plates Condition of plate teeth Plate to Wood tolerance lh-Plant Handling & Storage Bundling and Loading Marking Legibility } Jig & Press Adequacy General Appearance and Condition of Inventoried Trusses: Excellent Good SatisfactoryPoor REMARKS: CORPORATE HEADQUARTERS 420 W. Pine Street, Suite 10 Lodi, California 95240 (209)334-6956 (209)334-6970 Fax Non -Conforming Not Acceptable CLIS Inspector, .. Countersigned