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0205-052 (AR)(n I - (V U) W o =) ch dLo o Z to 0 O W W Z M LO N ON U rn Q tr Z Lo a 0 LL XW — IbUU O cl: LO rn H "t Z_ cb 5 �0 Q J 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 ,+ 1Exp. Date Date Signature of Contractor L OWNER -BUILDER DECLARATIQ I hereby affirm under penalty of perjury that f 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 ection 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 MATE MD Policy No. 2292039102 (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 jagree thnif I should become subject'to the workers' compensation provi�ionslof See ton -3701: of the Labor ,,Code, I shall forthwith comply with those pkvisi • ri . "Date: ?1, 1? 5 Z)�--Applicant I 11� � � Warning: Failure to secure WorkerAom ensation 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, anq State laws relating to the building construction, and hereby autharize represe�tative�''gf this City to enter upon the above-mentioned property fo i�npsypec�i'on `urposiesy.. -� ' Signature (Owner/Agent) �� ('1 > J Da e y BUILDING PERMIT PERMITr 11 TRACT DATE VALUATION LOT 1 $32.39f]-9� 100 21 26524, JOB SITE�T ,E�Y�93 ADDRESS P-Q�w., 671LbOiaArf. YBisGe�S APN �� f i 4i 1i�� OWNER CONTRACTOR/DESIGNER/EN (NEER MARX.800N.WTU S Sv1AMIU40v1.c.alCowriwC'1IO1a',,fl c. 79-4135RR00I VIMI X 2 SOUTH COVE, DME E L&Q` 11147A CA 92233 1ND1Afi WFUA4 CA 92210 (160)779.-0280 Ct3 ► USE OF PERMIT REME1,'1A1:, AI DITION Q'?o ,ar F.eS"1IJ.ritif'!' AL ADDITION PER A P?ROVZO FLANS.. TrUXT CONSI'. UCT1ON 508100 Sp IF ORC:1'IfFATIO 362.00 air S . =, D COST OF CORN' CONSTRUCITION FEE 101 -000 418-0 O $304:00 3 LhN CHECK PIZ 101-000-439-318 $246.31 MEG1.1.f NIC.AI,�+'1?Lr 101.000.421-.O00 �39a�n Y!. rLt,TR1CA1, ITE 101-000-420-b00 X32-79 PLUMT4 )10 FEE 101-000-419-000 143," STR.O'NO MOT101'4 ",Z - REBID 101-000-241 -000 $3.24 OR ADTb O FrS, . j.a� p yam- � ec�c 0 Who i JUN�2 6 ?1HR, CITY OF LAQUINTA RECEIPT , ' INSPECTO Z INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - /— 6z ° Underground Ducts Forms & Footings — o Ducts Slab Grade ^ DZ 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 v/—oz 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 Ap �3 Plumbing Final Equipment Enclosure Shower Pans _ O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection e, 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: 4-j -4 /G ` P�%r© L,pT/,�c�c ✓l� 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 6/20/02 No. 23315 Owner NameMark Sommers N0.79435 Street Brookville City La Quinta Tract # Type of Development Comments Lot # �y1FlBD BERMUDA DUNES <n RANCHO MIRAGE INDIAN WELLS b PALM DESERT ,y t� Ili QUINTA , INDIO .y�. APN # 772-040-008 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 470 Residential Addition No. of Units 1 ition of guest room 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: 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 470 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 Exempt - Jeff Hochadell Telephone 760/564-6166 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Exempt $0.00 Check No. - Signature 40TICE: Pursuant to Assembly 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 rbove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to :ollect 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 Jun 04 02 12:06p Robert Marriott N. SHEAR TRANSFER SYSTEMS . 7609485330 POST -INSTALLED BASE PLATE INSTALLATION WITH EXISTING FOUNDATION BOLTS `B'- Project: Subject: �w Date: 1124102 p.2 1) Remove all interfering portions of the sill plate, the original ShearMax cast -in-place base plate. 2) Prepare the concrete surface below the new Post -Installed Base Folate and Panel location to ensure that the concrete is flat. 3) Using the Post -Installed Base Plate (SMXXBR) as a template drill a W, diameter x 6 W, embedment hole for each Shear Pin hole (C). There are XX Shear Pin holes in the referenced post -installed base plate. 4) Place the Post -Installed Base Plate (A) over the installed adhesive hold-down anchors (B) and secure. 5) ..Install 5/8" diameter x 6" Shear Pin Anchor (D) (A307 special head configuration bolt supplied by Shear Transfer Systems) into each available shear -pin hole using Covert CIA 7000 Gel, Hilti HIT HY-150 or ITW Ramset/Red Head A7 per the manufacturers recommendations. Fill all Shear Pin holes with Shear Pin anchors. Note: Special Inspection is required for all Adhesive Anchor installations. Shear Transfer Systems, Inc. 9895 Santa Fe Avenue East, Hesperia, California 92345 P.O. Box 402563, Hesperia, CA 92340 TOLL FREE 1-877-SHEARMAX (743-27629) FAX 760-948-5330 REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY 0 POST TENSIONED CONCRETE 0 ASPHALT 0 REINFORCED MASONRY 0 FIRE PROOFING 0 pHER JOB i 1 ` e, LINv\ v REPORT SEQUENCE N0. TYPE OF STRUCj,11 1E PERMIT NO. D 1, DAY OF WEEK MATERIAL DESCRIPTION ���^_ � y -vp• `-�'` RC YN1EER II�EsQT(J HRS. CHARGED 'D ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL SUB CONTRACTOR iJ out c-(4 CONTRACTOR .Aitlate44A 1 I AZ 6Q1A CR e� COPY SENT TO CLIENT O CONTINUED 0.11-T T PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS a -4 -.- GA URE OF REGISTERED IN CTOR — 6 GIF. 73 ATE O REPORT REGISTER NUMRFR