0301-229 (CONR)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
r•.
777699 B 0+1,130.12(
Date .y Signature of Contractor .:iW-
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 LIS -,,U )T . MUTUAL .7 Policy No. WA2621 OOV2:101 IT
(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: Applicant ,2- 7 rr -
Warning: Failure to secure WorkersCompensation 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) _
' -� —�----Date
BUILDING PERMIT PERMIT
L"
DATE VALUATION LOT_ 41301- 29 TRACT
y q /y
JOB SITE I
APN
ADDRESS SD -•345 POMELO
y7a � 0-t�2t
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TOIL £sZd.O•DWER3 TUC
TC7LL13RROTf,-7 IS Mc
73-121 T+it WA I%�t� ioo
93-121F: 'f1°iWARDIGIA00
PALM DEMTr C"4A. 92260
PALM DEJ" fItT
CA,. 92260
Q60)674-9699
CB1Jf 3832
USE OF PERMIT
"7y %.T p y
COW
'X960 M.F. SPR S+Gli,l`!"Y�t17L1A117tA1"lCfAt't)r3.Y.
POROWP1 TIO $29,00 OF"'
.SPR1NKi t£ 7,430.00 SF
A/C -- COMMERCIAL 7}400,00 3F
CONTRAC'T.AMOU14T 421,434,00 3 S
4
-T UC;'.1.`,ION'
467,261.70
. Efs--ruled!"b (30S OP Cf?i+a'S'.ki
7f'=vur Frr, t1 J7 A� t
COOS TRUC'T10114 FEF 103-000-418-000 s2,952.04
PI.e�1A,f ICfil;4iSC 1rEE 101-000-439-318 3AS37.90
MWRAN [CAL F2.9, 101.000.421.000 $272.00
E1.fi.:C`3'R1C::�I..I�F - - 1:11-fJOQ-4?ti-t3fi0 . �233.?0
PLUICMCBINO FEE' .'.101-000-419-000 $2312S.
S'TRONO MOT10H .F'EE - COMM 100-000-24.1-000 12
GRADTNt91FFM 101.000-423.000 s m uo
DEVELOPER IMPACT FK8' �13ti9E�.t3C
ART 114 PUBLIC PLACES • COM? 270.100-445.000 $2,336.3;
FEE DEPOSIT 101-000.439-318 .4000,00
,ALTS-TOTK,, Ci NIfft°t UC;'T'TC)N ANDPLAN i'FMCs7C
$22,636.32
use FPtF PAW Fist; ,
a�2,G00.00
D
T U FEUMIX� FIKEN DMIE 14 Ow
S20,0632
MAY 13 2003
:g
CITY Or' LA GQUIN� T- • :4r�y ,!�e�v�' � i
FINANCE
RECEIPT
DATE
BY
40�P
INSPECTOR
• .,� t �'.. � • - . x 1, / V
INSPECTION RECORD
r
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
01
Slab Grade
Ducts
Return Air IV
Steel v
Combustion Air
Roof Deck 7
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation—Vents
Fireplace P.L.
Grills
zq-
Fireplace T.O.
Fans & Controls
Party Wall Insulaticn
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 APPROVAL
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 A
Pool Colieer `
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Finai�
Utility Notice {Gas}
ELECTRICAL A PR6VALV'
Temp. Power Pole
Underground Concuit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels 10 oz
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Pero-) JJ ZZAAa-ra
COMMENTS:
,o vn
ire
VF
�"�-•L 7 ,.2
VVV r
FOUR UNIT MANIFOLD KIT
(PART NO. 78694)
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2 I? INLET 1
AND OUTLET I
MANIFOLD
CONNECTIONS
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3TYP, 124 U16'
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2
_
SEALED DIRECT VENT
VERTICAL
50' INTAKE, 50' EXHAUST
SEALED DIRECT VENT
SIDEWALL
50' INTAKE, 50' EXHAUST
I
1. Direct Vent/Sealed Combustion
The ultimate venting system for either horizontal
or vertical applications.
This system gives the specifier and installer
optimum venting flexibility in placing the
Cyclone XHE at point of use. The safe, two -vent,
system allows clean uncontaminated air to be
drawn directly into the unit. The flue gas products
are expelled directly through the wall to the
outside. This two -vent system protects the unit
from harmful flue products being recirculated.
2. Sidewall or Vertical
The Cyclone XHE series can be vented directly
through an outside wall or vertically up through
the roof. Quick and simple. Perfect for retrofit and
cost saving installations.
INDOOR CONVENTIONAL
VERTICAL
50' EXHAUST
INDOOR CONVENTIONAL
SIDEWALL
50' EXHAUST
SEALED DIRECT VENT
HORIZONTAL INTAKE
VERTICAL EXHAUST
SEALED DIRECT VENT .
VERTICAL INTAKE
HORIZONTAL EXHAUST
SEALED DIRECT VENT SEALED DIRECT VENT
w/CONCENTRIC VENT w/CONCENTRIC VENT
VERTICAL TERMINATION HORIZONTAL TERMINATION
A 104.7
2
2
2
2
=I
INDOOR CONVENTIONAL
VERTICAL
50' EXHAUST
INDOOR CONVENTIONAL
SIDEWALL
50' EXHAUST
SEALED DIRECT VENT
HORIZONTAL INTAKE
VERTICAL EXHAUST
SEALED DIRECT VENT .
VERTICAL INTAKE
HORIZONTAL EXHAUST
SEALED DIRECT VENT SEALED DIRECT VENT
w/CONCENTRIC VENT w/CONCENTRIC VENT
VERTICAL TERMINATION HORIZONTAL TERMINATION
A 104.7
�0�-23-2003 15:33
FROWIVIDS CONSULTING
7607714073 T-578 P.002/002 F-137
PLANNERS I ENGINEERS I SURVEYORS
Offices located in
Irvine and La Quints
June 23, 2003
City of La Quints
Building and Safety Department
78495 Calle Tampico
La Quinta, CA 92253
Finished Floor Verification
Tract No. 30357
We have checked the top of form for the finish floor elevation referenced below and find it to be in
substantial conformance with the approved precise grading plan.
Lot # Plan Elev. As -Built Elev. Variation
187 -Spa 40.00 1 40.00 NONE
Stanley C. Morse
R.C.E. 20596
Expires 9/30/05
GA38206\gen\FFeert5
F ESS /p�
Z, " No. 20596
Exp. 9-30-05
S P
OF CAO
Stanley C. Morse 79-799 Old Avenue 52 VOICE: 760-771.4073
Gary W. Dekich La Quante, CA 92257 FAX: 760.771.4077
J.R."Skip^Schultz EMAIL: mdslagOnto 0 diconsulting, not
Copy 1"`J nspections Copy 2 Project Superintendent
Copy 3 Governing Agency Page 4 of
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JCM Inspections
39725 Garand Lane Suite�F�
(—�
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LM
Palm Desert, CA 92211 b C�
I N S P E C T I O N S
Phone: 760-345-5554 -r Fax: 760-772-3895 I N S P E C T I.O N S
REINFORCED CON��RETEINSPE&ION) REP0R1 r`Dat~��'
^�
Project Name:
Project No:r
Mom,
- so 0_ `1
Cou,,� � u' `
Project Address:
City:
Title 24 AWS UB Other:
%0 – c o
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File # E] D 1.1
Client:
Sub -Contractor:
App# E] D 1.4
o` r Q CS►
GC—
❑ Other
General Contractor:
Architect:Structural Engineer: A
'�\ ei COY\& V 1 0
(�
`or O • ct1 , \ Q..
Slump (inches):
,\ a � Supplier: 1y
Weather:,
YTime Sampled:
' t Mix Design:
Time In Mixer (min.):
Specified Strength (PSI):
un
Unresolma Items:
Water Added @ Jobsite (gals.):
Addmixture:
None
Concrete Temperature (F):
Truck #: Ticket #:
Ambient Air Temperature (F):
Field ID Marking:
See Below
Location of Sample:
® No Samples Taken
Description of Work Inspected:
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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 • rk to comply with thevprov P
plans, specifications _applicable building laws. Final report issued at project completion. 14
Inspector: Jack C. Millin IT
C if c tion No: 0842216-80
Contractor' R sent e-
Q
Copy 1"`J nspections Copy 2 Project Superintendent
Copy 3 Governing Agency Page 4 of
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Sladden Engineering ,.
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 -Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date l'7 Z—o?
Job No. 127�
FIELD MEMO r
/�
�- Project Name A/jOLAJ?al/t Vieo Client:
Site Address
s
Job Phone ;
Work Done .
Test Summnary`/ Footings Inspected
Test
No.
Location
Elev.
Dry
Density
Moist
%
96 Relative
Compaction
Ref. Max
pcf
Moist
%
Comments .
1 od ir? o; CTG/P
0141'
.s.
Aeld Tech. Super. or Agent
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service.
RILE No.710 06/25 '03 15:06 ID:R L GOODSON FAX:214 739 6354 PAGE 2
Gelebrakno
5o year
1953 2003
RAYMOND L. GOODSON JR., INC.
coNsuLTiW ENGINEERS
FIELD REPORT #1
MOUNTAINVIEW COUNTRY CLUB & SPA
SpA BUILDING
Imo► QUINTA, CA
RLG File No., 02515.000
DATE: Tuesday, June 24, 2003
TIME: 1 PM (local time)
WEATHER: Sunny, clear, dry, 91°F, wind 7 mph, 19% humidity
THOSE PRESENT: Frank Prusa, Hayhoe Construction Corp,
Roberto Riquelme, Hayhoe Construction Corp.
Santiago Mascorro, rebar foreman
Ann -Marie Doughty, TxPE, R.L. Goodson, Jr., Inc.
PURPOSE:
To observe the general progress and quality of construction. To determine if construction generally conforms
to the contract documents.
CONSTRUCTION STATUS:
The maintenance building has been erected and appears to be in use.
The foundation excavation for the spa building has been completed and the foundation reinforcing was about
85% complete at the time of this observation. Mr. Prusa and Mr. Riquelme indicated that they plan to have the
foundation reinforcing inspected by the building official on Thursday morning and will follow as soon as
possible with the concrete pour.
OBSERVATIONS:
The foundation excavation was completed during this observation and the perimeter footing reinforcing was In
place everywhere except at the rotunda and at the concession building and exterior rooms adjacent to the
concession building. Mr. Prusa and Mr, Riquelme indicated that they were waiting for the plumber to finish his
work in the concession area and that the rotunda had been the last thing to be excavated so that they could
access the rest of the building thru that area.
The slab reinforcing was complete in the exercise room, the aerobics room and the locker room areas,
however the slab reinforcing in the aerobics room area was not chaired up yet. Mr. Prusa and Mr. Riquelme
indicated that the reinforcing would all be chaired up once they had finished laying it in the office and rotunda
areas.
Several areas along the northeast wall of the exercise room were observed to have pipe penetrations directly
adjacent to the reinforcing dowels. Mr. Prusa and Mr. Riquelme indicated that they would move the reinforcing
dowels over to allow for the concrete to flow between the pipe and the rebar.
.W)HNF. STULL. PL. DAVIDM. (_f)01).',ON, FtF
(,:hief Executive 011iu0e Pr(!!*1u111
STt1ARTA. MAHKUSSFN, r'.F... R.P.L.S.
AssmiulC
knlilni'G.WOOD.R.P.L$. PETER U.IAttSnN.f.E.
I xocuBvo Vico f'nsidcrd Vico Pmgiclont
MI(:HAkL U. PY_)WELI , P.F.
A':: noiH IH
,),mS LA SIEHHA SUITE 300, LB 11 DALLAS, IEXAS 75231 41:38 214/7:39-t3100 FAX 214/739 G3b4
- FIE No . 710 06/25 '03 15:06 I D : R L GOODSON FAX 214 739 6354 PAGE 3
Mountainview Country Club & Spa
Page Two
Some sloughing of the footing excavation was noted, Mr. Prusa and Mr. Riquelme indicated that they would
clean out the bottom of the excavation just prior to pouring concrete to assure a clean, firm bearing surface.
Mr. Prusa and Mr. Riquelme also agreed that they would check all of the grade beam reinforcing for adequate
concrete cover of 3" bottom and 2" sides prior to pouring concrete.
The typical footing/foundation wall section has been replaced by the contractor with a monolithic footing/slab
detail. Although this was not pre -approved by the Engineer of Record, the revised detail will be acceptable
with the following adjustment. The #3 double hooked stirrup/dowel that was substituted for the footing dowel
and the slab dowel must be placed at 12 inches on center maximurn (it was installed at 15 inches on center at
the time of this observation.) Mr. Prusa and Mr. Riciuelme indicated that this would be corrected and agreed
that changes to the construction documents would be presented to the EOR for approval prior to construction
in all future cases.
Sill anchors had not been installed at the time of this observation. Mr. Prusa and Mr. Riquelme indicated that
they would be tying the anchors in place at the required four feet on center according to the Wood Framing
Notes on S2.01. Mr. Prusa and Mr, Riquelme agreed to have the testing lab inspect the final rebar installation
and the sill anchor installation prior to the concrete pour.
Mr. Prusa and Mr, Riquelme requested a clarification on the installation of the hold down anchors at the ends
of the shear walls. The hold down anchors are to be installed per detail 04/S4.01. The anchors are to be
drilled and epoxied according to the Post -Installed Anchor Notes on S2.01 for accurate placement. It is not
our intent that these hold down anchors be tied in place prior to the concrete pour, but rather that they be
located and installed per the detail and notes.
Site observations and report by:
-7.
Ann -Marie ghty, Tx
Project Manager
cc: Hunt Fugate, Three Architecture
E gieaGoodson
avid rk
Presidentr�'�,ti
rij,5 34
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