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0304-227 (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 6922v, B :Elle 07/31/2( Dat" a r^) 023Signature of Contractor i 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 compensatioh, Will do the Work, and the structure is not ihtehded o'r offered t6e 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 Sion 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 FUID) Policy No. 044-02-16014319 (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.oflSection 3700 of the Labor Code, l shall forthwith comply with,those'provisions. - rDate: ?O 11 ;Applicant f f�4 .. .f /l, —A.I 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 perso whose request and for whose benefit work is performed -under or pursua any permit issued as a result of this applicaton agrees to, & shall, inde & hold harmless the City of La Quinta, its officers, agents and employ 2. Any permit issued as a result of this application becomes null and v if work is not commenced within 180 days from date of issuance of uch permit, or cessation of work for 180 days will subject permit to caricell ion. I certify that I have read this application and state that the above informati correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to J%er upon - the above-mentioned property for inspection purposes. ,signature (Owner/Agent) �� !. Date IBUILDING�PERMIT PERMIT# • 0304-227 DATE ) VALUATION LOT TRACT $16;370.55, it'L I "3 ADDRESS S - ST d�T. A't. 'X 4�+P�3yG.1"i.Rl? APN 761-017a-IDZ}L OWNER CONTRACTOR/DESIGNER/EN (NEER QUARRYRANOX.12Z C & G CO3+ K'RUCt'fON 1 QUARRY 1AAKE 965 )P6avWSFI, :ILECON D A'd'1 (ir 1..A QUOTTA CA 92253 LTLAND CA 91756 (909)932.9965 C13LO 3539 USE OF PERMIT WIZ COURSE P1JMP HOUSE 13UILDIiNO (515 5.r.)' ITH 57 LF 51 �l 1zUb N }3itJG4� &if1�,LI, s 2 CicOtXr?A Cii T'4"l'F� •!fN (26tH CDC) 61x1'. WALL 47.00 V CONTRACT AMAUNT 15,553..00 1-3 '? lt,MVnrD C691' OF C4nS`%kZUC'110.bT PP!Mrf F99 SUMHARY COWSTRUCT1014 FEE 101-000-418-000 $180.00 ' PUY M'HL01K FEF, $149.09 MEC MICAL F1•;L 101.000.4.21-000 $21.30 ZI.X..0 TIU.CA], FRE 101 _0)0-420-000 $60.00 STRO140 M071014 FEE = COMM `100.0001 241 -000 53.113 ORAD) 0HFZ 1.01-000-423-000 $15.00 ART 1N PUBLIC P;j AC&4 • COW 270.000-445.000 $32,$5 PLUM)5)NO FEE . 101-0010+»419-000 SZ 3.OQ CAL C0.,1�1^�1'Fl,�UCITON AND 13I,/tNG'.•W $53$.511 IMS 'PT.aPAW T'.&.P.,S $07.00 2 3 2003 roI'm ?���� FICES Duxcoo �LA FFI QUINTACE DEPT.,. ;, RECEIPT DATE o BY ' DATEFINA D Z . f 2 OJ' INSPECipR 6 lv- INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade Ducts 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: kA Uri law 1.Ci. `tel 1. •� t 4 \�'1II���'- ••(pS�YAPvry P.O. BOX 1504 f�ilding,� %1 78-495 CALLS TAM1504 O APPLICATION ONLY r address+V`' LA QUINTA, CALIFORNIA 92253 Owner tiq�� tea. LLC, ; Mailing j BUILDING: TYPE'CONST. OCC.�GRP. Address I �ar� Lghe A.P. Number ! CityZi C—A 7-15 Tel. o-21� i yg-l�2� Legal Description .Contractor Project Description Address �� O s �5 e City _ Zip Tel. �otA State Lic. City / & Classif. - Lic. # Sq. Ft.No. I No. Dw. /T Arch., Engr., Size Stories Units Designer New)4 Add ❑ Alter ❑ Repair ❑ .Demolition ❑ Address Tel. y Zip State C alp c CA 2?.coa Lic. a C 13� ► 3 A Name of Contact Person- Sq, Ft.: # Stories: # Units, X Telephone # of Contact Person: stimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE d Submittal Req'd Recd - TRACKING ' PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed. ready for corrections 903 Plan Check Deposit Truss Calcs. Called Contact Person 903 Plan Check :Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan ?nd RevieN, r dy for corrections/issue B4 Electrical Subcontactor List Called Contact Person �i'L� �� Plumbing aL Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading ' IN HOUSE:- '"' Review, ready for correcti s/issueDeveloper Impact Fee Planning Approval Called Contact Person, .r N _J A.I.P.P. Pub. Wks. Ap.pr Date of permit issue School Fees - _ � r 6-3;OK.:�ISLScJff74a/ "-'�, --.•., ..- Total Permi: Fees., t &441 - Dhns Manv>>lle ❑ SR -50 X SR -60 ❑ SR -8 ia;:^cr[i;iier[ Solar iteflectanes UltraGard SR -50, UltraGard SR -60 and UltraGard SR -80 mem- Solar Reflectance values are: New (83%); branes are non -wicking weft inserted polyester reinforced, for Three-year aged (76%) and Emissivity is (0.9). mulated of an ultra-violet-resistantpofyv'myl chloride (PVC). (For white membranes only.)' Placement of JM Membrane UltraGard SR -50, UltraGard SR -60 and UltraGard SR -80 mem- JM specifications require treated wood nailers to be installed branes can be installed in new, reroof (tear -off) and recover according to Factory Mutual current recommendations in Loss roof constructions: In recover construction, if the existing roof . Prevention Oata.Sheet 1-49 and'currentJM Detail Drawings. is sound, the Johns Manville (JM) roof system can eliminate the Insulation must neatly fit around all roof. penetrations and projections. cost of disposing of the original roof. UltraGard SR -50, UltraGard SR -60 and Ultra6ard:SR-80 membranes are installed over Insulations used must be accepted by JM for use in the.system to approved cushioning layers or insulations, when required, and -be installed. Fastening of the insulation must be in strict accor- •secured.to the roof deck utilizing either mechanical fastening dance with JM standard fastening requirements and/or any methods that have been tested for wind uplift in both dynamic applicable code requirements, whichever is most restrictive or and static pressure vessels or adhering the membrane to an required by the building owner. . acceptable substrate. JM PVC membranes are thermoplastic; therefore, when rolled out onto the roof substrate, they can be ftlathad of Attachment easily welded into one homogeneous sheet using hot air weld- The membrane may be attached using either the adhered or ing procedures. An independent seal, JM Sealant consisting of mechanically fastened methods. For the adhered system, the mem- the same material as the membrane itself, is applied at all non- brane is adhered to the appropriate substrate with JM Membrane encapsulated or cut edges of the membrane seam. edge.. Adhesive. For mechanically fastened systems, JM offers a disk and Consequently, no dissimilar materials are'used to bond: the fastener system which is installed within the laps at increments as seams, allowing.both the sheet and the seams to have the ' determined by the applicable building codes, specification criteria same strength and aging characteristics.. or printed guide specifications and/or technical data. mi t3 UltraGard SR -50, UltraGard SR -150 and UltraGard SR -80 mem- Tvypica; Physical Properties branes are mechanically fastened or adhered to the structural properly Test tiAetlrod Values roof deck according to FM requirements, published standard Thickness ASTM D 751 0.05(' 11.3 mm), fastening patterns or adhesives recommendations. The mem- 0.06(.11.5 mm) or branes should not come into direct contact with asphalt, coal 0.080' (20 mm) tar Och or any petroleum-based product Breaking Strength .• ASTM D 751 .i2(16 -lbs. .. (35 kN/m)' Elongation at Break ASTM D 751 >20% - Factory 75° (1.91 m) wide sheets, in standard lengths as follows; Retention of Properties SR -50 x 80' _ (24.4 m) After Heat Aging of Membrane SR -60 x.1 00- _ (30.5 m) (1344 hrs. at 176°F [80°Cll SR -80 x 50`-_-(1 5.3 m) Breaking Strength ASTM 0.751 >90% of original Elongation ASTM D 751 >90% of original Tear Resistance ASTM D 751 A5 lbs. . White: Other colors are available by contacting your sales rep- Low Temperature Bend ASTM D'2136 Pass at -40°F (�0°c) resentative for information.. Accelerated Weathering Test ASTM G 26 Cracking (@7x magnification) None ?, sPc. hEr 5i ndards Crazing (®7z magnification) Negligible . JM Mechanically Fastened and Adhered Roof Systems are clas- Discoloration (®7x magnification) Negligible sified by UL (Underwriter's Laboratories, Inc.) and'ULC Linear Dimension Change ASTM D 1204 <0.5% (Underwriter's Laboratories of Canada), Warnock Hersey and 6 hrs. ®176°F (80°C) - Factory Mutual. In addition, JM membranes are approved by all Change in Weight After ASTM D 570 '<3.0% , three Model Building Code Standards: SBCCI, BOCA, and ICBG.Immersion in Water The PCV sheets meet all of the requirements of ASTM 4434. 1168 hrs. ®158°F [70°C) IGV20 62105 Refer to the Material Safety Data Sheet and. Product Label prior to using this product For en identical copy of this data 3-2 sheet, ask for RS -8057. - EZ�r�