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�