9911-177 (SFD)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.
Ly Lic. Class Exp. Date
YYrrgg 1 y
(J.W2921,5 .� w lam.
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 (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. 1
( ) 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.
(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 asMo 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 shI l h comply.with fho provision
Dater ° Applicant "r-7.,
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 Tset 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 applicator 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 arid'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 l 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 Jepresentatives of this City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent)– ;140
400-
�
r J
PERMIT#
1
BUILDING PERMIT
'
DATE VALUATION LOT TRACT
e �y. i2 IY .' 1'S4ll/t._1ft 7 ..
JOB SITE "�"�
APN
ADDRESS
1
46.491. 9.0UML LANE'
' OWNER
CONTRACTOR/DESIGNER/ENGINEER
73-195 C-TUAD&:G1PR AVE
73.195 ti1.7A.'�.31,UPY AVE
1.63' :0n- MIG CA, 92261
PAL, -61 DESERT r_;.r1h f:2261
(760)341.0102 >vUTA 5811
USE OF PERMIT
ERAU DOES 1407' INCLUDE, KVICK VIAL1.1POWSPA OR
A,PPROACU OIZi.VP;WAY r -
TRACT CONSTRUCTION SIS
0ARAOFICAMPO •T
5 FT. Wool.) Ic'�:1�7�Ls ,.� � 200.0 LF
VS'l1�,�ki1:3:ED Wd`!:' G F Ct7+NMUMON'
1egSrzao
)NIS '��iadd•,I3f'pI•i�3:1t���1.�'' E 101-1[1I0l��i14,s✓a��ryX000 r1k?A:%I
4;.',
PLAN a:�HEC:K 1''A%a:'' Z�R"\�:.fW"n0.7 �J .��GF.=- rr :,.:.�!"."+'7.�3�,. ...
•.
a1I't 11 %Cam nt •.;,.1KQ•1.OQO 1
.
ELIEC;TRUCA.L il'�ls
8Tk0!dG MIOTI H .F", 3 MID 101•-000-2,43 000 Gf5.9�
51RASJ31IO".!it 101-t3t3�•:=a'.23�f3
D;;Z EL��f.C��PERp. F:�y9PIAC' f PF 36?tir[�7.li�1,0y
t9
� -3445 situ, VS
N+
�A(yLfU.gLCISE
yCCUF!9R 9 d �y REEK �10'11...r,, �1}�rtt7.4y
ART A7•�7 PUBIL TC P1,AC&S ., 15.1�'.EK 01 "i��Cf••� 7 �"�flL.� �LMI.�t• Vi?
FEE i7M)= 101.000.439-418 -825q,00
} SUB -TOTAL COihF'u�'i'.�AT!' '{e9Ay{.tA1iW1TLO AlPh CHEM
$4,260.42
1203 r-R,,RPATDF1?QSD
`.4.LL.;c?'
101M- T-1 <T�MC YN DUE NOW
$4,0:10.42
JAN 26 20101
RECEIPT
DATE i�
BY
DATE FINALED
INSPECTOR
RECORD
INSPECTION a
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
r
Set 8 cks
31 c�
Underground Ducts
Forms & Footings
3 q_
-�
Ducts
Slab Grade
3
Return Air -
Steel
Combustion Air
Roof Deck_
Exhaust Fans
O.K. to Wrap
Sl o
F.A.U.
Framing
Compressor
Insulation _�� ��
��_�
Vents
Fireplace P.L.
f
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
015 L—. 1 1�
Imo
Final I
Final
POO S - SPAS
BLOCKWALL
APPROVALS
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
Waste Lines
_
fj��f $lob
Cid
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
� _
L(p
�
Pool Cover
Encapsulation
Gas Piping
_
Gas Test
Appliances'
Final
COMMENTS:
Final-001�
Utility Notice (Gas)
f 'G
ELECTRICAL APPROVALS
Temp. Power Pole
fl�2� oCe
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
GTI
Smoke Detectors
Temp. Use of Power
Final
I• `
Utility Notice (Perm)
V..
1
F
Building
Address
Owner / ¢ Clic= a t yN
Mailing
Address
City Zip
Contractor
ress
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
S j' LA QUINTA, CALIFORNIA 92253
(—,l9(
Zip Tel.
.DING: TYPE'CONST. OCC. GRP.
Number % V 9_ 05- 00 7�S �i0 7
Description
:t Description
RECEIPT City of La Quinta, 78-495 Calle Tampico, P.O. Box 1/5�04pu nta,CA 92253 /
en DAT V 20� 4�C�'���
RECEIVED FROM
ADDRESS _ n I I ��� n n i i
At,000NI HOW
AMT. OF CASH
ACCOUNT
AMT. PAID C CH K
BALANCE
DUE ORDER
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above•
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
DOLLA
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side.Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Datei
Validated by: , ty ojm
Validation: lifet
Vt
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
/
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
.
Stories Units
Arch., Engr.,
New ❑ Add O Alter ❑ Repair O Demolition O,
Designer
Address
Tel.
NO 7-
. G9 T.6
City
Zip
State
''
/ 2.5-o -f"-
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license Is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Permit to construct, alter, improve, demolish, or repair any structure, prior to ,Its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis-
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1'2 1, 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, Bulsness and
Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
.0 iTari that such improvements are not intended or offered for sale. If, however, the building
Estimated Valuation
PERMIT AMOUNT
r_.
Plan Chk. Dep. 2- 0
Plan Chk. Bal.
Const.
Mech.
Cl_,#r; I
Ma h„rrtaa
RECEIPT City of La Quinta, 78-495 Calle Tampico, P.O. Box 1/5�04pu nta,CA 92253 /
en DAT V 20� 4�C�'���
RECEIVED FROM
ADDRESS _ n I I ��� n n i i
At,000NI HOW
AMT. OF CASH
ACCOUNT
AMT. PAID C CH K
BALANCE
DUE ORDER
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above•
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
DOLLA
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side.Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Datei
Validated by: , ty ojm
Validation: lifet
Vt
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 12/28/00
No. 21424
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameKen & Cherlyn Cates
No, 46-491
city La Quinta
Street Roudel Lane
Jurisdiction
APN # 649-051-007
Permit #
Log #
Zip 92253 Study Area
Tract # Lot # 7 Square Footage 2760
Type of Development Single Family Residence No. of Units 1
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
2.05 X 2,760 or $ 5,658.00
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
P_
IR M -
t � �R
Fees Paid By CC / 1st Bank / Kenneth Cates
ephone;t760-*341-0102
Name on the check
v
By Dr. Doris Wilson
r
Superintendent
Fee collected /exe ted by Annette Barlow
Signature
Payment Received $5,658.00
Check No. 57267
NOTICE: Pursuant of 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
above 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 District(s) or to another public entity authorized to
collect them on the Distdct('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
/ CITY OF LA QUINTA SUB -CONTRACTOR LIST /
JOB ADDRESS `96 - J-01 (�i .Oc / A-,h/;PERMIT NUMBER OWNER ,4e:6s✓ 6I-y,�rs BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes .to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stopp a of work and/ the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable respons .3—C91vo�-
Trade /Classification
Contractor -
State.Contractor's License
Workers Com ensatioa Insurance
Cit Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
Ixx/xx/xx)
EARTHWORK (C 12)
moi/
90 p
cCn�D TL X.,i
O - 3 �30f, - O
l .x ? O /�
O
(o r
CONCRETE (C-8)
.c( 7 3. O
�' �! 0.2
Un►l�P kt . Ca. k
z a Dg4D X
l l
0
(C!.5)�C
FRAMING IC
,C3
'�77-2-5 o x
�o o�
/oh /.�Sc�.r� a �• X
wesloigOS/•"t� X
/o/ 70X
STRUCT..STEEL (C-51) .::
MASONRY (C-29)
C '
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e 0 O,lb
C
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Q�/•Z It 6
PLUMBING I6=36)
1
C. -,a
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711+,1,01
LATH: PLASTER (C-35).:
.ZAP .[AS lie/dGly
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ELECTRICAL .IC -101 ;.
ROOFING C=391_
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X300
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5HEETMETAL (C431
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/5 K
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GLAZING (C-':17)::,., <.:
C - 7
6s ? /_2M
/ /
X
0-%i ,3
/I �OI '
C 0
INSULATION X:21 ::
/ ,v S -- K
X
7
3i o�
of.
SEWAGE DISP. (C-42)
PAINTING (C-33) > :; ::.
1 Y
G'
> >
03 O Z
7`
59� X
7/ O
CERAMIC TILE.(C-54) ,::
2 - j
x
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7
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09
1'agCABINETS
FENCING (C -13I .'
LANDSCAPING. (C=27) :.
POOL
10
J
is -
YOUNG ENGINEERING`SER VICES
• Engineering • Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of La Quinta
Attn: Greg Butler
Tel
No.:
We are forwarding: By Messenger
No. of Copies
1
1
1
1
1
Date: 1-22WU,1
Project: PC#9911-491 (2" check)
46-491 Roudel Lane
W. 0.:
Tract No.:
Description:
Plans (1s` submittal)
Plans (2 Id submittal)
Structural Calculations
By Mail X Your Pickup
Structural plan check responses with coresponding calculations
Truss calculations w/Letter of Acceptance
Comments:
Greg: All structural plan check comments have been adequately addressed. "OK" to
issue building permit.
This Material Sent for:
Your Files X Per Your Request
Your Review Approval
Checking At the request of-
Other
fOther
By: John W. Thompson
Phone # 342-9214
47-159 Youngs Lane • Indio, CA 92201 • (760) 342-9214
•Bron Young •
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, 'CALIFORNIA 92253
January 8, 2001
To: Whom it may concern
(7 60) 777-7000
(TDD) (760) 777-1227
Re: Assessment District 2000-1, Phase VI Improvements -Areas A, B, C & D
The Property Owner: ✓�� L �r-cs APN Off/ - 6V 7
is located within the City's current sewer assessment district. The City anticipates construction of
sewer facilities within the referenced project limits .beginning in mid to late _ J 6W_ d �j
expected to be completed in lat you have any questions regarding t e project pleas //
don't hesitate to contact me in ely at 777-7045.
Sincerely,
Jo M. Free
Se 'or Engineer
c: Tom Berg, B&A
Project File 98-19A,B,C&D
T:\PWDEPTPROJECrS\98Prycts\98I9PhVNetoas\CmricSwrMmo.wpd ���
COPY to:
N
ii
0834G80
Date P -
Tract
TOTAL
Water Service(-
Cashier
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: 619-_�(I",tk 1
C, c
Address: 713 C6
Account No.
Lo
Service 3ss-\4
0" L 13"(_
C
• Meter(s)
• Service(s)
• Backflow(s)
• House Lateral(s)
• Detector Check(s)
0 Meter Surcharge
"I,
Lc�'Sanitatlon Capacity Charge
5_5
0 W.S.B.F.C.
• Temporary Construction Meter
• Turn on Charge
• Uncollected Account - Name
• Inspection Fee - Tract -
Fee -
• Plan Check Fees Water / Sewer -
Tract -
0 Bond Payment - A.D. --Bond
Assmt.
0 Customer Deposit
0 Other
COPY to:
N
ii
0834G80
Date P -
Tract
TOTAL
Water Service(-
Cashier
Certificate of Occupancy''
City of La Quintal
Building and Safety Department 0IF..��°`�v
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
46-491 ROUDEL LANE
Bldg. Permit No.: 9911-177
Type of Construction: VN Land Use Zone: RL
Owner of Building: KEN & CHERLYN CATES
Building Official
Address: 73-195 GUADALUPE AVE.
City: PALM DESERT, CA 92261
.By: STEVE TRAXEL
Date: 07-16-01
POST IN A CONSPICUOUS PLACE
March 13, 2000
From: Ken Cates, Contractor
Visions West Remodeling & Construction
Lic. 722925
To: Gregg Fox
Laquinta City Building Inspector
Re: Missing Foundation Detail @ Front of Garage
Gregg,
In researching that missing detail at the front of the Garage, what we came up With is
actually n error. There should have been a "Simpson Strong Wall" at that location, and in
fact (4) of them across the front of the Garage. Since the bolts are not in proper location
for that, I contacted Simpson and they sent me the attached information on retro -
installation of those bolts for the "Strong Wall".
I am assuming you will want to check the depth, size and so on of the holes that will be
drilled before the bolts are epoxied in place. Would you please call my cell # 413-9037
and confirm that with me, and once the holes are drilled I will call you for your
inspection if it is indeed required.
Thank you Gregg,
Ken Cates
M4R-13-2003 TUE-08:36 AM SIMPSON STRONG TIG ENG FAX SIO, `26847306:
. SIMPSON STRONG -TIE® COMPANYs INC.
The World's "No Equal- Structural Connector Company
4120 Dublin Boulevard of Suite 400 • Dublin, Calitotnia 94568
phone: 925/560-9000 • FAX: 928/533.1496
March 13, 2001
Ken Cates, Visions West remodeling and construction
73195 Guadalupe Ave.
Palm Desert, CA 92260
Ph: (760) 340-1976
Fax: (760) 341-0102
RE: Lpoxy Repair of Anchor Bolts
Simpson Strong -Tie SET high strength epoxy may b'., used v 7th :he appropriate threaded rods as an
alternative to cast -in-place anchors or, as required, for field repair:: due to misplaced or omitted anchor
bolts. Anchors shall be installed in accordance with the following requirements:
• Existing concrete strength shall be 2000 psi or greater. When- applies, guidelines shall be
established, by the engineer of record, to avoid `drilling near' pest-tensio►ied cables.
• If the Strong Wall is not in place, then the. corresponding Simpso Strong -Tie template should be
used to ensure the anchors are installed vertically plumb and at the correct locations. If the Strong
Wall is in place to remain, then slight overdrilling of the 5/8 inch anc:'�or bolt holes will be required
for installation of the shear anchors. This oversi2ed mudsill hole shall :>�- filled with epoxy after the
final position of the wall is set. if the holdown anchors need to be installed then one-time removal &
reattachment of the pre -attached holdowns is permitted for installation accessibility. Epoxy fill
of the mudsill shall not apply around the 7/8 inch diameter holdown epoxy ancrors. Angled
installation of the epoxy anchors with the use of a bent bolt is also not permitted.
• For the holdown bolts, drill a 1 inch diameter hole and install a 7!8" &-ameter A307 threaded rod
witn 15" mir4zitozn concrete embedment, 1 %" minimum cgncrete edgt distance, 5" minimum
concrete end distance and a minimum projection of S inches above the ;oncrete.
• For the mudsillbolts, drill a % inch diameter hoke and install a 5/8" di. n.eter A307 threaded rod
with 5" minimum concrete embedment, 1 3/4" minimurn edge distance, 7 1/2" minimum end distance
and a minimum projection of 4 inches above the concrete.
Epoxy capacities are in accordance with 1CB0 ER -5279 which exceed the demand .requirements
of all Strong -Walls. Special Inspection may be required in accordance with the lo. -,al building code.
Sincerely,
SIMPSQN STRON -TIE C0., INC.
Louay �ou�kh, P.E.
Research & Development Engincer
CC: Mark Crawford, Karen Colonias, Jerry Gridley i
May 14 01 05:39p
Island Links Resort (843)681-3994 p.l
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