9905-144 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 91(commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lia Class-Exo. Date
/ate_Signature of.Co
1),
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exemptffom the Contractor's
License Law for the following reason: J
( ) I, as owner of the property, or my employeeswth wages as their sole
compensation, will do the worR-and the structure -Isnot 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 Policy No.
STridli FUND ""g -9m i.!N1'1' 0016 r) s
(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
workersYcompensation laws of California, and agree that if I should become
su�eet to the workers' compensation provisions •f -Section 3700 of the Labor
�CC�+ode, I sh $/11 fohwith comply-with-tho- pro i'I
Applicant
Warning: Failure to secureorkers,Compensation ; o"erage is unlawful and
shall subject an employer to criminal penalties and civyil fine`s up to $100,000, in
addition to the cost of compensation damages as pf'ovided for in Section 3706
of the Labor Code, interest and attorneyssa ees��
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 0.
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. N
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 complyfwith all'Cfy, and Siate,laws relating to the building
construction, and hereby�@Lthorize representatives of this City to enter upon
the above-mentioned propeft fo_r iinspectio.purposes.
.Sig�ure (Owner/Agent)-- - Jy . Date nl
BUILDING PERMIT PERMITN
DATE VALUATION LOT TRACT
1.00 2
/b
JOB SIT
APN
ADDRESS fc4^�WFJr �A�Y`€tYiO�'F:(ilw>i6tl�0�f
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ROGER. MAINO
USj,iFal i, 0N,1*'IIUlTNG M'R,VIC DR
78005 SAN TIMOT1?0
512.75 C/ LLE QUITO
LA Q PINTA CA 97253
LA QUIN TA CA 92253
('l€()7'7t-2384 CIAL11 4999
USE OF PERMIT
t l lttl1.I'iU.IL,DDJOV
�i,k','i xi�iF i i'TL 11 i� i2�aiT +� 4 f►I.Mti2� r�DL�i I l'tJ. ;t00 STR03TURE
WNLY, 1N1Ti{ jWOF'1.'.t4138
SYSTEM AND ROOF 0JAfrHR Alb1MR. A:PPRt.:rVV t PLAN-
E43'��5IATED COST 0:, (::C1NS'1'Rt'C310N
0.001
erf.RMIT Fr4l SUMMARY
PLAN CHkI`f:1T EH 14)►-E►tltl -d39-; l �t �i:}5.t�)
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",1,\'�C"ONSt'?ZOCTION AND PLAN (144. K
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)TAI,
1999 LEeS €'R€iTAIA1:1�€ E S
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of XJ%
RECEIPT ti,
DATE
BY �"
DATE FINALED
INSPECTOR
I
I
INSPECTION RECORD
` OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings :-
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulatio1
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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 Condul
Rough Wiring
Low Voltage Wiring ,
Fixtures r
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp: Use of Power
Final
Utility Notice (Perm) "
COMMENTS:
LSMG CONSULTING SERVICES
P.O. BOX 1490, LA QUINTA, CA 92253
. (760) 771-2384
GENERAL ENGINEERING CNTRACTORS
CA LICENSE N0742117
Mr. Mark Harold, Mgr. Building & Safety April 14,1999
City of La Quinta,
La Quinta Ca.92253
Re: Remodel of 78005 San Timiteo , La Quinta
Dear Mark
As per your request, we herewith submit the Structural and mechanical conditions we uncovered
during the demolition and rebuilding of the residence. Because of the age of the structure, we had
to completely remove the entire roof structure because of bowed roof joists and de -laminating
plywood. Additionally, the following conditions were found and replaced as opposed to repair.
1. Foundation bolts were rusted, to a point where less than 1/4 " dia. remained.
2. All Copper piping was passed through the concrete slab without any sheathing.
3. Soil pipe, cast iron, was cracked and leaking.
4. Exterior water pipe was 3/4 " G.I, and was almost 1/2 closed off and rusted
5. All roof joists were bowed 2-3" .
6. All of the roof diaphragm was de -laminating and would crack under the weight of the workers.
7. All the glass was not tempered or at least aged such that when broken shattered as untreated glass
would behave
8. All wiring was low temp. cotton/paper wrap insulation
9. Headers over some windows were not bearing on king studs or trimmers.
10. Almost no metal straps /ties/hangers were used, no shear ties from joists to plates were installed
11. No hold-down straps /or tie down were employed.
12. No shear walls in the entire. house.
13. Exterior stucco paper and lath wire were stapled with perhaps 3/8" embedment into the 2x4 studs.
The complete house was re -roofed using mfg. trusses and sheathed with 15/16 OSB with 10d nails
to conform to the diaphragm nailing required by our structural engineer.
We have prepared an "As Built' structural and roof plan showing the shear walls and hold -downs which
were installed, and reviewed by our structural engineer.