0202-008 (AR)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
f^apter 9 (commencing with Section 7000) of Division 3 of the Rtisinass and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
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.
(,,.) 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 =1". 11-`; 7 @:FN.J'r 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 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
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 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
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
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USE OF PERMIT
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' CHARLES ®. CARLANC '
c1l"I Architecture, Interiors, Space and Land Planning
• �+ Structural Calculations
21 August 2002
The City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253 '
Project: The Single Family Residence for:
The Schlesinger Family at:
78-023 San Timoteo -J:. •, f
La Quinta Golf Estates t: 1
La Quinta, California
Regarding: Project Observation
To Whom it May Concern, 1
I have recently performed structural observations for the project noted above at the request of the owner
and Tom Kennedy, the general contractor for the project. These observations were on behalf of the En-
gineer of record, Hossein Zand. In particular, two areas were chosen in the field to change the roof con-
struction from flat roof design to 4 and 12 sloped roofs. My observations found the construction and de-
tailing for the sloped roofing to be compatible with the construction documents I was provided and were
sufficient to support and transfer the loads properly.
I also observed two (2) shear walls that were specified to have 3x PTDF sill plates and 3x studs at abut-
< ting shear panel joints that did not have the noted specified construction detailing. I have instructed the
general contractor to stitch nail the double 2x studs at the panel'butt joints with 10d at 6" o/c side to side,
staggered. , With regard to the missing 3x sill plate, I am herewith submitting the attached detail that I
have found to be sufficient in the past when 3x sills have been missed and which I find can support the
loads for this project.
All other -aspects of the structural systems weee observed to be in substantial conformance with the strut-
-tural design intent of the construction documents. :4
If you have any questions or comments regarding these issues or any other issue please do not hesitate
in contact'R my firm. ® ,q• ti
Sin re ���5 D. �q
�
No. ell 91 p '
Chart s D. Garland
Architect >► EXP. AT6 Y ,
Encl. ,
744154 Velie Way, Suite 5 o Palm Desert, CA 92260" ❑ Phone: (760) 340.3528 ❑ Facsimile:, (760) 340-3728
C11M
IARLAND' '< .
Architecture, Interiors, Space and Land Planning
Structural Calculations
=--
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:
Certificate, of Occupancy
. T4ht * 4 4Q"
Building &Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, thisstructure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 78-023 SAN TIMOTEO
Use classification: S.F.D.+
Occupancy Group: R-3
Owner of Building: M/M SEHLESINGER
Type of Construction: V -N
a
POST IN A CONSPICUOUS PLACE
Building Permit No.: 0202-008
Land Use Zone: R -L
Address: 48-751 SAN PEDRO ST.
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 10/18/04
JCM Inspections
39725 Garand Lane Suite F
Palm DesertCA 92211
Y N S P E C T I O N S Phone: 760-345-5554 - Fax: 760-772-3895
-
rs.
I,
I N S P E C T I O N S
EPDXY INSPECTION REPORT
Date— _�
Project Name: n Project No:
sLSL
Project Address: City:
(0oz ` rn ��+�o u `0..
Title 24 AWS
File # E] D 1.1
App# D 1.4
❑ Other
UBC Other:
Client: Sub-Contractor:
General Contractor: Architect: Structural Engineer:
C\. CA XO C- A O
Anchor Bolts Rebar
r 1 n
Epoxy Type: ° n S�T I`O (` oil CT
Epoxy Shelf Life: SL' eca� •' X003 .
.
Hole Cleaning Method(s): CtQa,
WeatherSU.r1
Unresolved Items:
� None
See Below
Description of Work Inspected: 0
r I
t
LA
r—nipq AS
'&6 &G✓o f`o A�
C. C ai Ld V i t 1.: oSLu
' ILL
V.pIr
Work complies with written approval from Structural Engineer and ICBO Evaluation. Report # ci
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 work to comply with the approved
plans, specifications .applicable building laws. Final report issued at project completion.
Inspector. Jack C. Millin ICBO CA ation No: 0842216-49
Contractor's Representative:
Copy 1 JC>In'spections Copy 2 Project Superintendent Copy 3 Governing Agency Page of