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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
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 +, ''A I //j .r, a.f
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.
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 i -, %+ , : a . � 0
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 resdlt 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) / �/� ' r +'� + „ Date
BUILDING PERMIT PERMIT CONTROL#
M01.s
5674
DATE S�)� VALUATION S 1 fy.6.1,4 RACT
4 LOT T
ADDRESS I7-53 t C.tii�.i•I, �-'fIMHiJ�l�MA JOB
APN 774-051-093
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MAN Al?akNA
UWNEf; l BUILDER
USE OF PERMIT
13t!iLDJN%.f
►:t. WIIA; I i PAKAI't;s t. ri11V 0AfW,,01 j&h„ 4_1A_,ht: f & i 18i'.1 Ln)
,ii:ii3t rii}Td ::SF CA t SF
IK.+K<A111'A I R -s 2+ti€.rrt; SP'
P, k ti NIATED �1. t. 1i 1 �.ilkt �-E.)NK.i~RUCi ION1
f'ialKt�i1 f i� f�.[�. �it1A"ist►t�5#di
f'f.AN +'ifIi- X I•Fii 14)1 -000-4 0- 41x S i I" wo
+'411N4tt'd?t+'+'i•10NtR:N fill•((())(//MX�)-41X4W s1r1,K+rt�t►
�4ila •t���ia(�.�f�l. I�I:ts 101,_000-12! (T(1(1
fJ.I:t."1'lilt A1. ! I:Is 101-UUt►•_I.'►1. mom �..t+►��
+N.11fV1+tftic.� f ii(! to1-()f) )_410 (0) w
f"Upt)WIN11e'1)fJI'VU-RPS11) 101.00)•'=11 (Mtir,j
tilt�if)fP'lt.; i f1i .UI 10) 123 (M) tio9t(ifI
R( 11140'Af, 00INCI10 1(710N ANT II 11f.AN VIIVC K
$vg) `n
If )VAI, drlfi'htll01' Fir.FS MIl+.INf W
5,3*)f1.1f1
RECEIPT
DATE.BY/
DATE'FINALED
INSPECTOR
INSPECTION RECOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
L
F.A.U.
Framing
yjij
Compressor
Insulationq
Vents
Fireplace P.L.
(
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
steer,
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
-
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final '
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover i
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICA #—A
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r
Final
Utility Notice (Perm)
COMMENTS:
~°
Contractor: 0%,�N -9— it– Telephone:
Address: Project Descripfion:
Telephone: struction Type:
Con Occupancy:
State Lic. Prdiect type (circle one): New Add'n Alter
Name of Contact Person: Sq. Ft. # Stories: # Units:
Televhone # of Contact Person: -- Esti=ed Value of Project:'-
CONSTRUCTION ESTIMATE N0. ELECTRICAL FEES NO. OLU48ING FEE•$
!ST Fl_, iJ FT ,t =
UNITS -
URDERGROUND
A.C. WMT
COIL, AREA
YARD SPKLR SYSTEM
1n0 Fl. SO. Fr. .�
BONDING
HEATING (ROUGft
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT •i<
DUCT WORK,
ROCK STORAGE
GAR. SO. FT. •d
POWER OUTLET
ROOF DRAINS
BAR P sO. FT .4
OTHER APPJEOW.
DRAINAGE PIPING
WALL SO FT 'R
TEMP. POLE
DRINKING FOUNTAIN
SO cT. a,
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION S
FINAL INS/
WATER Pt PING
NOTE: Not to :e :sec at; lroceny :ax .aluat on
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM PAN EVAP.COOL ,000
SIGN
WASHER(AUTOXOISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT MALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B•T U
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. 4ip c
BATH TUB
SPARK ARRESTOR
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESIO q 1% a
SEWAGE DISPOSAL
LATHING
SO.FT.GAR a isc
HOUSE SEWER
GAS PIPING.
PERMIT FEE
PERMIT FEE
PERMIT FEE
OBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMO FEE
STRUCTURE PLUMBING ELECTRICAL HEATmGAAIR COMM SOLAR
SETBACK
I GROUND PLUMBING
URDERGROUND
A.C. WMT
COIL, AREA
SLAB GRADE
ROUGH PLUMES
BONDING
HEATING (ROUGft
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRNq
DUCT WORK,
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH
METER LOOP
HFATWO(FINAU
OTHER APPJEOW.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INS/
BOND SEAM
WATER SYSTEM
GRAOIIM
�p4
LUMBER GR.
FINAL INSIP.
FRAMING
FINAL INW.
ROOFING
Rim
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWBOUNO
FINISH GRAOING
r
FINK INSPECTION
cm. OCC.
_ c@tJCE RIMAI
INVECTOIri iIOtMTY11RI1N1TIALi .
GARDEN WALL FINAL
JUL-31-97 12:58 PM SMOKETREE->SECRETARIAL 760 325 3264 P.01
ARCHITECTURE • INTERIOR DESIGN
JAMES A. MCBRIDE II
July 31, 1997
City of U Quinta .
Building Department Plan Check Division
Attn: Mark
Dear Mark:
Dave Grimmett is authorized to locate sheer panels as required by UBC
Engineering Standards fur the existing dwelling on 77-535 Chihuahua St- in
accordance with nailing requirements as shown on drawings and as approved by
the City of i yd Quinta and any other minor adjustment required by the City of La
Quinta for this specific project.
Thank you.
Sin crely,
James McBride. II
Architect
619-323-3314 • FAX 619-323-35 t 5
P.O. BOX 5078 • PALM SPRINGS, CALIFORNIA 9.2263
mr�� ICBG Evaluation Service, Inc.
cow n 5360 WORKMAN MILL ROAD + WI.111TIER, CALIFORNIA 90601-2299
'"'I' A subsidiarycorporatioli of the International Conference of Building Officials
EVALUATION REPORT ER -4630
Copyright 01996 ICDO Evaluation Service, Inc. Reissued August 1, 1996
Filing Category: HOOF COVERING AND ROOF BECK CONSTRUCTION—Roof Covering (202)
PERMAX 108 ROOFING SYSTEMS
RESIN TECHNOLOGY COMPANY
2270 CASTLE HARBOR PLACE
ONTARIO, CALIFORNIA 81761
I. Subject- Permax 108 Rooting Systems.
II. Description: A. General: The Resin Technology Corporation's Per-
max 108 Roofing Systems consist of spray -applied foam plastic and elas-
torneft coating. The foams are classified as RT -2030 and RT -2031 poly-
urethane foams. The coating systems are labeled as Permax 108 grey
base coat and Permax 108 white top coat. Foam thickness, density, coat-
ing information and roof -covering classification for the various systems
are in Tables 1 and 2. Typical roof penetration and flashing details are in
Figure 1.
8, Deck Preparation: Root surfaces must be free of grease, oil, dirt,
sediment and moisture. All surfaces, not covered with foam, must be
masked oft or otherwise protected from overspray. All parapets, cilckets
and valleys must be flashed In accordance with the code. Where precast
concrete planks aro encountered, all joints must be taped with minimum
2 -Inca -wide roofing tape identified as DT -100.
New plywood decks must be primed with a neoprene primer. New con-
crete decks must be allowed to cure at least 21 days prior to application
of foam. The surface Is then primed with a catalyzed urethane primer.
New metal decks are primed with a two -component wash primer. Gaps
In end or sidetaps must be sealed with an approved sealant.
Where wood decks aro permitted, the deck may be covered with a vapor
barrier in accordance with manufacturer's specifications and with the ap-
proval of the building official.
C. Foam Plastic Application: The foam is spray applied to the prepared
substrate in minimum 1/2 -inch -thick passes to thicknesses noted in Table
1. Wind velocity cannot exceed 12 miles per hour during application,
Application shall not proceed if the ambient temperature is less tharr 40°F.
or if the substrate temperature is leso. than 50°F. The foam ciinnot be
applied over wet substrates or If rain or inclement weather is imminent.
'fire foam is applied in a one-to-one ratio with equipment capable of me-
tering each component within plus or minus 2 percent of the design ratio.
If the foam application is terminated before the final thickness Is attained,
additional foam may be applied within 24 hours, provided the existing
foam is prinied with a catalyzed urethane primer and a minimum of
112 -inch foam is applied in a single pass. The foam must be free of bumps,
pin holes and ridges, Any of these irregularities must be eliminated,
D. Coating Application: The coating is applied in two coats of contrast-
ing color at a rate specified in Table 1. The coating cannot be applied if rain,
tog or inclement weather is Imminent or if temperatures below freezing
are anticipated within 24 hours of coating application.
E. Existing Roofs: The roofing system may be installed over existing
roofs, provided the substrate Is as required for the system. The existing
roof covering may remain In place if permitted by the building official
In accordance with provisions set forth In Appendix Chapter 15 of
the Uniform Building Code,The roofing systems described In this report
may be installed over built-up, composition, or asphalt -single roof cover -
Ings recognized by the code and the roof classification will be as noted In
Table 1.
Prior to foaming, the surface must be prepared as noted below to as-
sure adequate adhesion. All loose rock, cementitlous coatings, peeling
paint, dirt and debris must be removed by brooming, power vacuuming
or wire brushing. Blisters in the existing roofing larger than 6 inches In
diameter must be removed from the roof. Blisters In the existing roofing
less than 6 inches In diameter are to be slit and nailed with 1 -inch roofing
nails.
Curled asphalt shingles must be either removed or nailed to the deck-
All
eckAll projections through the roof deck must be sealed with roof mastic. Par-
ticular care is to be exercised to seal under all roof -mounted equipment
with cold -process asphaltic products and to prevent roof depressions
when it is not feasible to spray foam, The surface Is then primed with a
chlorinated rubber primer at a rate of 200 square feet per gallon and al-
loyed to cure a minimum of one hour prior to foam application. Spray
applications are subject to the same conditions as listed In paragraph II -C.
On flat surfaces, the foam may be built up to provide a slope to assure ade-
quate drainage provided the maximum thicknesses noted In Table 1 are
not exceeded. Where the existing roof covering is removed to the,sub-
strate, the deck Is prepared and the foam plastic is appliecl as set forth In
paragraphs (l B and II C, respectively.
F. Identification: All material drums and containers are Identified by the
manufacturer's name and address, product designation, the evaluation
report number (ICBG ES ER -4630), shelf life, and an Underwriters Labora-
tories inc, label noted as (R-10185, BW -345),
Ill. Evidence Submitted: Reports of tests In accordance with U.B.C.
Standards 8.1 and 15-2, Are Test Standard for insulated Roof Deck
Construction (UL 1256) and Acceptance Criteria for Membrane Root'-cov-
cring Systems dated July, 1992 (corrected April, 1994).
Findings
IV, Findings: That the Resin Technology Company Permax 100 Roof -
trip Systems described In this report comply with 1994 Uniform Build -
Ing Code"", subject to the following conditions:
1. All system components are prepared and applied by qualified
personnel approved by Resin Technology Company.
2. The roof -covering system Is applied In accordance with this re-
port and manufacturer's Instructions.
3. Where moderate or heavy toot tralfic occurs such as for malote-
fiance of equipment, the roof system must be adequately pro-
tected to prevent rupture or wearing of surface.
4. Where plywood sheathing, Installed In accordance with Section
2602.5.3 o1 the code, or noncombustible cementitlous sub-
strates ate provided, a thermal barrier is not required.
)valuation reports Of ICDO Evaluation Service, Inc., are issued solely to provide tnfonnation to Class A n,ewbers of ICRO, urilizing the code upon which the report
is bated, Evaluation reports are not to be construed as representing ucsthetiis or a{v other attributes not spetU11colly addressed no., as an endorsement or reeommon-
datian fur use of the subject report.
This report is based upon independent testa or other technical data submitted by the applicant. 7'he ICDO Evaluation Service, [tic., technical staff has reviewed the
fest results and/or other data, but dues not possess test facilities to make an independent vocation. There is no warranty by ICDO 6valuofiurt Service, Inc., express
or lrnplicd, as to any "Finding" or other matter in the report or as to any product covered by the report. This disclaimer includes, bill is not lirnued to, merchantability.
Page t of 3
��"Iff-W�Ustemum Z11111111
Pad 2 Of 3 ER -4630
5. Installations addressed In this report are limited to areas with 7. All system components are produced a1 the Resin Technology
a maximum basic wind speed of 80 mph, !exposure B, on roots Company facility, 2270 Castle Harbor Place, Ontario, California
not exceeding 40 lest above grade. 91761, with quality control Inspections by Underwriters
6. products are manufactured at Ontario,. California, with fol- Laboratories inc. (NER-QA403).
low-upInspections by Underwriters Laboratories Inc. (NER- This report Is subject to re-examination in one year.
QA40)-
GVSTEM NO, G41./40
1 3
2 3
_ .--. 3
3
5
TABLE 1—PERMAX-108 HOOF COVERING SYSTEMSI
MINIMUM FOAM
rr Film FOAM THICKNESS
*n0s0 THICKNESS MAXIMUM FOAM PLASTIC TYFF
NIIe$ TOP SURFACING Inch6s Inchq9L AND DENSITY JR411
24 Not Required 2 111' 030
2.5.3.0
See Footnote 3 NIA 2 RT -203(
2.5.3.0
Set footnote 3 4 4 RT -201(
. 3.0
See Footnote 3 2 2 RT -201i
24 1 See Footnote 3 1 1
2.5.3.0
4 RT -2030
3.0
1h RT -2011
2.5
4 RT -2031
2.5-3.0
IM ROOF
fix.FL)
O
CLASSF
.
1 A
1 — A
5 B
17 A
5 A
5 A
3 A
g Z 24 SeeFootnote 3 It/z 4 RT -2031 I B
2.5-3.0
ye l 24 9ee17ootnote3 1- 4 RT -2031 4 A
2-5-3.0
J_
tLxcept where noted, substrate must be of noncombustible cementctitious materials,
1Substmto may be minimum 112-inch-tltlek plywood bonded with extcriur glue, with all board edges supported by blocking, tongue-and-grouve. joints or other approved
type of edge support.
1'Mr.. coating is surfaced with No. 11 roofing granules applied at a rate of 50 pounds per I(X) Square feet to yield a minimum 100 mils dii0ness.
IlSubstrute may he existing Class A or Class H gravel surfaced or smuodl surface BUR over comhustible or noncombustible substrates.
SScnms in plywtKxl deck must lie covered with minimum 12 -inch -wide 90 -pound mineral CapshCcL
RNIA Not Applicable.
Ttligher stupes may be used subject to kesin Technology Cautpany's written concurrence.
aSUbSlntle may be 4 -ply BUR assembly surfaced with a flood coat of ion ting asphalt and 4(X1 IbsJsquare of roofing gravel embedded in the asphalt. with all tone gravel
removal.
TABLE 2—FOAM SPECIFICATIONS FOR STEEL DECK ROOFIN13 SYSTEMS
PRODUF,Y MAXIMUM FOAM MINERAL
FOAM DESiGNATION AND THICKNESS GRANULES PERMAX-100 COATING
ITEM NO, MANUFACTURER DENSITY Ipel) pnehael HEOUIRED QUANTITY
I Resin T chnntogy RT -2030 and 2 Optional 3 Gel./100 FLS
Conipaay RT 2131
(2.5,3.u)