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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 Contrac
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.
".60 1 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 .VTA-rg Ia[; WID Policy No. 22040 UNIT €f t1►9
(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 37CYQ of the Labor
Code, I s all f � rthwith comply Fwith-those 7�pro Bions"
Date Applicant.G�!T3tr!'�G.. ; :�f�✓,t.
Warning: Failure to secure'Worker's"Compensation-coVera'ge-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. i
Signature (Owner/Agent) �'�r�`�i��y't�✓� -1Date
BUILDING PERMIT PERMIT#
01" t—B&9
DATE % VALUATION LOT TRACT
6. 47 28470.1
16.W
JOB SITE
ADDRESS 7,? _40. C-()YCrJ1F SA
APN
! r �-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
101.0r, & SuWku SCIHM
'JOM613 DE31'ahGdN'fi 10C !
J 1 "%3QaY•S&r/A iB1t
1`0DOAYYP 4656
LAQMNTA, CA 9225E
T
1?ALMDE1' Wr CA 92261-4E
(76(t )346-: 366 CB1,ft, 7,096
USE OF PERMIT
wCi,1'O1,R .f'A1.b11L Y
SPO a PERMIT .i3OWS) NOT .134CML POC: UBLOCK. W,fiALWORIV'EWAY
AWROACH. COMPLIANCE, WITH ALI, FED &WAM, MCI,
E'Ni)ANtBWLSIi :lPECIMS :ACT OF 19 X3 I? ,P PPL1C..A€SI ,1U P,,VQ'D
90P.CWPA.TIO a,313.w SF
3A..'fZAWC'.tf►YWORT 87.1.00 3F
XIMUMM t*:0q'r 0111, CON: MU�'`:�'.I:C)N
MTi't9ltlO7:` FBF u(T:t1/L.°§�tD RY
101-000418-1000 S55mm
NAN CliT:Ci'' KUP 101-000-439-318 $1,234.00
FIJI? I317i'C+ T 1171-000-439.318 411000100
MUMM It A1.,I E 1.01-OOCJ-421-OW $182.00
I+;UECTRICALTTZ 101.-000.420-000 '%230142
Pl.UMB,PNO YBE '101-000.419-000 $222,115
S FaOWCBMs7'4'iON PER, - R; UND 101-M-241-000 1£35,4,
0Y%,ADY'140 Y9;11 101 -000 -423 -WO `"30.00
13Eia''k,i.,C. PER.1><APAC: (' .fiRE $1,907.00
�sol?'i' "t.I1 t7�LTC fl1:.AC i?� • RU' SIr 270-�,0 I044 r-000 $395.44
RR`
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45';Q68,?'8
1.03 P11F.-PAM �.
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41,000.00
OCT 18 2001
]TO
VAL PrK.Ma MI) S DUE Now
CITY OF LA QUINTA
FINANCE DEPT.
�Y
RECEIPT
DATE �yy l����r.
l,� 6/, l ,r�,,,,,.
BY'.
DATE FINALED
i `�r
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2_7
�/Q� /�
Underground Ducts
Forms & Footings
CJ
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/z . O
Exhaust Fans
_
O.K. to Wrap ��
F.A.U.
Framing
_ _�
�o?� �Q -r
Compressor -
Insulation
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
—('j —C y
Drywall - Int. Lath
`
Final..
Final
POOLS - 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
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
�°�(� 0
Appliances
Final
COMMENTS:
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)
G�—
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P.O. BOX 1504
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n �f I y� f� _,!� ) U#-81495 CALLE TAMPICO
APPLICATION ONLY
! �Lfl /�l ' �� �P� I 1 F �1�//kt OUINTA, CALIFORNIA 92253
VJr Tk III- ✓
`l -1- I 1 v ~' " `U IL—
BUILDING: TYPE'CONST. OCC. GRP.
Mailing
A.P. Number
� •��'
Legal Description
�ff 2�'� 00 t0l
/�
Contractor j
IW"&fs �� ()�- 1�j
Project Description
^� �+' f
Ir 1 �. +�WI 1 f/ t5 `I _70
Address 1-
-1' U ! A Q I -,Y..
/4P&WvEb PE
City—:�? I FVl.t
Zip)
Te�LI tO
State Lic. Q City
& Classif. 1
�I Lic. #
Sq. Ft. 2/� �ZNo.
U
iz
Size J'j U
SNo.tories
� Stories Units
s
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
(1A/ ( /
G f �f�
1 (, %„ f✓ . _J4
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the"and Professions Code, and my license is in full force and
effect.
/ j/}' / /�'J/ -7//1
�` Jl 4 / F d� 50,z J
�✓ !_�7 • l
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 or 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
forthe 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).
i I'. 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
buildsor improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. 1t, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
ofproving that he did not build or improve for the purpose of sale.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
I 7 I am exempt under Sec. B. 8 P.C. for this reason
f A
Dale Owner
Estimated Valuation
346/ X25
PERMIT
AMOUNT
plan Chk. De P
�.
Plan Chk. Bal.
Const.
Mech.
Electrical`
_
Plumbing
S.M.I.
Grading
U Q gnnf (I
Driveway Enc.
m
I i
Infrastructure
-A QUINTA -
WORKERS' COMPENSATION DECLARATION
ml IVI,U t V T
jI hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
'
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lhp 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.
Date Owner
NOTICE TO APPLICANT: 9, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
r CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
' Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
`a 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.
r I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Data Permit
i Signature of a0plicant Date
Mailing Address
Validation:
- City, State, Zip
WHITE = FINANCE YELLOW =
APPLICANT
PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 10/18/01
No. 22592
Owner NameJack & Susan Schiffer
No, 78-405 Street Coyote Canyon Court
City La Quinta
Tract # 28470-1 Lot # 47
APN # 770-2407005
Jurisdiction La Quinta
Permit # 0107-064
Log #
Zip 92253 Study Area
Square Footage 3932
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 3,932 or $ 8,060.60 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
Fees Paid By OC / Wells Fargo & Co. - Pamela Salinas Telephone
Name on the check
r
By Dr. Doris Wilson
Superintendent
Fee collected /exe pted by Annette Barlow
� W
Signature
Payment Received $8,060.60
Check No. 0689032065
JOTICE: 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
lbove 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
:ollect them on the DistrictCs)(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
J
Sladden
Engineering
6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
January 15, 2001
Mr. Steve Jones
P. O. Drawer 4656
Palm Desert, California 92261
Project: Lot 47 Tract 28470-1
Coyote Canyon Court
Tradition Golf Club
La Quinta, California
Subject: Geotechnical Update
Project No. 544-1013
01-01-022
Ref: 1. Report of Observations and Testing During Rough Grading prepared by Sladden
Engineering dated July 30, 1997, Project No. 522 -6138 -GI.
2. Geotechnical Update prepared by Sladden Engineering dated December 12, 1996,
Project No. 444-6130.
As requested, we have reviewed the referenced geotechnical reports as they relate to the design
and construction of the proposed single family residence. The project site is located on Lot 47 of
Tract 28470-1 along Coyote Canyon Court within the Tradition Golf Club development in the
City of La Quinta, California. It is our understanding that the proposed residence will be a
relatively lightweight wood frame structure supported by conventional shallow spread footings
and concrete slabs on grade.
The lot was previously graded during the rough grading of the Tradition project site. The rough
grading included overexcavation of the native surface soils along with the placement of
engineered fill material to construct the building pad. The site grading is summarized in the
referenced Report of Observations and Testing During Rough Grading along with the compaction
test results.
The referenced reports include recommendations pertaining to the construction of residential
structure foundations. Based upon our review of the referenced reports, it is our opinion that the
structural values included in this referenced grading report remain applicable for the design and
construction of the proposed residential structure foundations.
Because the lot has been previously rough graded, the remedial grading required at this time for
the proposed residence should be minimal. The building area should be cleared of surface
vegetation, scarified and moisture conditioned prior to precise grading. The exposed surface
should be compacted so that a minimum of 90 percent relative compaction is attained prior to fill
placement. Any fill material should be placed in thin lifts at near optimum moisture content and
compacted to at least 90 percent relative compaction.
i
i-
January 15, 2001 -2- Project No. 544-1013
01-01-022
Allowable Bearing Pressures: The allowable bearing pressures recommended in the grading
report prepared by Sladden Engineering remain applicable. Conventional shallow spread footings
should be bottomed into properly compacted fill material a minimum of 12 inches below lowest
adjacent grade. Continuous footings should be at least 12 inches wide and isolated pad footings
should be at least 2 feet wide. Continuous footings and isolated pad footings should be designed
utilizing allowable bearing pressures of 1500 psf. An allowable increase of 200 psf for each
additional 6 inches of depth may be utilized if desired. The maximum allowable bearing pressure
should be 3000 psf. The recommended allowable bearing pressures may be increased by one-
third for wind and seismic loading.
The bearing soils are non -expansive and fall within the "very low" expansion category in
accordance with Uniform Building Code (UBC) classification criteria. Pertinent 1997 UBC
Seismic Design parameters are summarized on the attached data sheet.
If you have questions regarding this letter or the referenced reports, please contact the
undersigned.
Respectfully submitted,
SLADDEN ENGINEERING
Brett L. Anderso
Principal Engine
SER/pc
Copies
4/Mr. Steve Jones
Sladden Engineering
..y
January 15, 2001 -3- Project No. 544-1013
01-01-022
1997 UNIFORM BUILDING CODE INFORMATION
The International Conference of Building Officials 1997 Uniform Building Code contains
substantial revisions and additions to the earthquake engineering section in Chapter 16. Concepts
contained in the updated code that will likely be relevant to construction of the proposed
structures are summarized below.
Ground shaking is expected to be the primary hazard most likely to affect the site, based upon
proximity to significant faults capable of generating large earthquakes. Major fault zones
considered to be most likely to create strong ground shaking at the site are listed below.
Fault Zone
Approximate Distance
From Site
Fault Type
1997 UBC
San Andreas
12.5 km
A
San Jacinto
30 km
A
Based on our field observations and understanding of local geologic conditions, the soil profile
type judged applicable to this site is SD, generally described as stiff or dense soil. The site is
located within UBC Seismic Zone 4. The following table presents additional coefficients and
factors relevant to seismic mitigation for new construction upon adoption of the 1997 code.
Slodden Engineering
Near -Source
Near -Source
Seismic
Seismic
Seismic
Acceleration
Velocity
Coefficient
Coefficient
Source
Factor, Na
Factor, N,,
Ca
Cv
San Andreas
1.0
1.1
0.44 Na
0.64 N„
San Jacinto
1.0
1.0
0.44 Na
0.64 N„
Slodden Engineering
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY jC "oxy
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION
-79 -q,05 co,ro� cM�Ga� (.,� btu;�,��
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
PERMIT NO.
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
dK
ARCHITECT
INSPECTOR
le � �-
HRS. CHARGED
�� t s2�z9
ENGINEER
,rrEE r-L'rijt- aLt rneess
ASSISTANTS
NRS. CHARGED
SUB
INSPECTION GENERAL ^�_ ` ����� CONTRACTOR n� G� l
DATE CONTRACTOR �/ N ` CT
3 -1q -oz-
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t -Eo v S (Lu S rF - t B to O ct-.Q a ti (Woe- -,(a
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE ' OF 1
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS
SIGNATURE OF REGI RED INSPECTOR
3^19 -OZ, =C-60 LVL1?'2ro-Vj
DATE OF REPORT REGISTER NUMRFR
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
UCT. STEEL ASSEMBLY O S
❑ ASPHALT HER
O FIRE PROOFING
JOB LOCATION
('/
lid
REPORT SEQUENCE NO.
TYPE F S UC UR o
Ci L •� e�
PE MIT N0.
Dt�JE� / .,0
DAY OF WEEK
MATERIAL DESCRIPTION
-3C A-&° D
ARCHITECT
I P OR
CT�'
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPESUB
DATE CTION
CONTRAGENECTOR 1 e� �aJ��
CONTRACTOR ui
T7
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
IGNAT RE OF REGISTERED II PECTOR
I 3 oi TZA b
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00 REPORT REGISTER NUMBFR
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STRUCTURAL AND CIVIL ENGINEERING
DENISE R. POELTLER, INC.
73.66T Highway 111 • Suite G • Palm Desert, Califomia 92260
02 October 2001
Mr. Tom Hartung, Building Director
CYfY OF LA QUINTA
Department of Building and Safety.
78-495 Calle Tampico
La Quinta, CA 92253
12E: Schiffer kesidence - -
Job Site Address: 78-405 Coyote Canyon Court, The Tradition
Subject: Truss Acceptance Letter
Dear Mr. Hartung:
I have reviewed the total deflection, live,. dead, and drag loads used for the design of the'
gang -nail roof trusses prepared by TRUSSWORKS (dated 9-04-2001, 9-06-2001 and 10-
® 01-2001), and found them in substantial conformance with my original design loads.
Respectfully submitted,
Denise R. Poeltler j
R.C.E. 33446
(760) 779-0405 0 FAX (760) 779-1317
A
(760) 779-0405 0 FAX (760) 779-1317