003049 (RPL)Building 55-306 Shoal CreekAddress.
Owner
Mailing
Address
City Zip JTel.
Contractor
P.O. BOX 1504 N Q . JJU J U 4.3
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A. P. Number tu test
Legal Description
Project Description Phage 14A Pno.1•
'Parke: 300 L.P. .. 14-k i�a�Q `a�ll�' 42A L. V_
City
Zip
Tel.
State Lic.
City
& Classif...
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
- Arch:, Engr.,- -..
Designer
New Qi Add ❑
Alter ❑` Repair ❑ -Demolition ❑
Address
Tel.
City
Zip
State
Lic. # .
LICENSED CONTRACTOR'S DECLARATION.. .
A _ I hereby affirm that I am licerised under provisions of Chapter 9 (commencing with Section
7000, of Division 3 of thel(Bussiness and,Professions Code, and m license is'in full force and
r 1 effect. �..7' .. j y'_ j �' 7
SIGNATURE i7 .;r +.'� r _. _v..�,y,.t DATE-
(�'` OWN ER-BUILDER'DECLA RATION
Thereby affirm that I am exempt from the Contractor's License Law for the following . -
. reason: (Sec. 703 1.5, 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 rile 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 Busihess an'd'ProfessfonsJCode, 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 penaffy of not more than file hundred dollars ($500).-
❑ I, as owner of the property, or my employees with wages as their sole compensation, will -
Estimated Valuation
. . ��>'�'A �'��•�i�1 •
PERMIT-
- AMOUNT -
-Plan•Chk.-Dep.
'
Plan Chk. Bal.
$87.42
Const..i(p
, ��1
do the work, and the structure is not intended or offered for sale. (Seca 7044, Bulsness and
Professions Coder The Contractor's License Law does not apply to an owner of property who'
Mech. -
builds or Improves thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended or offered for sale. If,, however, the building,
- or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
EI2CtrlCal
'
Plumbing-
O 1, 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 contractor(s) licensed pursuant to the.Contractor's License Law.) - -
❑ I am exempt under Sec.- B. 8 P.C. fos•this reason '
S.M.I.
Grading
Driveway Enc.
Date ��'�` •Owner�'r<!•..
Infrastructure
WORKERSKCOMPENSATION DECLARATION
�J/ I -hereby affirm that I'Aave'a'certificate of consent self -insure, or a' certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is tiled with the city.. O Certified copy,is.hereby, furnished..
TOTAL��;lZ
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
'
' Date Owner
NOTICE TO APPLICANT: If. 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
CONSTRUCTION LENDING AGENCY
Side Street Setback,from Center Line
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.) .
-
SideSetback from. Property Line '
Lender's Name
FINAL DATE
Issued by:
Validated by:
INSPECTOR
I
Date L}7 W87 •Permit
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 cartify.that I have read this application and state that the above information is correct.
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 property for inspection purposes.
Signature of applicant Date -
Mailing Address
Validation:
67747
4 14 1 "t 23,22 it
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. p
BONDING
Y
ARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SD. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
THIS IS TO CERT FIG that the -following desc ib dTcommodity was SUPERIOR READY MIX CONCRETE, L.P.
weighed, dit i t�qzed. or counted by a xRighmasti r, who: signature SERVING SOUTHERN CALIFORNIA SINCE 1958
is on Ihji, t6stificate. who is a recognized autllarlty of accwaw,, as
prescribed by Chapter 7 (commencing with section 12700) of WITH LOCATIONS TO SERVE YOU
Division 5 of the California Business and Professions Cade.. SHOWN ON REVERSE f
administered by the Division of Measurement Standards of the
California Department of Food and Agriculture.
CY = Cubic Yard
PY = Per Cubic Yard
Weighedat: 3-5_ gCr -P1 L-L.6w P_DW D • I tNW 0 T
DATE CUSTOMER NO. ORDER NO. CUSTOMER P.O NO.
5 77043
PLANT NC.
075
DELIVERY TICK?•: r NO,
Z4 I3
CUSTOMER NAt;E
CUSTOMER JOB NO
'P&LA, wt-sT
JUs
JOB ADDRESS
o s F+ ce_F_�-: ►G( L_P} o�j ( h1T 14 turf- S
P,W PAGE
,SPECIAL INSTRUCTIONS
P ALNEe- aAT r= 3�V
'NEIGIAW STER
ltJ It l.0 1 AM (�.� iVl�l P-9y
DESIGN NO.
6WP F-
SLUMP
`t • GO`�_7
UCK NO.
rs
DRIVER NAME
Po ZT I Ll_p • ►gAF__t o
ORDERED BY OTY ORDERED
5 t F= v I- 1. o 0
LOAD QTY
CUMULATIVEQTYJ
UOM
I PRODUCT DESCRIPTION
PRODUCT CODE
UNIT PRICE
TAX
AMOUNT
q.
c1,vC2
CY
4S00 p5I_ CONCLVTR
D831P
ENV IP- ME`l7-f\J SURD
E�
QTY TO GO
Excessive water is detrimental to concrete
C.O.D.
TICKETTTME ARRTVE
performance.
❑ Cash
do ; q A
TOTAL FOR THIS TICKET
Gallons to toll load V 'Slump
❑ Check NO.
START FINISH
Gallons to W4 load /Slump
❑ Credit
TOTAL FOR THIS ORDER
Gallons to 1/2 load /Slump
Driver Comments
STAND-BY TIME FOR THIS TICKET
Gallons to 1/4 load /Slump
PRE'lIOUS STAND-BY
Water added on Job at customer's request.
Authorized By:
"Customer acknowledges that the described material has been selected and ordered by Customer and that Superior has not reviewed any plans or specifications nor Riven any of
recommendations or assurances regarding the fitness of the material for a specified purpose, unless Superior has provided such review, recommendations or assurances in a writing sir*m
by an authorized representative of Superior. Superior does not warrant that the materials supplied comply with SB 800. Concrete is porous. Some cracking*. pop -outs. Surface blemish
or color variations may occur for which Superior is not responsible. Water is added only at Customer's request. Added water will increase water/cement ratios. decrease strength al
may cause increased cracking and color variations. Superior is not responsible for the addition of water or any other material to the concrete by the customer. Customer agrees to defen
indemnify and hold Superior harmless. to the fullest extent of the law. from any liability or claims for damage relating to the ordered material being not Suitable for its intended use or n
suited for placement upon the ground soils or conditions where the materials are placed
' 1 1' 1IIIIII1 1 1 1
Received in good condition by: �T.1S T PJM R
Mix Design Report
Superior Ready Mix Concrete, L.P.
1508 W Mission Rd
Escondido, CA 92029
760-745-0556
Mix ID# D837P-- 4500 PSI 1" [01
This design is being submitted for approval. Conformance with specification should be reviewed.
Compressive Strength :
4500 psi at 28 days
Aggregate size :
1" -- 25 mm
Air:
1.2 ± 1.0 %
Water/Cement ratio :
0.45
Slump:
4.00 ± 1.00 in
Contractor: PGA West
Source of Concrete: SUPERIOR READY MIX CONCRETE
Construction type :
Placement: TRUCK PLACE / 4" PUMP
Unit Weight: 147.89 pcf
Design Date: 01/14/2015
Constituents :
Quantity
Density
Volume
ASTM C150 TYPE II/V CEMENT
559 lb
3.150
2.84
ASTM C618 CLASS "F" FLYASH
99 lb
2.200
0.72
Water
296lb
1.000
4.74
ASTM C33 #57 ROCK
1418 lb
2.670
8.51
ASTM C33 #8 ROCK
350 lb
2.640
2.13
ASTM C33 FINE AGG
1269 lb
2.640
7.70
ASTM C494 TYPE A WATER REDUCER
26.32 floz (US)/yd3
1.000
0.03
Air
1.2 %.
0.32
Total:
3993
27.00
Remarks
Reported by Superior Ready Mix L.P.
Approval by:
Date: 01/01/2015
Date : / /