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9803-144 (AR)LICENSED CONTRACTOR DECLARATION I`hereby affirm` under penalty of perjury that I am licensed under provisions of , 'Chapter'9 (commencing..wiih SecVen 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License 1t' " Lic. Class Exp. Date 6 i r6i}ii 13 950//99 f Date '�. 0%I�/d" 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 p� ` may{ Policy No. Evl ilt�' r (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. J +... Date: w%fw =>r!y 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) a� [ i':. -C. 'lf L Z�12 Date BUILDINGPERMIT PERMIT# CONTROL# DATE VALUATION $%,569.00 LOT; TRACT , S Q q eJ ��jj i 9 .. t JOB SITE ADDRESS 54.-6339 SO$T�T'��t.Rl1I..N'�YLLS APN 769-4�iw�iFS��► OWNER CONTRACTOR / DESIGNER / ENGINEER KERN NILSGN. GUS"TAFSON C(}MSI'i`tiUtr RON 54639 SC`?U`1T.-1.MN HILLS - PO B©ti 10427 LA QULNTA CA 92253 Pm,&j -DESY.wT ('A. 92255 (761))772-1530 Cee 1651 USE OF PERMIT AWN •I r. Lwl�ilY,kli d. 9.'i C�\.i.h:i� Vff i..i:I�nY ,9l Y\liY'4,80i.4i1W '. (3���"J.�� PERMIT FEE SWII.M11.R Pi./1NN (1f:E(:K ME'S 1011.000-1139-,3113 rot4SWIXIT'IC)N F'-k=E 10.1-03-418-000 S 108 00 Il WC1 ANTICAi. VL -V. $0 .00 ELECTRICAL 6F_ A01-000-420-000 $18,85 S'f.R.ONG NI(71"ION FF..P,- .Rf-'ilt) 101 -0(* -291-000 t - ;t • � ,,'�;Cf(�fl-r. NIP, !?i� �r�"' / l� '. LL':l �.cu-.:•^i���i..i1.i t'Y:to n>1 50,00 NA RECEIPT �\ DATE BY DATE FINALED INSPECTOR 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 - 7 — Exhaust Fans O.K to Wrap F.A.U. F ming Insulation r Compressor Vents rireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 7 - 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 I 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 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground ConduR Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles i G.F.I. Smoke Detectors Temp. Use of Power Final utility Notice (Perm) COMMENTS: Desert Sands Unified School District Notice: 82-879 Highway 111 ' t t, T Document Cannot Be Duplicated d Indio, CA•92201 f 619-775-3500 4, 'CERTIFICATE OF COMPLIANCE , Date 3/24/98 APN # 769-451-066 , No. 16780- Jurisdiction La Quinta Owner NameKen Wilson Permit # Log #No.54-639 Street" Hills .City` La Quinta zip 92253• Study Area Tract# Lot _# Square Footage .110 Type of Development Residential Addition.. ' . No: of Units 1 Comments Atrium enclosure..N ; At the 'present time, the Desert Sands Unified School District does not. collect fees on garages/carports, covered er 500 square feet, detached accessory structures or replacement mobilehomes. patios%walkways,. residential additions und It has been -determined the above-named owner is exempt from paying'school fees at this time due to the following reason: Residential. Addition 500 Sq. Feet,on-Less EXEMPT - This certifies that school facility fees imposed pursuant to Government Code 53080- in the amount of ,K 0.00 X ' 110 or $ 0.00 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 N/A Tel_cphcn"`-:772-:4'5`30 Name on the check By Dr. Doris Wilsons, w Superintendent!-'' � t � Fee collected /exempted by . Juanita Green` Exempt )`{�}$r0`00,,r Check No. N/A Signature ^� NOTICE: 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 above 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 collect them on the District('s)(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 s Copy - Accounting g-.L- - -51 um C HVA'Cl: C-20 Aa 01 mr[n C4 -17 -33 'DECO RATIN . . . . . . . . . . . . . . . . . . . . . . . . I ' O �Oo s� .. F ►n d S�r�L1 ILA)- . • s r C3�_' E IE A HELj'NGR IR '� �\Q c A cu" - fly V., GUSTAFSON CONSTRUCTION eyv��V -P.O. BOX 10427 �..... PALM DESERT CA 92255-0427 -7 �'.- I V 3 O ReVt\,eX E�NrRy . i . .n 1. • i I . j � .i • r NOW x co OA ' KO 0 -R'! •'� -t ► is . t a • . y ;'p _ (�� • .� , 00 "-A. e r ' H " •^ . � - *• .. _ t ... "f 'S. asp. '�'r'_ :'y� 4'it` .' ` f a ..4'�=1��(.�yj�j_.x. -....[ ..0..;/•.tsu...f.'Sw'1...4.:.•.-rrnowwYLT!•fe,+w•�.vr,ax-u�._��! N w r ... -- � fp1�,. � y - ' f }«'. �Y• r* � f. � .• t ` {` r.. id .p' V ;i•, r • , • , } 444 • •'' ..• '_�.. . •l .` .. , ,� � �i .` � ..` f � fR�- . o � � it �a . � t! � .- } � ' Y tj'4, p, r (•� 7, N � '"i ♦ - • • r a ' - • _.. _ r °d' 70 -73 • � t � x,11 � �L ' t ♦ ♦ / MAR— 3-98 TUE 13:54 CAMERON—ASHLEY Mineral Surface/4 Ply Roof With Nalki le Deck SPECIFICATION NOS. M-64TP-N, M-BaSP••N ' Asrl IAI I' Two r'LIE' TllUiil I r-1 Y IV / Ili iIIA •:AP ONE PLY a I VI TnA BAF.0 NA'LABI E• (N:Ci! MATERIAL RF0LJIRL-MCN I S SPECIFICATION NO M-6111 P -N (F.ligihle for 12 YP.af Premium Guarantor, 7onc Al MATERIALS: Mechanical `nslencrs as required INTECIPERMAGLAS UL HA BASE ° • I Ply INTECiPE:RMAGL.AS TOUGH PLY IV - 2 Plies INT ECJPCRMAGLAS ULTRA CAP Asphalt - as rugllirAd Accessories and flashing Materials as required APPLICATION RECOMMENDATIONS ROOF DECK shall be firm, clean, dry and smooth All memo !+.laps shall bo applied so the flow of water is over or pear ltal to, but novor against the laps. INTECIPERMAGLAS ULTRA BASE Lap 2" (5 cm) on sides, 4" (10 (;n1) on crids arid turn up to top of the can[. Nati on 9" (23 cin) critters through the Laps and on 18" (4G crn) center along a line 12" (30.5 an) tion? each Pd,1e. VALLEYS AND WATERWAYS shall Icccivo an omm layer 0l TOUGH PLY IV which Shull be at leasl 39'la" (100 car) wide and shall extend atloast 8" (20 cin) up the inclines out of the valleys, set in a uniform mapping of hot acpilalt, optimum of 25 Iblsquaro (1,2 kg/m'), Thi, ply shall ha laid prior to lht•! arppliuitiun of the roofing plies. INTECJPERMAGLAS TOUGH PLY IV enri laps .;;all be at Ieast 4" (10 cm) and adjacent end laps shall be art lea ;t 12"(30.52 cm) apart. Install two plies of TOUGH PLY IV in shingic fashion, lipping 2011,Ie" (1j3 r:rn) wile a 18'y,d' (48 cin) exposure, Starter sldl)s of 1911s", a:Id '319'/x" (50, 100 col) shall be used and the second full sheel shalt be laid a maximum of 171J6" (45 cm) Exposure. Embed rho full width of each ply shed in I1ol a�arh.,lt, optiliuml of 25 Ib/square (12 kg/m^). Each ply shall be ligh!ly broontcd as it i:. applied. Turn up all plies to top of cant. INTECIPERMAGLAS ULTRA CAP s'iali be crit into niaximuni 18' (5.48 n1) lengths, the length depe:Wing upon IeiaperLrtui0 arid woallier Cunditions, and allowed to rc-lax. Cnlbrd ULTRA i;AP inlo a uniroim solid mopping of hol asphalt, oplinlunl of 25lblsgcla"c (1.2 kgjn1"), Set neatly in place with 2" (5 cm) side laps anal ai" It c(t) end;cps. Adjc:cen, end laps shall be at least 3' (91 cm) apart. There must be contp'oto aclhosion belwo.nn the ULTRA CAP and the mopping asphalt, Apply extra proGsulo tr avoid creating open channe[s,whareINseat morcmembrancsar ;a,;7f'd.SA�EFLASHING: All guarantor root systems must be flashed arcordii;g to the "Flashing Dolens", Section 7. All of 1110 Rocommo idarions and Application Ter;hniqu ; sF; 101111 if) 11115 manual aro considered pail of this Sp! C11iCa'.'tlrr. ' NOTE TO SPECIFIERS: SUr'ER PLY ("SP") may be ,p?r;ifiLd in Zonc A only (See Zone) Map pg. 36). To specily, call out spocification M -643P -N arid use (tie wurds SUPER PLY in plate 01TOUGH I i LY IV wf, !ever thoy appear in this specification, ' Pcrmaglas Bondible Base Type 28, Contbinaiion Ga.%e, Fi(!x 6w..,e 30, Type 40 Smooth or Permavent may be suhstit-.rled for Ultra R., -.se, ------------ FAX N0, 7603426461 P.01 Mitic:r'll :itlril+c:eJ i illy P oor Vilili M-01;11017 D("Ck SPL•CII-ICATION NOS. M••F]3'FP N, M-S3SP-14, 130,03TP-N," ANi'I IN I ONF PI Y IOUl111 PLY P/ o1Nt- PLY T11,8,SJL17W1 � Ant F or.CK MATFRfAL HLouinCPr1F.NTS SPECIFIGATION NO. M-B3TP N (Fligibio for 1 U Year Standard (3uarantor,, 7onc A) MATERIALS: muchimical Paslcncrs • as requ;red INTFCiI'Ff1MA61 AS ULfHA BASE' - 1 Ply INTECIPERMAGLAS TOUCH PLY IV - I Ply INTE:CIPLHMAGLAS ULTRA CAP Asphalt • as required Acrrasnrivs arid Flashing Malclials as required APPLICATION RECOMMENDATIONS: ROOF DECK shall be firm, clean, dry and snluoth. All ntenlbranes shall L,e applied so the flow of water is over or par allot to, but never against ilio laps. INTECIPERMAGLAS ULTRA DASE Lap 2" (5 rrn) ort sidCIG, 4" (10 cm) on er1118 and lura up ;o top of the Carl[. Nail on 9" (23 cm) cerili-m Ililuugh !hc laps and on 1311 (45 cm) centers afonrl a line 12" (3U.5 c111) from Penh eclp. VALLEYS AND WATESWAYS shall rensive an extra layer of TOUGH PLY IV which shall boatieaw39'11e)"(100em)widearrdshallrxtondallca t8"(7nc:nr)uptheinclines out of the valleys, set in a, unilorm rnopping of hot a.rpliall, optimulil of 7.5 Iii/;quaro (1.2 I(q/ntr'). This ply shall be laid pliur to the application of lire rooting plies, INTECIPERMAGLAS TOUGH PLY IV end I;af1 ,hall be at lead 4" (10 CM) ,and adjacent and laps shall beat lea l 12" (30.5 cm) apart. Install una ply of TOUGH PLY IV in shingle tashlon, lapping 2" (5 urn) with a 37'1c," (90 cm) ?xpo pure. Embed the full width of each ply sh41al in hot asphall, optimum of 25lb/squarc (1.2 kglm'), Each ply ,hail be lightly I7roomed a.. it is applied. Turn all plies up to lop of cf1111. iNTECIPERF"AGLAS ULTRA CAP shall be cul into maximum '18' (91 cm) lengths, the Ienylh depondlog upon lemparabug and weullier cundiliuns, and allowed to relax. Embed UL i HA GAP into a uniforin solid mopping of hol inipliali, optirnuln of 25 Ibl.•quare (1.2 k,ylnl'). Sot neatly in place with 2." (5 an) side lap -5 and G" (15 cm) end laps. Adjar;erll end Inps shall be al least 3' (91 col) apart. There must be c:crnpluda ndhrsion bMWCv F.ln the ULTRA CAP and lllc rnopping asphall. Apply extra pres.;uro to avoid Creating oprnchani uls,whc10111reoormorememhranesarelwippsd DASOFLASHING: All gurtraTntFae roof syG[onis must be flashed acrordfi q to the "Flashing Details", Section 7. All of llty nPconuncn!9nrions and IlpfAcalion Tr -u imituoc, sol loilll in this 17711711a1 alC COngirlry!•r.l hart of INS ,"p('•Cific vol). ' Ultra Cap premier 730 may bo SUbstilU.rted for Ullra Cap. Uso specification 730 B3TP-N. Eligible for 10 Year Premium Guarantee, Zone A. 2 NOTE TO SPECIFIERS: SUPER PLY (`SP") niny be specified in 7_orle A only (Sec Zone Map pg. 36). To specify, call out specification M-63SP•f•1 and a„u ll,c words SUPER PLY in place of TOUGI I PLY IV wherever UIFy a1ltear in this specification. ., Pernlagfas 8oild'able Base Typo 28. Combination Ba:;e, flex Baso 30, Type 40 Smooth or Perrnavwil way be Subctilu(ed for Odra Base. S� 1 J'