0305-159 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000),6f Division 3 of the Business and
Professionals:Code, and my License is in full force and effect.
License.# Lic. Class Exp. Date -
6 . i90 13 1. 1/V
'Date° ,f 4 f% 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: �,-•
( -) 1, 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.
.�Yp 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 sun d um) Policy No. 222-02 UNIT 466 1023
(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
CodeA'shall forthwith comply with thd,,�sse provisions.
Date f75,Applicant y1�r�l%��//i''/lam
Warning: Failure to secure VvAers' 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 applicator 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/,2,
Signature (Owner/Agent) f ,
'•'" " r fr � ` Date , �' •"
�1
BUILDING PERMIT PERMT# .
V
030&1.59
DATE VALUATION Sag ry LOT TRACT
i y � it � � •bF.i7glN�� ; ..
JOB SITE
ADDRESS 54^•287 S0UrMJR. 1=8'
APN
_ ..
OWNER
CONTRACTOR/DESIGNER/EN INEER
mer -1 D PRIT - - -
- P.A.% D)_VF-T,0P1l-H%1''',
,.. ,.., �... .
PO BOX 1000)
LA QY.TIAirlL CA, 92253
PALM xiMM`l:
CA 9225
C760)340-6169
mg 3m
USE OF PERMIT
xMSMEM7.P&1iDDY YOlC`i'
123 S , PA'1'1f2 2NC OSU"r�. S1'.WWAI'ri 1R YZA..TUR1
POOL AWEVOR SPA 1g006l,Gs? U,
CUSTOM PATIO CC?A1VEMSlON . 128.00 ,3F
PF.RMCFF SMI VYL4JRY
PLAN C'OECK FEE $1211.70
CONSTRUCTION .FEE 101-00"19-000 $198.00
'MECHA tiCAL kE -- POOL 101-000-421-000 . S24.00
I?LZCTPJC AL "Z -• POOL '101 MQ>; 0420-000 $43.00 .
f'L111�.A.i1:tC1���°a?OL `�1C�1•C1f�0��'1��00f9' �2°A:t1A
$w�' llCt 1,, 'd� RiJ T'I�.iiJ',�A�7i71+LAI-'tom.
422.10
iESS 1 RR -PAID P
$0,00
T 1: rMS VUE NOW
5422,10
JUN ••2:6.2003
' CITY OFLA. QUi2TA'
FINANCiE DEf?T.' ' ✓
RECEIPT
DATE „�
BY
DAT I ED
INS
R ^
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
FEWReturn
Ducts
Slab Grade
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
0.1
Exterior Lath
Drywall - Int. Lath
/�—
Final
Final if 17
BLOCKVVALi APPROVALS
POOLS - SPAS.
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
OX 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 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)
COMMENTS:
r
YES
You M Engr g Setvir
77.804 Wildcat orive,.Suite C, Palm iJElSOM CA 92211 - (760) 360-5770
• Civil & Structural Engineers • ArChltecys - Surveying
Code Consulting - Building & Safety SE rvice5
TeleCOPY Transmittal
To: WY of La Quinta FAX No: (760) 777.7011
Attn: TOM date: 8.28.03
PhI:wIC A. pwenzei
Phone ProJect: Pruter Resitlence
PhonW.O. No.:
No: (760) 360.5770 ea. 104
Descrlptlon of DOC Urnent:
Structural observation letter fo 5412$7 rSauttlern Nil
Thanks.
Comments:
original to be Mallfid: ❑ Yes ❑ No
This Material 'Sent:
❑ Your Piles Your Review
❑ F,t Your Request ❑ Please Call upon Receipt
Other ] 4
Copies:
Yota( N'um0er of Pages (including tills 2
TranSmlttaIj:
Note: Please call and ask for telecopier operator if you did not receive the total number of
pages or cannot read the gages transmitted. Thank you.
TEL ECO PIERS
Indio
CWE7b 5/98 (760) 360-5719
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YOUNG ENGINE'ERIN(► SERY7CES
77804 Wildcat Dr., Palm Desert; Ca, 92211 (760) 360-5770 (760) 360.5719
August 28, 2003
Tom-Hariung
Building Official
'City of La Quinta
Re Pruter Residence, 54-287 Soo rthern Hills, La Quinta, CA
Dear Mr. Hartung,
' We have performed. structural observation with regards to the framing for the above referenced project
and -find it to be in general conformance with the approved structural plans with the exception of the
following:
• Need to provide full height 6x8 post to support_ existing 8 3/a" Glu-lam beam of bar area.
• At king post 29, use ST6224 strap at each side of 5 1/8"'Glu-lam-beam to 6x6 king post. Also ,•
use ST6224 strap at each.Ade of 6'/a" Glu-lam beam to 6x6 king post.
• . Need to provide vertical 111ST48 strap at right*end of beam R4. Sirap should be centered on
Glu-lam,beam and be nail;d to both post above and below.
• Please provide MST48 strap from beam R4 to new 4x6 blocking provided in existing shear wall. .
Need to remove existing s e' aching and replace; new sheathing to match existing shear wall type'
and nailing.
• Do not need:to use HGUS 5:88/12 hanger at beam R2. Connection is adequate as beam is sitting
.directly on existing post a,td is toe nailed. '
• Use 435 at connection of .24 to R2. Also provide post for added bearing support under beam
R4.
• If top plate is broken by placement of beam R2 must use MST-37 at top plate splice as shown by
detail 1/A4:
Need to provide •1 WA hold down with 5/8" epoxied all thread per Simpson, structural-set.. The
all thread must have a min.:mum embedment length of 12". This occurs at new 2x4 framed wall
next to new pocket door at rear of house.
This structural observation does nor relieve the City'in any way from performing their standard structural
inspections nor is it in lieu of any code required special inspections. The structural observation
performed should not be construed as a detailed structural inspection but as a structural observation for
general conformance as per CBC 1. i 02,220. '
y If you have any questions please call.
Sine
1• Jeffreun S.E. y _ i
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