9705-069 (AR)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
4_19669 8 9/3088
ate ` / . ?i f Signature of Contractor " " U/', h s►�' , y �
1 i,�tist",l' , v � r.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contr or'§
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
Se tion 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:.
COi itL .i i lri 1,0
.(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
sybject to the workers' compensation provisions of Section'3700•of-the Labor
Code, I shall forthwith comply with4hose provisions.
Date: s 4� I.- Applicant t - qq f , fR, `;...
Aev
Warning: Failure to secure Workers' Compensation coverage is un l vyf I d
shall subject an employer to criminal penalties and civil fines up to $10,000,anin
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) _+ ' - !L Date Of
BUILDING PERMIT PERMITN CONTROLN
970.10)69 5130
DATE VALUATION LOT TRACT •
JOB SITE
ADDRESS 78-875 DULC.E DEL MAR
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LANn_JkU
1IMP RI L SUN C;ONSIM.UC."t'ION
I3.0. BOX 0115,
2525 TA HQUfI Z CANYON €iii I
PAI,10SPRINGS. CA !MO
PALMS.I'PLINCS CA 922163
(760328-2277 CRIN 3787
USE OF PERMIT
e10011V
a�C�Otsftil'I.1'�3rI%i:�iNti�(��ZiJ(�NL �;Wtd'va�}2`4`"�ki_76;�i�f�Ji:K�tOH 1(i
ADM' ij.i?d S
DOM.%, d OG)iVi 225.06 3
fW1..MA'S.;ii,ST 0 F $Pr;IN. R5:1'6"`Y.10 t
10,794,0
PLAN $81,9101
+w(t14,a`4'tatlr::f'1t?ivtlfvfr, IQJ_0tN)A19-000 $1:7Ef1q
�NfIrC lr�I":ICAi„k�f;)i
l,Cd'�.:`�'ftlC`•AL..i'.fil:: i.Cil-t�Uii-42il-i�tit� $�..d,ftt)
Pt.1^161140 FIDE ltf 1,-000.419-1)(H)
dlv`1.�1�i1,`,��i'ftf_1t:�".i'1-1lLls,`��:`u`t4 °r:,���I��.1-s#•�A•3�i� .`�cl;i.�3i
ART Ifo 14.'9 4,1C 1?.LAC11s 3 •-.421a�ilf:'7�JL-ifCb()�`� S7-Ui7G g�i.tit!
SIJII-T Y`I�A1, CO SM..I?,IIC"IIC•N.W AND }<i,;XN CiJFCK
VXSS PRE -MID FE$
$0.00
'aO-1All, PERMIT 1TF.S.I::IJH;Nt'N
$52A.68
RECEIPT
DATE,
BY
INALED
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
Exhaust Fans
O.K 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
Exterior Lath
Drywall - Int. Lath
'
Final
Final
BLOCKW
�
A PROVALS
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Appliances
Final
COMMENTS:
r
Final.
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/19/97
No. 15543 Jurisdiction
Owner Name Landau Developmnet Co., Inc.
No. 78-875 Street Dulce Del Mar
City La Quinta zip 92253
APN # 643-100-023
La Quinta
Permit #
Log #
Study Area 123
Tract # Lot # Square Footage 280
Type of Development New Residential Addition No. of Units 1
Comments
)onus room & bathroom
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 280 or $ 515.20 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 cc/Palm Desert National Bank/Imperial Sun Telephone
Name on the check '
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $515.20
Signature 0 pnn0 P 9 AI A.Q.8/'A-
Check No. 77650
tOTICE: 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
tbove 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 Districl('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 Copy - Accounting
Date: J3
To: Z 42J_ Dom,
Re: AO
Your request for approval of has been
/y Approved
• ! ! Denied
Reason for denial:
ha*n VofZrrchitectural Committee
co
(1-911
o
IV
j tzi
\ - 1
M04E-� L, 14-F
T
PHO
P-
LT 17-4
-Do
If
IF
wlsu—
AT T ...
Lo\,J� -T\
7o
Sly ��f SIDCQ'''
A 117=
7L -P .
F-Ef/lol-1 I I L
0Q
7'
4
Uf-\,/ WALLr�
or: Pc I c
CITY OF LA QPINTA
BUILDING & SAFETY DEPT.
APPROV D
FOR CONSTRU t,TION
DATE 3-o3 B,y
r •IFRI
.. qQ
is
1000 \ tgh OT CLQ �O►LC.4ac -a
I
7.
BA HROO'M ( 'i f
1�
CIL
4--t�� La: �
Z �� ,wS
Go^+ n�
C
s
4--t�� La: �
Z �� ,wS
Go^+ n�
C
A
19
x
X
Bin #�
City of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 7 g_ �,
Oa-ner's Name: S D +
A. P. Number:
Address: a.� c. ` Mad`
Legal Description:
Contractor: aL
Cin•. ST. Zip: Z -a—s—
FTelephone: '
Address: �0 2 �'
Project Description:
City. ST. Zip: Z -
Telephone: 3
w
State Lic. # :
Cin• Lic. =:
S
Arch.. Engr.. Designer:
Address:
City. ST. Zip:
Telephone:
State Lic. #i:
Name of Contact Person: c.
Construction Type: Occupancy:
Proiect type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 0 Stories: Units:
Telephone # of Contact Person:
Estimated Value of Proiect:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TR4CKING
PERMIT FEES
Plan Sets
Plan Check submitted
`/��
Item
Amount
Structural C2105.
v
Reviewed. ready for corrections M1
s,�
Plan Check Deposit
Truss Calcs.
Called Contact Person
5j v
Plan Check Balance
Energy Calcs.
Plans picked up
S�s(03
Construction
Flood plain plan
Plans resubmitted
7 (3
Mechanical
Grading plan
2nd Review. ready for correctio sue
/�6
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAt.l.
H.O.A. Approval
Plans resubmitted
Grading
I1 HOUSE:-
'^' Review. ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Tjz5 S n,.a- Ta fez DLe S/7 -lr4l&- F-&4 ?- t,)L'-
CLr/'lrll !}Prim on c c S O O t'
L S-rL,cT ;s -q a< —RFC
RAYMOND FRANGIE STRUCTURAL CONSULTANTS, INC.
44-100 MONTEREY AVE., SUITE 201C, PALM DESERT, CA. 92260
PHONE (760) 836-1000 FAX (760) 836-0856
APRIL 21, 2003
P-agozE� W6 /o 3
Mr. DAVID SHAW
78 875 DULCE DEL MAR
LA QUINTA, CA. 92253
Re.: THE SHAW RESIDENCE
LAKE LA QUINTA
78-875 DULCE DEL MAR
LA QUINTA, CA.
JOB NO.: 4077
IN REGUARD OF THE ABOVE MENTIONED.PROJECT, AND AS PER OUR
CONVERSATION AT THE JOB SITE ON APRIL 3, 2003, WE SUBMIT THE FOLLOWING:
1- FOR THE HALLWAY ADDITION CONNECTING THE EXERCISE ROOM TO THE
OFFICE, LOCATE A 6x6 HEADER AT THE DOOR AND ADD A 10 FOOT LONG
PLYWOOD SHEAR PANEL TO REPLACE THE EXISTING DAMAGED SHEAR PANEL
WITH SIMPSON HTT22 AT EACH END AND 5/8" DIAM RED HEADS AT 32" O/C. MIN.
5-1/4" INTO CONCRETE.
VERIFY THE ABOVE INFORMATION WITH THE BUILDING DEPARTMENT PRIOR TO
APPLICATION.
IF YOU HAVE ANY QUESTIONS PLEASE DO NOT HESITATE TO CALL OUR OFFICE
AT THE ABOVE PHONE NUMBER.
0
See
Attachments( 3
oit r1 C.- C0
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE S �6 b BY Uv FN
✓ S I D Ef�
N
A11 = 11- Ort
M� F�ltYwJ� � ►�`� F�tg��G /f
J �o,�iL I NTEi�C.oN� LT
�� rr
Jot PCS �
q1
ab -
r
Y
RAYMOND-FRANGIE STRUCTURAL CONSULTANTS
44100 MONTEREY AVE., SUITE 201C, PALM DESERT, CA. 9220
PHONE (760) 836-1000 FAX (760) 836-0856\
" — USE SIMPSON SET EPDXY-TIE SYSTEM
(DO NOT SUBSTITUTE)
APPROVALS! ICBG *5279 AND CITY OF
L.A. R.R. # 25279
REFER TO ICBO AND MANUFACTURER'S
SPECS. FOR INSTALLATION PROCEDURES.
SPECIAL. INSPECTION IS REQUIRED, DURING
ALL INSTALLATIONS,
MIN. CONCRETE STRENGTH Pc- 2500 psi
ADEQUATE SIZE WASHER 'REQUIRED WHEN
ANCHOR. BOLT SIZE IS SMALLER THAN
HOLE IN HOLDOWN.
CONTRACTOR SHALL SPECIFY'OVERALL
LENGTH OF ANCHOR.
1. .4X4 POST, U.N.O. SEE PL1 N
2. SEE TABLE
3. EMBEDMENT IS•FROM TOP OF•SLA13 AT
MONO -POUR FOUNDATION SYSTEM
4. OPTIONAL COLD JOINT AT 2 -POUR SYSTEMS
5. EMBEDMENT IS FROM COLD JOINT AT
2 -POUR SYSTEM
FIX FOR MISSING HOLDOWN.'
MISSING
. LACEW/
Rb0B
EMBEDMENT
HOLDOWN
~ *
I HTT22
8/B+
B'
AND HD2A
OBA
NDWHDBA
HD&VHDBA
7/V
7 3/4•
RAYMOND FRANGIE STRUCTURAL CONSULTANTS
44100 MONTEREY AVE., SUITE 201 C, PALM DESERT, CA. 92260
PHONE (760) 836-1000 FAX (760) 836-0856
s R€e, � W kka, ALv-r4 ZD6 a�- r,�s Zo 6e
u of
it
r