0303-258 (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
522213 B 1-VIC 61°101 5
Date 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).
O I am exempt under Section B&P.C. for thi"s relason/�
Date `r e`) `� 1 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:
Cartier OTAT1': Fit R) Policy No. 17037;111-01
(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 ofySection 3700 of the Labor
Code, I shall forthwith comply with those provisions° +`y
Dater' Applicant—
Warning-
pplicant 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 & 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 inspectiori purposes.
Signature (Owner/Agent) /, f 7 Date'r
DATE
BUILDING PERMIT
VALUATION LOT
PERMIT #
0303 -
TRACT
JOB SITE
ADDRESS � WKEOP•�r APN
'7 c E 7;7•I.. (, . 7
OWNER CONTRACTOR / DESIGNER / EN (NEER
1TW1GHT & K'AKKTKY' rjlw" kX_ 04rW:;aND CONS"lbi:'C3'G"`l'1:O
W,00MG11WAY 111, 0220 49-6 10 DAM, Ptalm OWE,
Lh Ql'. wr,A, Dill, 9Z. 3Lik QTJRTrA CA 9l23.�
C760)777-9931 031P 3.479
USE OA•pF^*,��PERMIT
,.L��p•� yy y� � t�♦�ir[�p�
YE331.tJ. 47",,Li�4
CUSTOM COHOTRUCTPX.-� MOP SF
Cf.'rNTRAC7.' A.5690FJNT 744 90 IS
"T'i iS�w:4f
1RUB-TOTAL C`i�:tvtiiY11TYCITOR !ND rLAlei C:i1:rwX $M, 7.01
RECEIPT DATE BY DATE FINALED INSPECTOR
1 w
,r,UNIrfF JCT;0.t�' FW?
101.000.4 f IR-0tV
$516100
PL Aix it l
I at -000-439-3 19
$416,26
t�1F(C"ri)1h1C133.`% £s
1011.000-421-000
W-513
24'-t}0i
101-OW1420-000
9.56.31
PLill4►l,CtTNi117M
101-t 00-4.194000
$97,00
10HO MOTION PET, • RE:SID
101-000-2.41-000
$165
CiRAMWO HE
31041-00101-4123-000 ,
s d,1,00
"T'i iS�w:4f
1RUB-TOTAL C`i�:tvtiiY11TYCITOR !ND rLAlei C:i1:rwX $M, 7.01
RECEIPT DATE BY DATE FINALED INSPECTOR
1 w
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Return Air
Combustion Air
Roof Deck
O.K. to Wrap
Exhaust Fans
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
or Wv
Final
Final
BLOCKWA
u
AP ROVALS
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
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 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:
Coachella Valley Unified School District
..� .-�
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
Owner's Name:
Dwight & Kathy Drake
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Address: 80-955 Weiskopf, La Quinta, PGA,
Project Description: Addition to Existing House
Date: July 29, 2003
Phone No. 760 771-9260
APN: 760 170 007 Tract #: 30582 Lot #'s:
Type of Develop t_:::
ent:ResXX! Commercial Industrial
Total Square Feet of Building Area: 974
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the er/developer.
Dated: 7 Signature:
***********************************************************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq.Ft. 974
Amount per Sq.Ft. $2.14
Amount Collected $2084.36
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Marcela Valdez, Facilities Clerk Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written otice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the i tion of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
t1V.cim}doc; de�fe: ,certiiicatc ofu+mpliwrice Ii?rm LablesT0 USE.doc 1/16/03 T
STRUCTURAL AND CIVIL ENGINEERING
DENISE R. POELTLER, INC.
73.661 Highway 111 • Suite G • Palm Desert, California 92260
www.theflyingbUttress.com
02 July 2003
Mr. Tom Hartung, Building Director
CITY OF LA QUINTA
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
RE: DRAKE GUEST HOUSE
Job Site Add=w-1M •�5'S ihiskopf
PGA West
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 TRUSS WORKS (dated 7-01-2003), and found them
within allowable tolerances.
Respectfully submitted,
Denise R. Poeltler
R.C.E. 334.46
W.O. 03-132
cc: Mr. Perry Rice, Designer
(760) 779-0405 0 FAX (760) 779-1317
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
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 (1a�r�
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ 0TH tOf'
❑ REINFORCED_ MASONRY ❑ FIRE PROOFING
JOB LOCAT N �-
)6 S �a % �� \
REPORT SEQUENCE NO.
TY OF STRUCTUR
�
- �� J�
PERMI N0.
pADATEDAV
pF WEEK
.
M RIAL DESCRIPTION
^ ?
ARCHITECT
INSPECTOR
HRS. CHARGED
2
2
ENGINEER
--• � Y. cess
ASSISTANTS
HRS. CHARGED
INSPECTION.
DATE
GENERAL ` �C�S SU
CONTRACTOR � CONTRACTOR
1r
a�5etrv Q
11
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF M1'
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.
ATURE OF RE
STERED INSPECTOR
Z
3
l QZ<2�7??
7I
DATE
F REPORT
REGISTER NUMBER
i pRoWrput?il�l-i i 17124i�.
73661 Highway 111, Suite G REVISSW �� QA��3 ��� �� ���� ��Pr • � $ •� i
Pain Desert, CA 92260 PAGE i
(760) 779-0405 FAX (760) 779-1317
PROJECT:
5PEGIA
INSPECTION
REQUIREDI
0
0
0
0
° 4 .
• v
;4 a
° de 5/4"
/15/4
a' MIN.
I:D6E
DISTANCE
120"
2-2X 51VM OR
4X WDOD POST (MIN)
SIMPSON Kma5,
24 - Ibd COMMONS
OR 51MP50N HTT22
52-I6d 51NKER5
5/6" + ASOI ALL -THREAD
BOLT 1N/ 51MP5ON 5ET
EPDXY AD4e5l\/E
I LB.O. NO. 521-R
Fallow - 51500
uplift
EXISTING FOOTING
No. 33446 i
Exp. 66-30-06
n �
*51i55TITVrION DETAIL FOR
1 M-022 AND HD5A
P05T ANCHOR RETRO -F I T
FN-RTO2