9703-108 (SOTB)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
c�S61.�€i C53 10/3 0 8
Date 2 Signature of Contractor*" y
c
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 Policy No.
t'a1'TtT'
(This section need not be completed if the perm)
() I certify that in the performance of the wor
permit
I shall not employ any person in any manner'
workers' compensation laws of California,/and
subject to the workers' compensation prrovisio
Code, I shall forthwith comply with thse provis
Date: -" '' Applicant "I", i.1 s
is for $100.00 or less).
k for which this permit is issued,
so as to become subject to the
agree that if I should become
ns of. -Section 3700 of the Labor
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 prsuant 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 applicatioWAnd state that the above information is
11 1
correct. I. agree to comply with all City,, and State laws relating to the building
construction, and hereby authorizerepresentatives of this City to enter upon
the above-mentioned property for inspection purposes.
=/Si nature -'Owner/Anent)' ' ref f Date •-� j
(LI 111.1
BUILDING PERMIT PERMIT# CONTROL I/
7��� 4 89 2
DATE ,�a<3119r% VALUATION ,� v 'LOT TRACT
- add
G) .JOB SITE
ADDRESS 54.5.15 WINO
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER141
5Mj1 1'�IFJC N J POsPt'
74423 JON 1.'iKTVE, #.A.
L A QLJONFI'A CA 92753
PALM [7►JS};Wr CA. 9226E
(619)3,10-9000 CBL #' 355
USE OF PERMIT
VAL.IJATICrN ,k7 t30 a..
l3"STI_N11A T'U,1) CO `4 OV COINISTRIX1, i10NI
PLAN Z'HK{:K ITS: 10140JI-43.9-3114 $70.00
$5440
1�.#i`,"f'?`<.tt.i1)..}fjiF iiT;:-Qij`�•••��d)•-3.1i?ff � $D..`.+,lJtt
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. �� � �
`�1't�NUiL1t33�.4t)N'.h'fl!?"-CZkiSitj 111144)-j:1L..i�}0 $;�4J
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C:
°('+
;;t,f)#-'TtC'37'A L C0RIKTIt,S.t(7110.K AICD PLA14 C;Tt�]}�f(;�'Y1K
"�' $1 (A. 50
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'T,'O'E'A1rTEK1VOT VC10;1 133 NOW
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RECEIPT
DATE
BY % +....+
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms Vootinv
Ducts
Slab G
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Under round Plbg. Test
Final AA,ko
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:
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)
6.
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-GROUP, INC. - Engineer:
651 E. Northridge Ave. PH:, (818) 335-4362
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ENGINEERING Client:--.
GROUP, INC. • Engineer:
6511 E: Northridge -Ave. PH:. (818) 335-4362
Glendora, CA 91741 FAX: (818) 963-4812 Date:. '7I �2-� °li Sheet of A'
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'WALL SPECIFICATIONS:
1.P.S.I. 28 DAYS
.. CONCRETE: 2 000 P .I. � •• - - - - - �-�-__ _' 'i • #
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BLOCK: PERU B C STA
STEEL: A.S.T_M. A-615 G B i
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STANDARD. #'LI-•�}' '
RADE 40 ARS �•.. • ;• '
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2. $ CONCRETE MIX FOR THE FOOTINGS SHALL BE I' i
1 PART CEMENT, 2 1/2 PARTS SAND, 3 1/2 PARTS
'GRAVEL_ WITH NOT MORE THAN 7 GALLONS OF
,WATER PER SACK OF CEMENT.
71-i
3. MORTAR MIX FOR BLOCK MORTAR SHALL BE 1
PART CEMENT, 3 112 PARTS SAND; 1/4 PART LIME.-
,, PLASTIC CEMENT MAY BE USED WITH 3 PARTS
'SAND TO I PART PLASTICNT - "-
CEMENT.
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.r GROUT MIX SHALL BE I PART CEMENT TO 3 ;
'. • , PARTS SAND„WITH WATER ADDED TO POURING
CONSISTENCY WITHOUT SEGREGATION OF THE
r GROUT CONSTITUENTS. --
. - � O TUENTS. (fc = 2,000 PST) -•- - --- -- _ � .._..- __-- _
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• Project:
PATRELL
ENGINEERING, Client: G''pooc-h t
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GROUP, INC.
Engineer:��- .
'651 E, Northridge Ave.. PH: (818) 335-4362 . '
Glendora, CA 91741 FAX: (818) 963-4812 Date: 3I Uzi °1l Sheets of
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651 E: Northridge Ave. PH: (818) 335-4362
Glendora,' CA-, 91741. FAX; (818) 963-4812 Date:. ' ' I ! Ifl SheetA�L of
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INATER LOAO SURCHARGE LOAD EARTH LOAD PORE PRESSURE LMD ,
COUNTERFORT WALL SLAT -- INTER R .A
10CALISEO DIMENSIONS ANO COMPONENT LOA De •f
MAONITUDE'`•... ,
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LOAD /FT
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NET LOAD ON - -
NEEL SLAB - COMPONENT LOAD&
COUNTERFORT HEEL SLAB.— INTERIOR PANEL y�Q
IOEALISEO .DlMLN$lONS AND COMPONENTIOADS
Fiaosn 3L—Counigfort IoaU, design example. CA1.���
CIIIIIIIIIIIII
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Project:
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PATRELL'
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ENGINEERING,
Client:
G
GROUP, INC. •
Engineer:
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651 E. Northridge Ave. ' PH:
(818) 335-4362
Date:
o� �1
Sheet_
Glendora, CA 91740 FAX:
(818) 963-4812
of
46 MOMENTS AND
REACTIONS FOR RECTANGULAR
PLATES
DESIGN
DATA•
Unit Weights
12' ►
- ::••• Surcharge• •i::�
}
Ll
Concrete
Moist earth
'Saturated
150 1D/fts
110 ID/ftp
�.,.•,hb�si �arin fill
1
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earth.
135.ID/ft
. •�: �':"�,- Level. ••f
;
watai
Surcharge Pressures.
a9.e le/f is
•. -.:.. -...
satTuroSan
I 1 I 1
I1 I I
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Vertical
3601D/ftE
.�•+�-�--t
;'►•'::+;•'
i I I
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Horizontal' Ito ID/tte'
Equivalent fluid Weights
`:Safurotcd
�� earth fill.
1 1
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Moist earth
e0 ID/fts-
ll � I
Saturated tortA
73 lb/ft, '
- -
1
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Water surfou
d 1
FRONT ELEVATION
.
'END ELEVATION
COUNTERFORT RETAINING RETAINING,
WALL
•
DIMENSIONS AND TYPICAL DESION LOADS
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COUNTERFORT WALL SLAT -- INTER R .A
10CALISEO DIMENSIONS ANO COMPONENT LOA De •f
MAONITUDE'`•... ,
I -
kv
LOAD /FT
• rn
+ 10r 1510 tGuN gE� Ere
i•►o.iES�+a-7.2511----pU
-•'�'+ ' ;..._..p� ;,_..J aC A YW. 7D
NET LOAD ON - -
NEEL SLAB - COMPONENT LOAD&
COUNTERFORT HEEL SLAB.— INTERIOR PANEL y�Q
IOEALISEO .DlMLN$lONS AND COMPONENTIOADS
Fiaosn 3L—Counigfort IoaU, design example. CA1.���
CIIIIIIIIIIIII
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