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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
634420 B MIC 1213 112C
Date • M� Signature of Contractor A f
r S 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 EXgMp1, Policy No.
(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 CaVornia, and agree that if I should become
subject to the workers' compensatign provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant y
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 witr 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.
k
Signature (Owner/Agent) r� i Dated•
Y �jQ+,.b" „j.
PERMIT #
BUILDING PERMIT -03W058
DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN INEER
CONxM'.ANDPA :DEV. HUDSON CONSTRUCTION
CAPAIM DEMIRT
CA 92211
(760),345-5154 csloq 5285
USE OF PERMIT
CiEAWtw+ LBURMiG
7M LIP, £' CkAF:ORN WAti I. ORCO SYS"f'ff:M
6 FF, WALL.
278M LF
619-Sobo
CONSTRUCTION FEE 101.000-418-000
D &
MAY 0 5 2003
CITY OF LA QUINTA
FINANCE DEPT.
Tit T'il;CP,T,ZwC`iN tlyC.r C� AIM PI:&W CTIECT' MOO
IMS PRE -PAM V. .1; ��QQU
RECEIPT DATE I BYDyTTF-Fl7p //� INSPE
J^ .e^' r.. x ,' 1,
/ V
4141-W.00
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings 5• . p
Main Drain
Bond Beam G
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:
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To specify your title block on Title : Job #
these five lines, use the SETTINGS Dsgnr: Date: 4:24PM, 29 JAN 03
main menu selection, choose the Description
Printing & Title Block tab, and ent Scope
your title block information.
Rev. 550100
User. KW -0604868, ver 5.5.0,25 -Sep -2001 Steel Column Page 1
(c)1983-2001 ENERCALC Engineering Software
Description STEEL COLUMN AT ENTRY GATE
General Information
Calculations are designed to AISC 9th Edition ASD and 1997 UBC Requirements
Steel Section TS5XSX114
Fy
36.00 ksi
X -X Sidesway : Sway Allowed
Duration Factor
1.330
Y -Y Sidesway : Sway Allowed
Column Height 9.000 ft
Elastic Modulus
29,000.00 ksi
End Fixity Fix -Free
X -X Unbraced
9.000 ft
Kxx 2.000
Live & Short Term Loads Combined
Y -Y Unbraced
9.000 ft
Kyy 2.000
Loads
Axial Load...
Dead Load 0.10 k
Ecc. for X -X Axis Moments
0.000 in
Live Load 0.10 k
Ecc. for Y -Y Axis Moments
0.000 in
Short Term Load k
Point lateral Loads...
DL
LL ST
Height
Along Y -Y (strong axis moments)
0.300 k 9.000 It
Along X -X ( y moments)
k ft
Column Design OK
Section: TS5X5X1/4, Height = 9.001t, Axial Loads: DL = 0.10, LL = 0.10, ST = O.00k, Ecc. = 0.000in
Unbraced Lengths: X -X = 9.001t, Y -Y = 9.00ft
Combined Stress Ratios Dead Live DL + LL DL + ST + (LL if Chosen)
AISC Formula H1 -1
AISC Formula H1 - 2
AISC Formula H1 - 3 0.0019 0.0019
XX Axis : Fa calc'd per 1.5-1, K*Ur < Cc
YY Axis : Fa calc'd Der 1.5-1. K*Ur < Cc
Stresses
Allowable & Actual Stresses Dead Live
Fa: Allowable 11.32 ksi 11.32 ksi
fa : Actual 0.02 ksi 0.02 ksi
0.0038 0.1546
DL + LL DL + Short
11.32 ksi 15.06 ksi
0.04 ksi 0.04 ksi
Fb:xx : Allow [F3.1] 23.76 ksi 23.76 ksi 23.76 ksi 31.60 ksi
fb : xx Actual 0.00 ksi 0.00 ksi 0.00 ksi 4.79 ksi
Fb:yy : Allow [F3.1 ] 23.76 ksi 23.76 ksi 23.76 ksi 31.60 ksi
fb : yy Actual 0.00 ksi 0.00 ksi 0.00 ksi 0.00 ksi
Analysis Values
F'ex:DL+LL 11,785 psi Cm:x DL+LL 0.85 Cb:x DL+LL 1.75
F'ey: DL+LL 11,785 psi Cm:y DL+LL 0.85 Cb:y DL+LL 1.75
F'ex : DL+LL+ST 15,674 psi Cm:x DL+LL+ST 0.85 Cb:x DL+LL+ST(-' 1.00�,�
F'ey : DL+LL+ST 15,674 psi Cm:y DL+LL+ST 0.85 Cb:y DL+LL+ST�'o` "irr�1.75 • r'
Max X -X Axis Deflection -0.257 in at 9.000 It Max Y -Y Axis Deflection 0.000 in 6t C� 0.000 It
r
�r�A-910
To specify your title block on Title: Job #
these five lines, use the SETTINGS Dsgnr: Date: 4:24PM, 29 JAN 03
main menu selection, choose the Description
Printing & Title Block tab, and ent Scope
your title block information.
Rev 550100
User KW -0604888, ver 5.5.0, 25 -Sep -2001 Steel Column Page 2
(c)1983.2001 ENERCALC Engineering Software
Description STEEL COLUMN AT ENTRY GATE
Section Properties
TSSXSX1/4
Depth
5.00 in Weight
15.59 #/it I -roc
16.90 in4
Width
5.000 in Area
4.59 in2 I-yy
16.90 in4
Thickness
0.250 in
S -roc
6.760 in3
S-yy
6.760 in3
r -roc
1.919 in
r-yy
1.919 in
To specify your title block on Title: Job #
these five lines, use the SETTINGS Dsgnr: Date: 4:27PM, 29 JAN 03
main menu selection, choose the Description
Printing & Title Block tab, and ent Scope:
vour title block information.
icer. a�uiw
User. KW.0604888.Ver 5.5.0,25Sep-2001 Pole Embedment in Soil Page 1
(c)198332001 ENERCALC Engineering Software
Description FOOTING AT ENTRY GATE COLUMN
General Information
Allow Passive
300.00 pcf
Applied Loads...
Max Passive
1,500.00 Psf
Point Load
300.00 lbs
Load duration factor
1.330
distance from base
9.000 ft
Pole is Rectangular
Width
24.000 in
Distributed Load
0.00 #/ft
No Surface Restraint
distance to top
3.000 ft
distance to bottom
0.000 ft
Moments @ Surface...
Point load
Distributed load
Without Surface Restraint...
Required Depth
Press @ 113 Embed...
Actual
Allowable
2,700.00 ft-#
0.00
2.850 It
387.92 psf
379.10 psf
Total Moment
Total Lateral
2,700.00 ft-#
300.00 lbs
01
\CHOIAje
Na C5058' r* .
Exp. ,�l3�:�
OF C
To specify your title block on Title: Job #
these five lines, use the SETTINGS Dsgnr: Date: 4:39PM, 29 JAN 03
main menu selection, choose the Description
Printing & Title Block tab, and ent Scope:
your title block information.
Rev. 550100
User. Kw -0604868, Ver 5.5.0, 25 -Sep -2001 Pole Embedment in Soil Page 1
(c)1983.2001 ENERCALC Engineering Software
Description FOOTING AT ENTRY GATE COLUMN
General Information
Allow Passive
300.00 pcf
Applied Loads...
Max Passive
1,500.00 Psf
Point Load
300.00 lbs
Load duration factor
1.330
distance from base
9.000 ft
Pole is Rectangular
Width
30.000 in
Distributed Load
0.00 #/ft
No Surface Restraint
distance to top
3.000 ft
distance to bottom
0.000 ft
Moments @ Surface...
Point load 2,700.00 ft-# Total Moment
Distributed load 0.00 Total Lateral
Without Surface Restraint...
Required Depth 2.644 ft
Press @ 1/3 Embed...
Actual 354.67 psf
Allowable 351.72 psf
2,700.00 ft-#
300.00 lbs
Nm C5058f ��