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0311-086 (AR)LICENSED CONTRACTOR DECLARATION I h eby 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 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: 1�4) 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). �; ( ) Pam exempt under Section B&P.C. for.thiiS reason Date ,1 it14 Signature of Owner / f✓., _ 4 by 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. (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 all not employ any person in any manner so as to become subject to the orkers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions ofiSection 3700 of the Labor Code, I shall forthwith comply with those prow sio a �aDate: 1 Applicant Lit' f ., fi VK.,(-__ 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 yotthe 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, intd & hold harmless the City of La Quinta, its officers, agents and em 2. Any permit issued as a result of this application becomes null an work is not commenced within 180 days from date of issuance permit, or cessation of work for 180 days will subject permit to CancI certify that I have read this application and state that the above informcorrect. I agree to comply with all City, and State laws relating to theconstruction, and hereby authorize representatives of this City to ent the above-mentioned property/for inspection purposes. ,,Sig ature (Owner/Agent) i 71 to Date A122 BUILDING PERMiT PERMIT# DATE VALUATION LOT TRACT JOB SITE APN ADDRESS1��A�' rx.��Iti%i OWNER CONTRACTOR / DESIGNER / ENGINEER ti:k+.�i 80.498 k11+.F2WI A W., L: QjM-TrA CA 72253 C 3 CB1J USE OF PERMIT REMEW1 AL ADD711 100 970 SF ADDITION/04 SP" C OVEP& D PATIO823 SP 9'12E111S PATIO COQ,=ERA001 C5C, TRACT CONSTRUCTION 970.00 SP PORCWPAT1CI 1, 776.00 SII' FF l!'. XIM) COST OF C:otmkUr-1110M c's��i Tait CONSTRUCTIONFEE 301-000-416-000 8500.00 I LAI? CHECK FEE 101-000-439-318 $403.36 MECHANICAL FEE 101-000-421 -000 $47.00 >jE=1'1:.1z..A), MIZ 101-000-420-000 $67.43 P14MO1NC1 FEE 101.000.4.19.000 U9.00 STR NO 111AD IOIN FFE• PLSti9 101-000-241.-000 �6.F13 1:91 ^7,0+�„i'U.. �4J V1.71,!S t..l VAi I,J ,G'd.•f'r��7� A.rrd,A`�L�i.�. $ I.,093.6 4 LESS PRE -PAM FEES $0.00 r . , U A . +fife r F �Jf�TIE.I�CDV1.' $3.M..64 AR 2 2004Iry OF LAi 4,r eo: •, � r RECEIPT-•” '"'DAZE R oV BY T FI DAED INSPECTOR l INSPECTION RECORD ry OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel r� Combustion Air 1f Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing ` CompressorInsulation I Fireplace P.L. �/ 6 Vents Grills + Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final O BLOCKWALL A ROVALS Steel POOLS - SPAS 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 t j Sewer Lateral Pool Cover Sewer Connection Encapsulation I 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: ! ' a ` Coachella Valley unmea scnooi Llsirict P.01kRox'847, Thermal, CA 92274 ;760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMIIND. AMOUNT: DATE: RECEEPT: CHECK IJ: MITIALS• CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: March 12. 2004 Owner's Name: Glen & Rate Pace Phone No. Project Address: 80-498 Hermitage La OUinta. CA Project Description: 1 addition APN: 762-210-001 Tract #: ?R603 Lot #'s: Type of Development: Residential 1XXX Commercial Industrial Total Square Feet of Building Area: 970 sq. ft. Certification of Applicant/Owners: The person signing certifies that lt"-bove information is correct and makes this statement under penalty of perjury and further represents that he/she is author' t igVVnt!�half of t)�wi�Wdeveloper. Dated: -,7. /1 lO 1 Signature: * r**«.,w•,w*#rtF MF*rr*,r«**r«r�,r,w*.+t,r�,r**«wrtw**,w *wrr.+r*«w *,r ,w*,w**r«ww*«,t ,r ,w ,r «*•** 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 17620 65995 Approval Number of S+Ft. 970 Amount per Sq.Ft. $ 2.24 Amount Collected $ 2,172.80 Building Permit Application Completed: Yes/No By: Carey M. Carlson Asst. Supt., Business Serv. Agreement Existing Prior to 1/1/87 Note: Not Subject to Fee Requirement "a� ( �-, 77 -, -- Certificate issued by: El Vi ra- Mattson Signature: Office Technician NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3091, effective January 1, 1997, requires that this District provide (1) a written notice 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 imposition 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. MV:c/mydocs/devfees/certificate of compliance 09/30/02 MAWES� FAIRWAYS ASSOCIATION Mr. & Mrs. Stanley Pace 80-498 Hermitage La Quinta CA 92253 11 0 September 5, 2003 RE:. Addition & Landscape Dear Mr. & Mrs. Pace: At the August 25, 2003 Architectural/Landscape Committee meeting your plans that you submitted were reviewed -and approved with the following conditions: ❖ The addition was approved with the condition that the maintenance and liability for the roof will be your responsibility because of the extra square footage. ❖ Replace the stepping stones in the landscaping with a sidewalk ❖ The boulders need to be in a planter bed. ❖ Replace the plants that are not on the approved plant palette (such as the hibiscus, fountain grass and yucca.) ❖ All additional trees will be your responsibility to maintain and replace. ❖ The wall needs to match the existing walla ❖ The gate area needs to be wide enough for mowers and trash maintenance. . ❖. You need to install your own clock and valves for irrigation that will come off of your house meter. If you have any questions or need to contact me, please call (760) 564-3858. Sincerely, DONNA MARIMACCIO, CMCA Association Manager lncp , CC: Southwest Concepts Post Office Box 1658 -'La Ouinta. California 92253 • Phone (760) 564-3858 • Fax (760)564-2329 Summit Structural Engineering P.O. Box 813 270 North Main Street Donnelly, ID 83615 (866) 862-8148 (208) 325-8148 Fax (208) 325-8149 April 19, 2004 Foxworth Galbraith Truss Company 10527 South Frontage Road Yuma, AZ 85365 Attn: Truss Designer Subject: Roof Truss Shop Drawings and Calculations Pace Addition La Quinta, CA Dear Truss Designer, The roof truss drawings by Foxworth Galbraith Truss Company for the subject project were received by our office on April 19, 2004, and are approved. The submittal has been reviewed for general conformance to the design concept of the project structural plans. The fabrication processes, techniques of construction, dimensions, and quantities are not a part of this review. Since the shop drawings were reviewed only for general conformance with the structural plans, unless variations from the structural plans have been clearly indicated, we may not have listed them. Our review of these drawings does not relieve the truss engineer and the framing contractor from complying with the structural plans. If you have any questions, please give me a call. Yours truly, SUMMIT STRUCTURAL ENGINEERING Benjamin Herbst, P.E. CC: BH c:\2003jobfiles\sv-212\212—trussi.doc Residential. Commercial. Industrial. Land Develooment TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED a O ` J SAMPLE INFORMATION AT(,a)(, t-0 PHYSIC DRESS . PERUS11 C JOS NAME PAce- TYPE OF STRUCTURE ARCHITECT ENGINEER GENERAL CONTRACTOR SU,BCO CTO IN ztr I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: INSPECTORS SIGNATUREO INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER ME TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP STEMPE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: INSPECTORS SIGNATUREO INSPECTORS CERTIFICATION AGENCY AND NUMBER .Ri INSPECTIONS JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 Phone: 760-345-5554 - Fax: 760-772-3895 2E INSPECTIONS , Project Name: V,Wy,o e o O EPDXY INSPECTION REPORT /� Yn Project No: G1�n E e Qcs2. f�2Z��Qv1CSL Date:l'J -a Project Address: 1 City. Title 24 AWS UBC File # E] D 1.1 App# D 1.4 Other Other: Client: Sub -Contractor: C -GC C., General Contractor: p�SsacA Architect: Structural E gineer: n S SV MM1c��.I Anchor Bolts Rebar Epoxy Type: �� S o rN ��r o n Q e_ Epoxy Shelf Life: u n Q ,c-,I00s \\ n Hole Cleaning Method(s): 4 a n . W c Q�_- 2z. t us1� >�./ si �1�1 e CZ- (, V Weather: Jerc s Unresolved Items: None See Below Descripti n of Work Inspected: a Ste, t1e..J C a_ �a o� tie uA AAa ;n o o � -Rr `% nn� rS s d.1 P627J a o or,� S Pv�bAb�MP e �.r Ai Work complies with written approval from Structural Engineer and ICBO Evaluation Report # Sa� I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications _applicable building laws. Final report issued at project completion. Inspector: Jack Millin ICBO Ce 'fi a i o: 0842216-49 Contra to!'s R presentative: A Copy 1 JCM Inspections Copy Project Superintendent Copy 3 Governing Agency Page �f