9712-094 (SFD)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
B C9 C53
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).
( ) 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.
()4 1 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.
G,Ut.i31`sN tiACli.l T�lrt: d.2rii)-Qt}
(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 of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
/Date: r Applicant " -.- 11
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, a&' 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) "- Date t7-
PERMIT# CONTROL#
BUILDING PERMIT
'
9712-111194
DATE > /� VALUATION ��{Zt�}�� 3� LOT TRACT 1079.40
G
ADDRESS 79-285 TOM F AZIO 1,ANC NI.i�.Y.1ti:
APN 76t-527-009
OWNER
CONTRACTOR / DESIGNER / ENGINEER
F,P11 e ISAIWI, V.)I��.
sTc};:1R. c:�; IMIlUCT10�r INTC.
YTA CA VALLEY CA 92284
rtrara� t r►1
USE OF PERMIT
SFI)
7.1.105 tv#C: CK}Ni: BIRO TR
SM - I`1Ei2MIT DOES NOT NC.LITOEs isiOCK OR 1,C 'X
tit},y l'0M CON IZI?, CfilON 8,30.11M 1,31
PGtiC *I11 T10 912.00 SF
C3AItA(WCA.tCilOdt't' t,!)+!!•i►i1 SM
E -S. l'iMATED C°1;51' OF f "ON81'RUCTII,` N
1
PERMIT ME Si. AINIARV
CQid4'r. (JT( rK.)N FFF
PIAN C 1Tf7(!K fell- 1014")_434-119 $1,1C440
Ff?i: Ov.1 41,2154).00
f14}?,CIfANICAL F"P'N, $2L1.50
FLEK7i2.tCALt'-t'E if}t-o{}ca-ayc}+ia}}I} 34113,8t
.
Idly. f4
in;tppmixliw1ffrn j(it-(yNV1JM�•a�'�
1d.1qy-tNl(i
H1,:_ED ED 100 ^-000 JtiJ. I!
� ►1tr�:>I N�a�.i��` 1 i► t-i�G-i �3-lbfK� �2i>,u�+
1..
ft'RA:3'i'}LSi+„"1't.JRt-.Vhi:
Cb
�5vrYJV51. ` 8'i, .l_1t�"t?S ►N AND I -ANi TIff,l4
'St 3XkZ.75
4Z -PAID UT 8
ICY
NY
'AL II'EHN11T F1f ..S OUR. iYi.1W
S 1. 918,3. 75
Q�v�'FO
RECEIPT
DATE
BY`
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
POOLS - SPAS
BLOCKWALL APPROVALS
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
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
Utillty Notice (Perm)
}'�IN
,; .
0
f�N�Gv
Tom F471V ZAN �� P.O. BOX 1504
Building `G%y fr/�/ ��78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
O y ,C f - Lmsw
Mailing � t.TI � 76M r AZ10
`Address 1. 1
City
Gk W I N O }�� C �� ZIp f ZZS J Tel.
Contractor
Address
City�`�YU, yp IZipeljZS� ITel-
& Classif. I Lic. q
Arch., Engr.,
Designer Wvlfr t\T ` -1
Address j Moc1-j *� N oya�� Tel
City Zip State
INV'I M 1�II:f,l r/, C�1 Q.ZA a Lic. a
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure; prior to Its issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that -he is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I; 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permil is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT., It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
111
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0pl
Mailing Address_
City, State, Zip_
APPLICATION ONLY
r
LDING: TYPE'CONST. OCC. GRP
Number 761 - 522 - C09
I Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. /QgG/.0
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
DEC 15 n997
TOTAL I /;;?:!5`d, U (/
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE .
Date 3/10/98
No. 16707 Jurisdiction
Owner NameJeff & Isabel Louis
No. 79-285 Street Tom Fazio Lane North
City La Quinta zip 92253
Tract # Lot #
Type of Development Single Family Residence.
Comments
APN # 761-522-009
La Quinta
Permit #
Log #
Study Area
Square Footage 8323
No. of Units 1
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the"amount:bf
1.93 X 8,323 or $ 16,063.39 the property listed above and that bdildiitg
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
n`Y
Fees Paid By CC/First Community Bank/Don Hawkins Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Rosita Jones Payment Received $16,063.39
Check No. 077237
Signature
NOTICE: 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
above 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
collect them on the District('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
1-99 WED 10:23 AM STOKER CONSTRUCTION
�.5;�
6Lg OF LA QUiNTA
�i& SAFETY DEPARTMENT
�� .•t. 777-7012
- -wSAON.REQUEST LINE
777-7153
Dwner ,TEFF &c ISABEL LOUIS
Contractor STOKER CONSTRUCTION INC
Permit Number 9712-094
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79"285 TOM I+AZIO LN NORTH
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SET"CK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLABlr�
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG.
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF y
BOND BEAM
O.K. TO WRAP U
GROUT ❑ 4' p 8'
FRAMING'
INSULATION
PRE -ROOF
COVER NO W6nk UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
-
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
(SEWER SEPTIC TANK .r`--/ •moi/
FINALS
PLUMBING `
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
. � OF �_A O!.alNrA JON TANDY , .
-r-= OCT m 8 REC'D 37630 Medjool Ave.
Palm Desert, CA 92211
BUILDING AND SAFEOffice (760) :772-7192
,SPECIALFax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY _O FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
(� En ��(� �� Y�Q^ '� �� ^ ,
REPORT SEQUENCE N0. -
T�SQFT,Q61CTURE L-OIV Y�� JL'C�Ji�r
i1—Q���
PERMIFTUNO.�/X-1..V
Z''D
7Tb-4 JIB
DAV OF WEEK
MATERIAL DESCRIPTION
ARCHITECT I
INSPECTOR
HRS. CHARGED
a
ENGINEER
ASSISTANTS
MRS. CHARGED
INSPECTION
DATE
GENERAL, j(�{/� _ SUB
� - _
CONTRACTOR ` CONTRACTOR_ ' '
• � -
� � "
S (� l 0 `� .tom G�-e.�-. � (,A
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SAN
COPY SENT TO CLIENT ❑
CONT= NEXT PAGE ❑
PAGE
OF
CERTIFICATION OF COMPLIANCE m .
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF.MY
KGNATURE OF REGISTERE NSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE �/� /
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED ,� 1_ Q Q. (J���
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE / V
GOVERNING BUILDING LAWS. DATE OF REPORT REGISTER NUMBER
SPECIAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
t. C17Y op LA
JON TAI Dy- �01 /0)
3580 Condalipve��Cp
Yucca Valley, CA M4 41 A.
(760) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING (�C�14CL4�
JOB LOCATION 9 -5- yo % 0 oz , _^ �/1 v ` .- _`. r
\1 �(•,
REPORT SEQUENCE NO.
�r�j
TVP FUTURE Lo �� 10
PERMIT NO.
DAjE
DAV OF WEEK
CTCR TION
MAT)TL
— siva
ARCHITECT
INSSPE TOR
7Aa
HRS. CHARGED
.�
-� S
ENGINEER
-
ASSISTANTS
NRS. CHARGED•
p
INSPECTION CONTRACTOR S . C:ONTSUB C�
DATE RACTCIR
o"iFeu-o Ljg-c4dt , s
B
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Neto 4 K6- NkKT—
(� L t c- t4 9 ?is
COPY SENT TO CLIENT ❑
NTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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.
� v
SIGNATURE OF REGISTERED INS CTOfi�
DATES OFREPORTREPPORTTj REGISTER NUMBER S
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•Materials and weldments conform to plans and specifications and RISC, and AWS Dl.l
Shipping Mark
905 SHEL
Special Deputy Insp.
U.L. 90 & U.L. fire'ri!M
ASTM air & water tested
ASTM E-1592 tested
-Tu Clip
-U. S. Pattnt Nn. 464147.5
--•-- 12340
fi 324 MM
TEE-PANEL CROSS-SECTION
vault derndge lee -Panel,
wpm, ao�
Berridge Manufacturing Co.
Snap-On
Seam Cap
wlPatented
Vinyl Insert
for specific joD application recommendations, please contact 9crridge
Technical Deparfineof - 1.800.231-8127.
..', .::...•
(Request. complete $psi iiic4k.Dn. ; lKini laerory);
Furnish and iri6tan 9erridge:T.eegPenel. S.tanding Seam.Sys'
ti"'. s man.ufactured:tiy8eiriiddi0iii,faciu[ing Company; .`..
Houston; . Taxa*6',%: •;
P..andl's 6hetl tieye.l2'14?'on=centei.seam spacing (othetsealir.
spacing ava0dble.wiM,fecfory.;Drodubod..panels):'Panele and
9eam9. shall. bo. roll-fortbda,'4h ;tontinuous:terlglhS '(M8)(ifiuM
40: or unlimited; if panels fCrmed onBeiiidge SS -14 06r(abte
rolf former). Snop=on seam6i6haII.contain'an extruded vinyl '
" .weather seaf.ins4n. cortificition.shiiltba submitted.'based on
indepandentrestingla6iatory,indicihngnomeasu�ableweter .
penetration? through the.etantling: seam si' Oem when tested .
in accordance' with` -AST -K eb3.1-86.','
Where. oquiied. panef aseeinbly'shall b0 Underwrle6.,
Laboratory-. UL90r pursuarii to. Construction Number. 296:
ROOF PREPARATION:
Roof dr3ck moat be. solid sheaified.andYree'of: all objects which
may puncture: urttlerleyirient'.:Eriiire roof:'erea must bs cdvered' .
with. a:minlmum, f one layer .of number thirty rool.felt'and'.
lapped.fiorizontallyo:siatting aY:tlie :save::::;
MATEit1AL:'ANDFINISH .';
(See '^SPe*:I" tion•,Page`.39)o1.<current'8'erri0ge Swears Catalog
insert (076t0/BERj;`. `.:..:..:'
24" MAXIMUM
PROFILE
I
PANEL • SEAM ASSEMBLY
U.L CONSTRUCTION ASSEMBLY COMPO
1- METAL ROOF DECK PANELS: No, 24 MSG in. 40,000 psi yield
41ratt0h coated steel. Panel widths to be 12-3/4' or 19-3/4' and rib
height to be 518'. Total seam heigMwRh snap on seam cover in place
is nominal 11. Panels to be continuous length. End laps to be
overlapped minimum 6'. Aline of sealant may be used at panel and
and sidelapa.
9erridge Manufacturing Company . Tee Panel'
2. ROOF DECK FASTENERS: (Panel Clips) one piece clip. 3/4' high
x 1-12' wide x 1.5/8' long. formed from the same type and thickness
M6110401 as that used to fabricate metal panels, Clips spaced max.
24' O.C., located at panel sides with guide holes in bottom to
accommodate slaw fasteners.
Berridge Manufacturing Company . Tee Clip*
2A R" DECK FASTENERS. (Seam Covers) Seams covering
Panel ribs are to be 3/8' wide and 7/8' high with vinyl insert (U.S.
Patent No. 4,641,475), formed from the same type and thickness
material as that used to fabricate metal panels.
Berridge Manulacturing Company -'Seam Covers.
3. FASTENERS: Screws used to attach the panels clips to plywood
to be No. 10 by 1' long pancake bead wood screw with a No. 2
Phillips drive. One screw per clip, Screws used to attach plywood
substructure to wood trusses or joist to be deformed shank nails.
When lightgaugestructural sreeljoists are used, screwsto be No. 12
x 1.5/8' long with Phillips drive head. Spacing Of screws to be 6 in.
O.C. sr plywood ends and 12' O.C. at interior joints.
4. SU13ETRUMRE: (plywood) - Plywood decking to be a nominal
5/8' thick, exposure shealhing span C•0, 40/20 plywood. All butt
joints are to be scaled with tape and/or caulked.
5. FELT PAPER: Two ply. No. 30 Ib. per too sq. It.
6. JOISTS: Joisr 30accd at 2'.0' O.C. may be one of the following:
A. Nom 2 x 6 wood joists No. 2 or better.
B. Nom 2 x 4 woad when used on A top cord of a wood
truss. No. 2 or better.
C. Light gauge structural steel framing with the memoer
againsr the olywood to be a min No. 22 MSG coated
steel.
FOR ADDITIONAL INFORMATION, PLEASE REFER TO THE UNOERWRfTERS LABORATORY, INC. BUILDING MATERIALS 0/RECTORY
Berridge
'lis Manufacturing Co.
Ra'A tr aw"Vw
UL 90 APPROVED DATE
TEE PANEL ASSEMBLY 87/89
CONSTRUCTION NO. 296.
TEE PANEL SYSTEM T�90
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