0305-286 (BLDG)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
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 n'ot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1,t•as owner ofthe 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. f"'
Cthisreason
Date :t Signature of Owner -
,W.�`•--���
`ORKER'S COMPENSATI1N D I�RATION
I hereby affirm under penalty of perjury one of the following declarations:
() I have and will maintain a certificate oi:consent,to self -insure for workers'
compensation, as provided for by Sectioh';'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.gf 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 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 thr
e provisions.
Date: Applicant 1 e _..*-+•M
91
Warnin allure to secure Workers' Compensat oni 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 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. F
Signature (Owner/Agent) Tt , l V Dated � �• �.
` J BUILDING PERMIT , PERMIT0#+26
DATE VALUATION LOT, TRACT
— /" /-, /�_Z__ s2d==
JOB SITE /"
ADDRESS 49-49.9 RLS"M OMF R DRIVE
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
. i..AM 11, CORPORN170M
OWNER DUU T)m
55-9Z0PdA.BLVD
LAQIIW.HG CA, 92253
USE OF PERMIT
28' FLA.QPOL..K
VtAi.rVePiIF,iON 1J
EST)MATED CUSP OF COSU' `AR�TL`�!7(OiN
PERMff ME ElUMM&RY
CONSTRUCTION FEE 101.000.418.000
}
r_ow-m` 7Cnaw �vm PiA Z.Fi rx.
$45.00
' I PRE -PAID F
$0,00
pTMAL PERW-rF"Ir DUENOW
V45.99
EJU,015 2003
Cl.
RECEIPT
DATE!
BY
DAT NA
INSPECTO
INSPECTION RECORD
OPERATION I DATE I INSPECTOR OPERATION I DATE I INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Fo§t!gP Ducts
Slab•Gradg, Return Air
Steel Ti CombustionAir
Roof Deck Exhaust Fans_
O.K.toWrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
FireplaceAT.01' 'I,'
Faihs-6 Cohtrbls
Party Wall Insulatign
Condensate Lines
Party Wall Firewall
Exterior'W4
Drywall - Int. Lath
Final,'
Final
BLOCKWALL APPROVALS
POOLS SPAS
Steel
Set Backs
Electric Bond
Footings
Tl�
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping'
PLUMBING APPROVALS
Gas Tee
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
-Gas Test
Appliances
Final
COMMENTS:
�`,, �a i.. F�
-6:
Y
,Final
Utility Notice (Gas)
17
ELECTRICAL APPROVALS
Temp. Power Pole
�Underground Conduit
'Rough Wiring
Low VoftageWiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice (Perm)
FROM :F1ags"A"F1ying-John Cuddihy
FAX NO.- May. 28 2003 09:33RM Piii
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FROM :Flags"R"Flying-John Cuddihy FAX NO.
MAY-23-2003 12:34
May. 27 2003 11:50RM P3
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This pole passes for wind speeds up to 65 MPH and -gusts up to 85 MPH.
x�CA�i�#**'*4�t***�Itt,Miltill$7K1C2d�.Rx$2:$At$�R$iRt7R7tx�:i.$�6$aci7R##�t*�Y1t*7ki#�k#lk##,:*7kit47�:1�t*RiM7Rat*
Pole .type. :..........Tapered
Pole material. ....... .. ..,.:..........,,.Aldminum
Mount height. above grade (ft:).....:.. .0
Height from mount to top ......... ....3o
Diameter at mount (in.). ........5.000
Wall thickness at mount'(inr): .0.125
Length o; tapered.sectioh (ft.)...... :.. ..._14.280
Wall thickness id'taper (in'.•) .......................... 0.125
Diameter pole top'(in.)............................. 3.000
-Flag material.... ......Cotton or nylon
Plai'length •(ft.)r... .............'...........8.000
Flag height .(ft .) ..
Flag height above grade (ft.)........ ....... ..30.000
-Material Density.':.,
..... .0.100
Modulus'of Blasti,dity:.
....'.........10,000.000
Allowable
bend ing'St ress:':.... ♦............�23,000
Allowable
Shear
S;tress...:.....................11,900
Allowable
Yield
5tress.... ......... ... .....2S,00o
Allowable
Axial
S°tress................... ........236.360
:g
'Lone.psf
A(seg) Cd Wp(l•bs)'L(rt)
M(ft-lbs) STRESS
•CALC11) ALLOW
. . .
11.
. . .. - .
.0-151�ibj�
. • . . • • . • • • •
8..Z511.101 �100'..51.
•.Y . • ♦ . ♦ • • • • • • • • • . • • 1 . . . . .
7.5; •'7541 Axial
. . . . . . • . . . ♦ .
36 236
j.l
15-301
6:01
.15.41 • ..931
31
15-301 18;
4.7611.101
55'.7•1
22.91 21881Bending
•23 M 25000
...........
..................
202.3,
.... .:..... ...
3035 Shear
263 11900
C('amp)a
0.954
Height of Flag Centroid(ft•:).,....................27.500
Wind Losd Due to.P1ag.... ,.'..:.............. .49.675
Bendfng'Moment Due .to Flag .................. ..1.366.057
'Wind Load.. Due to Pole:. • .... . 202.276
Bending Moment Due - •to Po'le..:_....... .....:....3.038.87.2
Total Axial Load;:..'....':.'.:.. ...:......:...68.408
Pale Base Area...../..;..... :.................:..1.814
Moment of Inertia- at'Pole Aase......................5.691
Calculated- Axial Stress.: .... .. .35.733.
Calculated•Bending• Stress ...................... Z3,198.335
Calculated .Shtiir`.Stress...................
.......263.215
Coefficien•t'of Ain lif•fcation................. .....0.953
Combizied•Stress Mafia (MUST be t'1',0)..............0.97&
CITY OF !4AF?KD_4EPTA
BUILDING &T.
APPROVED
FOR CONSTRUCTION
DATE . BY .