06193 (AR)BuildinL.
Address 54-780 Obregon
Owner
Eufrene Beloff
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 54--780 Obragon
City Zip Tel.
La Quints 1 92253 1 564-2037-
Contractor
64-20,37_
Contractor
ress
82-723 Doetur Cnrreon Blvd.
Zip Tel.'
State Lic. I City
& Classif. 523837 Lic. # 1461
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
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 f ,
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 the ofleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally of not more than free hundred dollars ($500).
❑ 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 irprove for the purpose of sale.)
❑ 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 bnddsor inproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
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
Date--L-Owner
NOTICE TO APPLICANT: ll, 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 dais Permit shall be deemed revoked.
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, CW Code.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if 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 purpose&
Signature of applicant Date
Mailing Address
City, State, Zip
No. 06193
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-,794-01, 002
Legal Description
Project Description _Rooii addition " frit merger
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
8115189
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size 1068
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$306.02
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
586.33
�`
TOTAL
$892.35
c ,,-
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
8115189
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE NO. I ELECTRICAL FEES NO. I PLUMBING FEW
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBI
NDERGROUN ,2G -
1ST FL. SQ. FT. ® $
UNITS
Ii
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
?V61 OND BEAM T /
WATER SYSTEM
URINAL
SQ FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING A
WATER PIPING
NOTE: Not to be used as property tax valuation
0;4w
"4
((I�
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBI
NDERGROUN ,2G -
A.C. UNIT
COLL. AREA
SLAB GRADE Y
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
4FCANDC . REINF.—� G/
ll
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
?V61 OND BEAM T /
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
f
FINAL INSP. Q
FRAMING A
FINAL INSP.
ROOFING&// �2p�
0;4w
"4
((I�
/1r �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
1
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
NOTICE:
���g� OF
NOTICE: THVIS DOi�.eC.Cti�7EI�1�D 11V �1 ITY FEES
BE UUPL1CA'r1-;U.
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to cer 'fy that ze. 7K
developer of �. hich is
located at y- p , within
this District, has paid school facility fees imposed pursuant to the
authority generate y Government Code Section,53080 in the amount of
covering a total of / 19 F square feet of ( sidential oe
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your.jurisdiction.
for.DESERT SANDSNIFIE 9,
0 fc—Ho6L DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
0 007
WARRANT REQUEST FORM "
INSTRUCTIONS: Complete form. Send to the Finance Department for
approval.
1. Nanw.and .title of requestee: 2. Date Warrant Needed:
TO►✓1 N a �� i,� ti C-, -
�t�r_i�i>`��; OFFiCcAL
3.- Explanation of warrant request:
�CF(�tiJD OF (d I1_bwC° _E -D TO - ` LQ& i 4((" 1 �1
4., Warrant made payable to:
S-1 EPN I E�
Name of.Payee
�242 _DC r, CAU
Address
N�i�o G�Lyp I
City State
'
S.
.6.
7.-
ZIP g,
Warrant Amount: ; -35
Account No,. -
Is this Warrant Request in
accordance with your departmental
budget. Yes No
Amount of funds budgeted for this
expense? ;
9. Signature of, Request
10. Approved b
Dept. Head .11.
Date of -Request
Q"5. 9
.12. APPROVED/DENIED
Finance Director
or City Manager
Date
RUBICON GEOTECHNICAL
65-861 PIERSON BLVD., STE. D .
DESERT HOT SPRINGS, CALIFORNIA 92240
(619) 329-3588 (619) 329-3041
SOIL TESTING / SITE INVESTIGATION /'FOUNDATION ENGINEERING
.September!18, 1989 Project No: 89-R224-101-01-
To:- Southwest Concepts
82-723 Dr. Carreon Boulevard
Indio, California 92201
Attention: Mr. Steve Nieto
Subject: Report.of Compaction Test Results, Building Pad at 54780
Avenida Obregon, La Quinta, California
At your request, we have performed 11 compaction tests on the near surface
soils at the subject site. The test results and approximate test locations
are detailed on the attached sheets (Figures 1 and 2). Laboratory maximum
density and optimum moisture tests were performed as per ASTM Test Method
D1557-78 to provide a criteria to evaluate the relative compaction of the
soils. The field density tests were performed using the nuclear densometer
method in accordance with ASTM D2922 and/or the sand cone method in accordance
with ASTM D1556.
The scope of our work was to perform compaction tests.for information
purposes only._ More detailed soil engineering information or any recommenda-
tions for an' evaluation of foundation performance are beyond the scope of
our present work. The scope of our work did not include review of foundation
or grading plans, or observing the grading operation during placement of
fills to check for uniformity of materials used, construction.methods,..etc.
Therefore-' we cannot make any stat einent'about Conditions below or beyond our
test locations.
Should you have any questions regarding this report, please contact, us.
Respectfully submitted,
RUBICON GEOTECHNICAL
Douglas E.: Stephenson
BJI/ct
Distribution: (4) Addressee
. c
Brent J. Inghram, RCE 4,`:�'
F
BhCi: T J. c
IY:a .RriiA �
No.40264 m
Exp. / 1- 3/- 90 V
CIVIL
Q
rl 0 CAL% '�J
Enclosures: Figure 1, Compaction Test Summary
Figure 2, Sketch of Test Locations
W
RUBICON GEOTECHNICAL
65861 Pierson Blvd., Ste. D
Desert Hot Springs, California 92240
Project No. 89-R224-101-01
SUMMARY OF FIELD DENSITY TESTS
Test
No
Test
Date
Test
Location
Soil
Type
Comondents
Test Eley.
Dry Dens., ocf
Moisture. %
Relative
Compaction
Field
Maximum
Field
Opt.
1989
1
9/7
See sketch
A
O.G.*
122.5
129.0
7.3
10.5
95%
2
9/7
See sketch
A
O.G.
116.3
129.0
11.1
10.5
90%
3
9/7
See sketch
B
O.G. + 3'+
93.5
107.5
15.5
14.5
87%
3A
9/8
(Retest of No. 3)
B
O.G. + 3'+
96.3
107.5
21.5
14.5
90%
4
9/7
See sketch
B
O.G. + 3'+
90.8
107.5
15.5
14.5
84%
4A
9/8
(Retest of No. 4)
B
O.G. + 3'+
92.8
107.5
14.0
14.5
86%
4B
9/9
(Retest of No. 4A)
B
O.G. + 3'+
99.5
107.5
18.0
14.5
93%
5
9/15
See sketch
B
O.G. + 3.5'+
98.0
107.5
14.2
14.5
91%
6
9/15
See sketch
B
O.G. + 3.5'+
98.5
107.5
22.0
14.5
92% .
7
9/15
See sketch
B
O.G. + 4.5'+
98.3
107.5
7.8
14.5
91%
8
9/15
See sketch
B
O.G. + 4.5'+
96.8
107.5
11.6
14.5
90%
Field density tests were performed with the nuclear densometer, in
accordance with ASTM Test Method D2922.
O.G..indicates original grade elevation
LABORATORY MAXIMUM DENSITY TEST RESULTS
Maximum Dry. Optimum -Moisture
Soil Type Soil Description Density. Content
A Native, onsite material: 129.0 10.5
gravelly sand with cobbles and.silt
B Import soil: 107.5. 14.5
clean, fine to medium grained sand.
Laboratory Maximum Density/Optimum Moisture Content tests were
performed in accordance with ASTM Test Method D1558.
Figure 1
SOUTHWEST CONCEPTS
S4-780 Avenida 06re9on,
LaQuinto , Caii-`orrnict
*9 Denot* e s Density Test Locodion
POOL I � " •