SFD (0206-069)77845 Calle Madrid
0206-069
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
NIA 02/2ViC
c`6ate ,7~ 2/ .1, Signature of Contractor -Il --
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,.B t sins Professionals Code).
( ) I,,as bwder!of th iroperty, am exclusively contracting with licensed
contractorsito conStrugYtbe project (Sec. 7044, Business & Professionals
Code). / , / , ( ti
O I am exemp under Section , B&P.C. for this reason
Date ' r Sigmature of Owner
V-Ii/v V—,.
WORKER'S COMPENSATION DECLARATION
I hereby affjrm.funder n lty of perjury one of the following declarations:
O I hav . bd\y`il"k Big a certificate of consent to self -insure for workers'
compensatian, Is?ro7cr for by Section 3700 of the Labor Code, for the
performance of tb Iwowhich this permit is issued.
( ) I have and willntain 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:
CarrierEr^ ` I3k}I,il Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(ol) 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 tho 7' rovisions.
r Date: Applicant le Pi7G 1 % r
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 pers t
whose request and for whose benefit work is performed under or pursu
any permit issued as a result of this applicaton agrees to, & shall, inde
& hold harmless the City of La Quinta, its officers, agents and emplo s.
2. Any permit issued as a result of this application becomes null and'v if
work is not commenced within 180 days from date of issuance of uch
permit, or cessation of work for 180 days will subject permit to cancella on.
I certify that I have read this application and state that. the above informati
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 ffo? insfpectionjpurposes.
Signature (Owner/A ent)- , j r i Date
BUILDING PERMIT PERMIT# `
DATE t VALUATION req f4Y y{ LOT TRACT 1 210 f Iyt
! !/ + 1 U!J?. p b i.A.4r i. .4 9.tK
,f .. • f'•
JOB SITE
ADDRESS
APN ry .,g✓p , i .9
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PO BOX 11355
VID BOX 11335
P.aN1MVC,MO . T CIA 92255
1r,*J MD UTtT (4.P. 92255
r,160)485.1657 (M 4360
USE OF PERMIT
ICILLrij&U'k` 1Y Cis
Sro. in_+ UVIN4 PERMIT DOES Nyr mCF.Y9t'3rz.; ti.i.R cK
WALLA P09aVY"A OR DRJV VWAY APPROA:Cff,
W
ACT Ci'JNSTRU `1014 .3'as.Do S -.
4
AC4MCARPOIRN 462,00 S?
ESIMMIMUD
PEkW . 9 Nt iA d UTtY
yq ,wtM
101-000-418-000 00ryhnee! t
P1.Ali CHEC.K.re!7, 101-(WJ-113 9
FEZ DEPOSIT 101-000-439-318 SiIr C
A/ F1C'VAN1Q L FEE 101.-000.421-000 SI.0515D
,
YLECTRICAL FEE
PLUMBWO FRE is.0
;
S TRf?M MOVOI 1 ME •, RUID 101-000-241-000 $10'*01
GRADING 17.t*Y, 101-000-423-000 t,15,00
D>"sVFLOPER.. IMPACT F&L 7r 40$1DV
T J' EQ JZ.. ,f"i'.K'e•.i+j 101-000-441-343
Q t XL CO 'T'f .IiYQrT:i014 bi=fS°i 3 °I.,; ;i 7 Mit:
$4,120.4.
113S PRE -PAID MES
42;5owo
DEC 2 6 2002
TMAL PER VAT YXE,13 1U9 VKM
0, AW -43
QUINTA
CI
d
MANCE DEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPM
qvg,--.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-- —
Underground Ducts
Forms & Footings
— C)
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
_
_ 3
F.A.U.
Framing
7 d 3
Compressor
Insulation
Vents
Fireplace P.L.
!
Grills
Fireplace T.O.
Fans 8 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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
_,
Waste Lines — s 3
Gas Test
Electric Final
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:
CHARILES ®. AAIB LAH
""" Architecture, Interiors, Space and Land Planning
Structural Calculations
8 March 2003
The City of La Quinta
Department of Building and Safety
78.495 Calle Tampico
La Quinta, CA 92253
Project: Single Family Residence for:
Richard Jilka
77-845 Calle Madrid
La Quinta, CA
Regarding: Project Observation and Field Revisions
To Whom it May Concern,
On or about 25 February 20031 visited the noted project site to perform code required structural observa-
tions. At the time I noted only minor blocking, nailing and strapping issues that were resolved at the time
of my visit. Now, I hereby state that the project's structure is in substantial conformance with the struc-
tural design intent as represented in the construction documents.
If you have any further questions regarding this project please do not hesitate in contacting me.
Sincerely,
74-854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340,3.528 ❑ Facsimile: (760) 340-3728
Earth Systems
y Southwest DAILY TEST REPORT
79-811 B Country Club Drive
Bermuda Dunes, California 92201 • (760) 345-1588
JOB NAME: . / 5 rc(f Mn ✓1 i 17 JOB NO: 6 V 9912- O 1 DATE:
LOCATION: LA Q V I N T p , California
CONTRACTOR: OWNER:
TEST
NO.
LOCATION
J S
LOT
NO.
ELEVATION
..
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
lbs/cu. ft.
RELATIVE
COMPACTION
% ^'
MAXIMUM
DRY DENSITY
lbs/cu. ft.
OPTIMUM
MOISTURE
CONCENT
REQUIRED
MINIMUM
DENSITY
` l P
Ll.q
11/•8'
qa
a'•
90 mo
t
.y- S
i I•
9a
DRAWING
REMARKS: /J Sm -s- A S ' ►tf .V L F
11F LT W) ✓t lFQ 01 'l T 19 (OH
0 o G v d rL A' 0 v c
l
All 01t
4.
AL Bun ci 0 1(L M i 514 B 0
t'lni►SN U`pD o c
LIMITATIONS: This report is to provide information regarding the status of the field conditions and our opinion as to the need for corrective action, additional testing
and or observations. No guarantee or warranty of the contractors work is made or implied. This report is subject to review by the project manager.
da4
• CLIENT REPRESENTATIVE SIGNATURE PECHNICIANS SIGNATURE
BD -FS -001 (07/02) N.0 MOO
Certificate of Occupancy
T4&f 4 4 Qgb&
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, . certifying that, at the time of issuance, this structure was in. compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 77-845 CALLE MADRID
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Owner of Building: RICHARD JILKA
Building Official
Type of Construction: VN
IN A CONSPICUO
Building Permit No.: 0206-069
Land Use Zone: RC
Address: P.O. BOX 11355
City, ST, ZIP: PALM DESERT, CA 92255
By: KIRK KIRKLAND
Date: SEPTEMBER 8. 2003