SFD (0288)52360 Avenida Madero
0288
PERMIT APPLICATION lL
City of
La Duinta
' Department of Building
and Safety
if
•.s
This permit becomes void work not commenced within 180 days Irom date of
issuance. OR, if work has been suspended or abandoned for. a period of 180 days.
' ' 1 • •. .a, •
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if', -
' LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under .provisions of. Chapter 9 r
the;permit is for. one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
r' (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force •
issued. I shall not employ any person in any manner so as to become,subject to the Workers'Compensation Laws of
and effect.
California.
license Class ' Lic. Number
Date Applicant
Date Contractor., •-
NOTICE TO APPLICANT: If, after. making this Certificate of Exemption, you should become subject to the Workers'
' •
' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt fr.06"the Contractor's License Law'for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
. "
following reason, (Sec.. 7031.5. Business and Professions Code: Any city or county which requires a permit to
be deemed revoked.
construct, alter,. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit totileasigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 1 hereby certify that no ixcavati6n five (5) or more feet in depth into which a p6ison is required to descend, w ill be ,
r ..(Chapter 9(commencing with section 7000) of.Division 3 of the Business and Professions Code) orthat he is exempt
;.' made in connection"with -work authorized by this permit, and that no building structure• scaffolding, falsework, or., ;
therefrom and.the-basis tot the alleged exemption. Any yiolation of Section 7031.5 by any applicant.for a permit
'demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2• Grp 2. Art 2, Sec341; Title B, • ;. .
subjects the applicant to a civil penalty of not morethan,five hundred dollars ($500.):
C.A.C.)'
. 0 I. as owner of.the property, or my employees with wages as their sole compensation, will do the work, and the
0 As owner -builder; I will not empldy anyone to do work which'would require a permit from the Division of .
'structure is not intended or offered for sale (Sec. 7044, Business and Professions Code:,The Contractor's License, .
Industrial Safety, as' noted above, unless such person has a permit to do such work from that division.:
• 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
17. Division of Indug)rial Safety Permit No.
building or improverrint is sold within one year of completion. the owner -builder will have the burden of proving that
Date Applicant "
he did not build or improve for the purpose of sale.). I
;^`CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
• ❑ I, as owner, of the property, am exculsively contracting with licensed contractors to construct1he project (Sec:
• - of the work for which this permit is issued (Sec. 3097,:Civ. Q. • , .• .•
'7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name'
:builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the '
BL
- Contractor's License'Law.). _
Lender's Address
O, 1 am exempt under Sec. B: 8. P.C. (Attached Certificate).
I certify that I have read this application and state that the above information is correct. I.agree to comply with all , -
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
-
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure. ora ..
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec: 3800. Lab. C.). . , -,s
• 'Signature of'Applicant or Agent Date
Policy No.-- Company
. , -• +. / •
O.Certilied copy is hereby furnished. /x :. /
/'
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OFENTRY:'Icertify lhave read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
• O Cert/ifled is bled the Building'Inspectioh Oepar entor C' 1 ' f Department..
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety, to enter
copy with Cny ✓ i r( / ! / /
upon the property for which 1. have applied for this'permit for the purpose of making inspections.
Dated ' % .24 '' er } a Applicanj /[ .fO2 , 1. ..
Signature of Applicant or Agent Date
F
Print Applicant/Agent Name
A P Py/LICANT NAME/ (/L/ FAM`I)f/ /`-A 1 yq ,/(j . . •-
A
i l` J
•
J -ems //I/fes/tI4•{r /, I'! •. fZ/.j,;'V
ADDRESS ,.. Y,/.:GN"'• " \ - , ..••..
CITU/COMMUNITY/SSTAT
,IZIP
W 7ZI
JOB SITE Ap f7RESS/SPACE
' a
•.s
Cl/TTY/ACCOMMUNITY//STATTEq/ZIIPP'''• ,'/pIF'f• .v .,•+ i •,: '(: .`f -r -A"--""
BOK
PAG
PRCC
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.-
TWN
I.#
RNG
SE
. 'S
TRACT
LOO
i
MOOT
'SB"
TRACT NAME - -
OF
CONTj IR
ACTOR -FM IEE&/70,
i..
0 0j
ADDRESS - .. .
7VV, "d / ox ,
CITY,/COMMUNITY/STATE/ZIP
A -FIRM NAME
- cin
ADDRESS
CITY/COMMUNITY/STATE/ZIP • . - .•
PHONE A '. v
LICNC •
-
USE O`/i,Fle_ Cao,, 1v .40 ells.
BL
• ZONFSB/
t • SSB
SSB ' r
RSB
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OFC
' 'ZONE ORD a+;
LOT SZ
END .:
SIDE
. APPL/PRMT:,++..•`o,OATt
- R A I., R ■H,
74'
71.•, '.
/- irndiiiy ice • ,. 3S,•t :-
7X '
Ft
- o ' a umta
.. TOTAL':
FEE
BLD .DEPT.
• VALUATION / >{ 7 •K d
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Ser Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
711
39 Appl. Clearance
7
Framing
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace. P. L.
❑
43 Final 40
10A
fireplace T.O.
ED
UP N
NO. ADDITIONAL INFORMAT ON -
8
/
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall o
13 Finish Grade
INSULATION Thick• al
Value
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb / p3
18 Vents '
19 Sewage Disposal
20 Sewer /
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final'
Tank / v y. Pit (- V / ( L. Line
ELECTRIC APPROVALS
REAR OVPROPERTY LINE
N O U
N
p/L G anJ DP/!
' A
'rAP%K
1.71
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAMEy
I
Fc 2vt :44
{'ATION Yr..
Nurh6er an
'
ff 'iL. f X11 Clty_ County
SST-w+l I.p = RTU
• . -Su DO iv iS On. .. :.r s'. un !_Ot Nu mo a
DESCRIPTION OF INSTALLA-TION:
ROOF --
Material Brand Name
Thickness linchesl
•'=--- Therma'f R'esistarice (R Value)•`
'EXTERIOR WALL /. ,ry • n T Q
Material Z .--1.ICT. .9i S' rand NaUme.;ivu.iC/liS:.CO•rn%1 c C3l Lx
Thickness (inchesl'' / Z Thermal Resi4tance IR Value)
CEILING
Batt or Blanket Tv'pe. 3rantl Name- kw 1'i- 1" o 1jN
:Thickness finches) Thermal Resi'sfanc_ iR Vaiue1
L,tose:Fill Type 3rand Name
Minimum Thickness. 11nchell. ,., Number of hagi` '" Weight Der bag 14 Ib '
e
Area Covere'o Ih'1 Thermal Rlesisiance IR Va uel
FLOOR• ELENVATE'D r
Material Brand Naniel'
Thickness linchesl;• -Thermal Resisrance.iR Value)
FLOOR. SL _• '
Material l•✓l , t.^. to.
9rmW `and.Nae
Thickness linchesl. [If Thermal"Resisiance IR •/atuel
!.
Width (inches) '
FOUNDATION WALL
Material Brand Name' -
• Thickness iinches) • Thermal Resistar;ce IF; Value)
DECLARATION
i hereov certify that ;he above insulation was .nstalleo in the building at the above iocat.on in conformance —in ,ne
current regulations setting Energy Conservation' Standards for new residential buildings located in T.tle 21: of me
California Code). q .'
zYn.Contractor 18unaerl .,este N _
t VRx . I)e "/ J&PIC 6Q_.
-Sgnature. nD Title mate
Suo:.ContraeYor, )Insolation ADolicatorf n License. Nunn Der
3.: nat.u,e in D .Title - .idle
If,
TESTING • INSPECTION
1731-A. WALTER STREET VENTURA, CALIFORNIA 93003. PHONE (805) 642-6727
83-91-254
September 30, 1983 Job No. B-13709-P1
Affordable Homes
%Dr. Harmon
43-576 Washington Street
Palm Desert, CA 92260
Subject: 53-470 Ave.. Alvarado 52-360 Av ..Madero '
La Quinta, CA
RE: Compaction Report
Gentlemen:
On September 8; 1983 a representative of our firm performed density tests on
the fill placed in the building area on the above referenced project. Tests were performed
at random locations in accordance with ASTM 2922-78.and ASTM 3017-78 Nuclear Den-
sity Test Procedure. Tests performed as per authorization of Jim with Date Constuction.
The estimated locations of the tests are presented'on the attached plan with .their
results being summarized on the attached test report sheet. A total of four (4) density '
tests were, performed. Test results indicate that a minimum of ninety percent (90%) of
relative compaction has been obtained within the areas tested. The maximum density-
optimum moisture was determined in the Laboratory in accordance with ASTM D 1557-78,
Method A, five (5) layer curve.
Classification Maximum Density-Optimum Moisture
Medium brown silty very fine
`to fine sand 100.2 17.9
VENTURA LANCASTER
(805) 642.6727 (805) 948.7538 ,
THOUSAND OAKS BAKERSFIELD SANTA BARBARA PALM SPRINGS SAN LUIS OBISPO
(805) 495'8484 (805) 327.5150 (805) 966.9912 (714) 3289131 (805) 544-6187
AM
,
83-9-254
September 30, 1983 Job No. B -13709-P1
LIMITATIONS
The backfilling and compacting• operations were completed at the time our personnel
were called to the site. The test results summarized in this report represent the moisture
and density only at the location and depth tested on the specified date. The summarized
field and laboratory tests were performed in accordance with engineering principles gener-
ally accepted at this time and location. No opinion is .expressedas. to the uniformity. of the
material, compaction nor the adequacy of the material to perform its intended function.
No guarantee or warranty of .the contractors work is made or implied. .
Respectfully submitted,
BUENA ENGINEERS, INC. Reviewed and Approved
6111, 2,096 4
Norman G.. Jac son, Jr.. Norman G. Hallin
C. E. 7370
NGJ/NGH/pJJ
Copies: 4-Dr..Harmon
2 - City of La Quinta
2 - P. -S. File
1 - Vta. File
BUENA ENGINEERS, INC.
CONTRACTOR:
ADDRESS:
REPORT OF RELATIVE COMPACTIONS
Job No. B -13709-P1.
DATE: September 30, 1983 Report No. 83-9-254
JOB a LOCATION: 53'-470 Ave. Alvarado & 52-360 Ave.
TEST NO.
DATE
DESCRIPTION
% MOISTURE
DRY DENSITY
RELATIVE
MAXIMUM
TESTED -
IN PLACE
IN PLACE
COMPACTION
DENSITY
1
9/8/83
1.0 from grade 53-470 Ave. Alvarado
15.7
99.6 •
99
100.2
2
9/8/83
2.0 from grade III I, It
19.9, -
95.8
96'
100.2
3
9/8/83
1.5 from grade_ - 52-360 Ave. Madero
14.7
92.7
93
100.2
4
9/8/83
0.5 from grade II ! 'I
13.4
94.6
94
100.2
WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH
COPIES:
i
BUENA ENGINEERS, INC.
~ I
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