ELEC (0105-300) + RPL (05405) + SOL (05457) + PAT (11065) + SFD (001718)53385 Avenida Madero
0105-300
05405
05457
11065
00178
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter (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
a
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 dothework, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( .) I, as owner of the pioperty, 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 ' 't :" r.TSignature of Owner x..
WORKER'S COMPENSATION DECLARATION
I hereby a4ir4m 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.
( ) I 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.
(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" ot 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
Cotte, I shall forthwith comply with those.. provisions.
Date: "I
" .:' t Applicant"O.
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, & shall, indemnity
& 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.
may,;..;,
Signature (Owner/Agent) ` *&- Date" n
PERMIT #
BUILDING.PERPAIIT' s
DATE VALUATION rt: .LOT 4) TRACT
JOB SITE
"
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MR In-10MM "W17014-0.
LA QVDATA 922.51.
USE OF PERMIT
Ati;CYITION 01*" M>i R O1FT)100R.
VALLi NTION 100100 LOP
PFUNOTIM SUMMARY
4
. 1
U.1'L.f."►C. (.SS.i+.C11 .
XT -M -PAM S
$0.00
MAY ;5 0p01E(M,.
-.G
V,F
_S116
1 diL2RNOW
of LA A
CIT FINANCE DEPT
.00-
RECEIPT
DATEr
BY
DATE FINALED
INSPECTOR
w
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & 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
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
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
tub Panels
Exterior Receptacles
G. F,.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
OWNER / BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as '.'Owner/ Builder',' you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if "that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the.City or County. They are'also required by law to put their license number on all permits for which they,
apply.
If you plan to. do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials:
and .other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, -then you may bean employer.
If you are an employer,, you must register with the "State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for, you if you do not carry out these obligations, and these risks are especially serious with
respeci to worker's compensation insurance.
For more specific information about your obligations under_Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S..Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the.Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees,.without a licensed contractor or -subcontractor, only under limited
conditions:
A frequent practice of unlicensed persons professing to be contractors is to secure an ",Owner/ Builder" building.
permit, erroneously implying that the property' owner is providing his_ of her own labor and material personally.
Building permits are not required to be signed by "property, owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPTT, OF BUILDING AND SAFETY -
78-495 Calle Tampico
La Quinta, CA 92253
(760)1777,-7012.
FAX: (760) 777-7001171
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
pros 3pD
PERMIT NUMBER(s)
Building 1;
Adero
Address -
Owner
1.11om Hartung
Mailing'
• Address same
City Zip
La Quinta 32253
+Contractor.
-
,. BOX 150q'i No. 110 6 5 •
'7&105 CA LE ESTADO :• k
LA QUINTA, CALIFORNIA 92253
BUILDING;- TYPE CONST: •OCC_ GRP,-•
A.P. Number 774-033-017
5 6 4 to d 7 U Legal Description `-fit 31
Project Description C6 ,'ems 6xi59king S oy6red
patio into P i
.-i.k!` E1s'.y •Y2d",ata
' City
Zip
TeL
State LiC.
City
-
& Classif.
Lia #
Sq. Ft. No. No. Dw
Size -- Stories - Units'-
-Arch., Engr., :
Designer
New ❑ Add ❑ Alter ❑ Repair❑ Demolition ❑
Address
Tel.
City -
Zip
State
_ - -• . ...
Lid. #
LICENSED CONTRACTOR'S DECLARATION .:
I hereby affirm that I am licensed under provisions of Chapter 9 (commending 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
Estimated Valuation
hereby affirm that I am exempt from the Contractors License Law for the following
'reason:
8775' 00
(Sec. 7031.5,8usiness and Professions Code:. Any .COY or county which requ6es a
permit.lo construct, after, improve, demolish, or repair any Struchue, prior to its issuance also
- • -
-f
requires the appiloant for such permit to fie a signed statement that he s'ficensed pursuant to •
PERMIT, AMOUNT. +
the provisions of the:Contractor's License Law, Chapter 9 (cormrmencirmg with Section 7000) of
-
• Division 3 of the Business and Professions - Code, or that. he is exempt therefrom, - and the bass-
-alleged exemption.'Any-violation Section. 7031.5. by -any for
Chk. Dep. -
-- plor•the of appbpnt a permit- -
' subjects the applicant to a civil penalty of not more than five hundred dog= (5500). - .- • "
.•-Plan ,, I
- _
-Plan Chk. 681. '70.20. -
as owner of the property, or my employees with wages as their sole compensation,.will
..,he
bb.work, the is'not intended for
and structure or offered sale. (Sec- 7044, Buisness and
A Professions Code: The Contractor's Law does
COrISt.'
License not appy. to an owner o/ property who;
1*" -•builds00
-.or" roves thereon and who does such work himself or'through his:own employees,.i•
such improvements are not intended or offered for sale. H, however, the building
+
- •
- + •
Mech. 00provfdedfhat
°F oi" rovement is -sold within one year o/ completion, the owner-bmlder w® have the burden _
that he
•Electrical y
- } 2
8
_of proving did not build or improve for the purpose of sale.) _
1, as owner of the property, am exclusively contracting with licensed contractors to coo- .
- _. I •
Plumbing -
. struct the project. (Sec. 7044, BusinessandProfessions Code: The contractor's License Law
,does not appy 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.) •
- . ❑ lam exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date OwnerM A' t r'. ?a
Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy -thereof. (Sec. 3800; Labor Code.)-•. -
.. •• - + -
Policy No Company
❑ Copy.is filed with the city. . ❑.Certified copy is hereby fumisheci '
TOTAL .216.97
CERTIFICATE OF EXEMPTION FROM
REMARKS
- - -. ' WORKERS' COMPENSATION INSURANCE .
(This section need not be completed if the permit is for one hundred dofiars (E100) valuation
- - - -
'... . or less.) .. .... - .
I certify that in the performance of the work for which this permit is issued,'I shall not
-
L• employ any person in any man er'so a Ao become'subject to the Workers' Compensation
- La ws.of.Califomia. .rr '' ,r/
( :.' \
- -
Date -0 Owner s !p a+f1' A
•' NOT/CE To' APPLICANT: If, 4a ter making this Certificate 'o/ Exemption you shouts become .
ZONE: - - • BY: -
subject to the Workers' Compgnsation provisions of the Labor cobs, you must forthwith-
- comply with such provisions-or((hls permit shall be deemed revoked- -
t
. M in imU m Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop, Line
" CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line '
' I hereby affirm that there is a construction lending agency. for the performance of the
- -
work for which this permit is issued. (Sec. 3097, Civr7Code-) ,
Side Setback from.Property Line
Lenders Name
_
Lenders Address
This isa building permit when properly filled out, signed and validated, and is subject to
FINAL DATE INSPECTOR '
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. •
"Issued' by: Date - Perrrllt'•+
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.
Validated by:
Signature of applicant Date
'
Mailing Address
Validation:
City, State, Zip
`
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® Y<c
HOUSE SEWER
REMARKS:
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
P.O. BOX 1504 N O . 05457
Building y 78-105 CALLE ESTADO
Address S3-385 Ave. Madero LA.QUINTA, CALIFORNIA 92253
Owner
'Tim Urtuns
Mailing
Address 8a
cityZip
Tel.
La.. Qiota .
9*2233
619/564--317D
Contractor
Sa3at Heating Specialists
Address
1860 Chicago Avi. Ste.. I_17
City
Zip
Tel.:
Riverside
92507
State Lic.
City -
& classif. 337636 C36
Lic. #
Arch., Engr.,
Designer
Address'
I Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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
reasom (Sec- 7031.5,Business 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
regimes the applicant for such permit to rile a signed statement that hes 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 the alleged exemption. Any violation of Section 7031.5 by .any applicant for a permit
subjects the applicant to a c/n7 penalty of not more than five hundred doifars ($500).
❑ 1, 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, Busness and
Proressions Code: The Contractor's License Law does not apply to an owner of property who
Lxotds of improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. H, however, the building
or improvement is scull within one year of completion, the ownerbufider will have the burden
of pmovf g that he dud not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractors 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.)
❑ 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) -valuation
or fess.)
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 Owner
NOTICE TO APPLICANT: H, after making this Certificate of L:xemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
coney with such provfsfons or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.) ,
Lenders Name
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct.
1 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 applicant Date
Mailing Ackl
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 774-033-117
Legal Description
Project Description Solar System fest pool.• 320 8et.Ft
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 3/8/89 Permit
Validated by:
Validation:
or eellec"tors a
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$4,000.00
PERMIT �
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
19.50
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
yq;� rip qt
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 3/8/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
-
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
_$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
u�jttc� ,
P.O. BOX 1504 No. 05405
Building 7&105 CALLE ESTADO
Address an£g.� LA QUINTA, CALIFORNIA 92253
Owner _
Mailing BUILDING: TYPE CONST._ -_ OCC: GRP.-
Address A.P. Number f -�`%-- cr+��• `S "!` P
City Zip Tel.
C-/? `1 k. 1-:1,_16 c/ 31 70 Legal Description
Contractor Project Description
c%
Address
City tyi��:3J0.4 Zip Tel.:
State Lic. City
& Classif. 4f Ar . 7 Lic. # Sq. Ft. C No. No. Dw.
Arch., Engr.,
Size r Stories Units
Designer New ❑ Add 2�' Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that-1,am licensed under provisions of Chapter 9 (commencing with Section
effect -
7000) of ivision,3 of the Business and Professions Code, and my license is in full force and
SaGNATUFtE -- DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License law for the following 7 Lj 4
reason_ (Sec. 7031.5,Busamess and Professions Cade: 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 rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant to a dvil penalty of not more than five hundred dollars ($500).
,741d❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. k 7,75-
do
o 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 appy to an owner of property who Const.
bmdlds or arproves thereon and who does such work himself or through his own employees, Mech. l
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 Electrical
of provirg that he did not build or anprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 S. M,1,
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Grading
Driveway Enc.
Date - owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company � ;,❑ Copy is filed with the city. ❑ Certified copy ishereby f, rnished.
TOTAL "�yi`%. 5'�ir ";`{`�' `.•r
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE �/ 's(117.18'. is r�
(This section need not be completed if the permit is for one hundred dollars (S1oo) valuation ,;i'{.f.F.�,IhA F-.' ,y�l",I7-v ,; -h rnV
or less.) .tv," o er+:_: rib..
I certify that in the performance of thg work for which this permit is issued, I shall not r.
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date owner
-NOnCE TO APPLICANT: lf, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply will such provisions or Mis permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
1 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.) Side Setback from Property Line
Lender's Name
Lenders Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certity that I have read this application and state that the above information is correct. Issued by: Date Permlit
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. Validated by:
Signature of applicant Date -
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
• 2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
') Iq (RFIRE
I
REMARKS:
VENTILATION
ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Ice-
P.O. BOX 1504 N O . �.
Building 78-105 CALLE ESTADO
34
Address 53-3t-4 Ate& -R&M LA OUINTA,,CALIFORNIA 92253
Owner- .. _.. - .. ....... ...� . ,,. ... ....-.. " .
TbM Haxt31; tQ' f
BUILDING; -TYPE CONST.- OCC., GRP.'
Mailing.
Address
A.P Number
City Zip Tel.
La. Qluallm ? , .. ,564.-317 3,. Legal Description
Contractor Project Description'
Address_,.
City'
Zip .
Tel.'.
State Lic. '
City
& Classif.
Lic. #
Sq.'Ft.
Size 121 UD.
No. No. Dw.
ftStories Units
Arch:,•Engr.;.-. -.
DesignerNew
p. Add ❑
ay
Alter ❑''- Repair O Demolition ❑
Address
`
Tel.
'
M lin. fi—_t of 6—fWt high ialodk.kali"
City
Zip
State
_
Lic. # .
LICENSED CONTRACTOR'S DECLARATION , r _
...
hereb affirm that I am licensed'under provisions of Chapter 9 (commencing with'Section
7000) of Division 3 of the Business andProfessions:Code, and mylicense isimfull force and
effect...
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the contractor's License Law for the following •
.r -reason: ,(Sec.. 7031.5,Buslness and Professions Code::Any city or•county which requires a
• " permit to construct, alter, Improve, demolish, or repair any - structure, prior�'to its a issuance also
requiresthe 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 301 the Business and Professions Code, or,that. he'is exempt therefrom, and'the•basis •.-
.. for the alleged. exemption. Any violation of Section •7031.5 by any applicant for .a permit
. y subjects the applicant to'a civil penalty of not more than five hundred dollars (3500):• • •' - '
0 1, as owner of the.property; or my employees. with wages as their able compensation, will' •.
`do the work, and the structure its 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
Estimated Valuation q��9
- -mwmm J..QJ
_ PERMIT ' ' .• .r---' - - AMOUNT
Plan.Chk. Dep.. - •. .�,
.. KCI! '
Plan"Chk. B61. _ ►aav r
.` Const. as= A.32.
Mech:•”'
- -
'• •-
'.builds or Improves thereon and who does such workhimself or through. his own employees,..
• ,provided that such improvements are not intended or offered for.sale. If,; however, the building.
_•
Electrical
- -
i 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.)
Plumbing
- . 0 I, as owner of the property, am exclusively contracting with; licensed contractors to con-
•strucl 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 contractors) licensed pursuant to the Contractor's License -Law.) .. ..
'
.I am exempt under Sec. B. & P.C. for this reason
-' $•M,I; .•
'- - . _ '..5
-
Grading
•
Driveway Enc.
Date.' Owner'
Infrastructure
- WORKERS' COMPENSATION DECLARATION
'I hereby affirm-that'I have a certificate of, consent. to self -insure, or a certificate of
w Worker's Compensation Insurance, or a certified copy thereof: (Sec. 3800, Labor Code.)
-
-
Policy No. ,. •Company
~
0 Copy is filed with, the city, 0 Certified copy is hereby.furnished.
_
TOTALJ.�Z
. • CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE . . ..
REMARKS
-
.(This section need not be completed if the permit is for one hundred dollars (3100) valuation
. or less:)., - . -._ , ,.. - _ . . , . ,._z ...
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 -Owner. .. ... _.
NOTICE • TO APPLICANT:. It, • after making. this' Certificate • of Exemption you should become
'subject to thV Workers' � Compensation provisions of - the Labor Code, you must forthwith '
comply with such provisions or this permit shall be deemed revoked.' ' '
' 'ZONE: BY: '
Minimum Distances: '' - ' .
Front Setback. -from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.' .
hereby affirm that there is a construction lending agency for the performance of the
. 'work for which•thispermit is issued. (Sec. 3097, Civil Code.) - -
-Side
Side Street Setback from Center Line
Setback from Property Line
Lender's Name
I ,
Lender's Address
f. - • This'is a building permit when properly filled out, signed and validated; and -is subject to'..'.
expiration if work thereunder is suspended for 180 days: :. ,
.Permit
,l certify that I,have read this application and state that the above information is correct.-.ISSUed'by:'
' 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 .,e -
Signature of applicant �f< rs�%c�` -'r Date
Mailing Address' �# �'
,
FINAL DATE.
f- .
Validated by:
i t'
Validation:
,
INSPECTOR'
9 t•� f.
Date
City, State, Zip
-A.58'59"
12 1 -` 54,12 2k
.. HARDCOPY--
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. 1 SQ. FT. ®
FOR. SO. FT. ®
GAR. SO• FT. ®
CAR P. SO. FT. ®
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
1
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
0
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
. armI .VIS J JIV ISM 1 V RLJ/1ryl I IMLJ
GARDEN WALL FINAL
Building
Address
,
53-385 AVenijda m? b
Owner
& Classif.Lic.
`
#
Mailing , ....
.
Address
53m777 Ammer viiu.
City
Zip -
Tel.
- Tm �U : ...
92253
Address
Contractor
Address. .
...
abMr
City- . . , .
.. ... ._,
Zip
Tel.' .
44�
P.O. BOX 1504 N O ... O U 171
78-105 CALLE ESTADO
LA QUI,NTA, CALIFORNIA 92253
BUILDING: TYPE CONST. - 'OG,C: GRP.:
A:P. Number .774-0317
;4:3170 Legal Description
Project Description```ffift4i5y 3�.i'tiF
State Lic.
City
e
& Classif.Lic.
`
#
Sq.'Ft:
0
No. No. Dw.
1:_
,
Size •
StoriesUnits• '
Designer
Newel Add ❑
Alter ❑ ' - .:..Repair ❑ . 'Demolition ❑
Address
Tel.
City
Zip
State
Lic'. # -
..
"°
..._ . 324.. ��yy '. ..:.. ..
.: ft, of ., �;.
LICENSED CONTRACTOR'S DECLARATION
w
. ®-
hereby.affirm that I am licensed under provisions of Chapter 9 (commencing with Section
* "
70 OO) of Division 3 of the Business and Professions'Code; and my license is in full force and
effect, .. ..
SIGNATURE - DATE.
' 'OWNER -BUILDER` DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law forthe following
lA
001-0699
. ;reason:, (Sec. 7031.5,Business and Professions Code: Any•city or-county.which requires'a
'
permiLto construct, alter, fmprove, demolish, or repair- any structure, prior: to its -issuance also
• •
- z- - �v, - - _.
r. requires. the applicant for such,permit to file a signed statement that he is licensed pursuant to
- '..PERMIT
- _ ' ' AMOUNT•-•'
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 the Any. Section 7031:5 by -for a
Plan 'Chk. Dep..
alleged exemption: violation of. any applicant permit
' subjects the applicant to a civil'penalty of not more than five'hundred dollars,($500).: ' -
Plan 881..�4s��,
+s
❑'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. (Seca 7044, Buisness and
Professions
.Chk.
Const...
w�►
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; •
Mech.'.;
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'
-'Electrical
- ' %�x �
„ • of proving that he did not build or improve, for the purpose or sale.) -
• ❑ I, as owner of the property, am exclusively contracting. with licensed contractors to con-.
Plumbing
- - •• '� -
- slruct the. project. -(Sec. 7044, Business and Professions Code:: The. Contractor's License Lawes.
..
does Inot apply to an owner or property who builds or improves thereon, and who contracts for
S.M.I:
• .t'; 7
such -projects with a contractor(s) licensed pursuant to the Contractor's License Law.).- .. -
Grading
0 1 am exempt under Sec.. B. & P.C. for this reason
Driveway Enc.
20.00Date�S"�v`+OwnerSr�^'7f�i�i.a�'ta+.e,5,."..,,
Infrastructure
®153.4.
! WORKERS' COMPENSATION DECLARATION
' I' hereby affirm *that I have a certificate of consenf 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.-
TOTAL
2.U4.28
_
• • CERTIFICATE OF EXEMPTION FROM
:. REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be - completed. if the permit is for one hundred dollars ($100) 'valuation
.r •'
.. ..:. 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 'Owner -
.�
NOTICE TO APPLICANT: If, after making this Certificate* of -Exemption'you should become
"
BY:" '
'subject to the Workers' Compensation provisions of the Labor. Code,- you -must roilhwith .''-
comply with such provisions or this permit shall be deemed revoked.
.ZONE:
.Minimum Setback Distances: .. .. -
Front Setback from Center Line
1 .
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY. " • '..:+'
,•.-:
Side Street Setback from Center Line--" '
hereby affirm that there is a construction lending agency for the performance of -the
• '
•Property
'. work for which this permit is issued. (Sec: 3097; Civil Code.), :• -Side
Setback from Line - - -
Lender's .Name
Lender's Address
FINAL- DATE.
INSPECTOR' `
-This is a building permit when properly 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.
-city
ISSUed by
Date permit .
••"I agree to comply with all and county ordinances and state laws relating to'building ,
construction,•and hereby authorize representatives -of this city to -enter • the above-.:
i
mentioned property for inspection purposes.- :.
�/-y - _
Validated by:
Signature of applicant /wr7 'Z?.s'~, e. > y�i f3ate`�
Mailing Address �`h' v ° ° l
Validation:
City, State, Zip
A2604. -
9.. l.6 - .2..,.4.4,2.8 CK
d - HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT. ®
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
FbWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FINAL INSP.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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
GROUND PLUMBING .(
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TAN$ C
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
lus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.//.2
ROOFING
L5Lc), G
lJ G
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Form Approved
nMR N. 2900.00AR
VETERANS ADMINISTRATIONiU.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
• •- VA'CASE NO.
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER -SUPPLY AND SEWAGE -DISPOSAL•
•-
IMPORTANT -This form should be completed and riled as required by existing law 38 U.S.C. .1• and 1810.
PART I—TO BE • BY HUD/FHAOR VA
MORTGAGEE NAME AND ADDRESS (Include ZIP Code)
MORTGAGOR OR SPONSOR
.
TOTAL NUMBER
IS THERE ASE-
-
OR OTHER AREA BE MADE INTO
MENT?
■YES
INSTALLATIO
•N?
li [:]NO'!
ADDITIONAL•-••
■YES 91N
G ■ ■
.. BEDROOMS
. •. .
SEWAGE -DISPOSAL
■ ■COMMUNITY
SYSTEM2.
i ■
PART O BE COMPLETED: .•
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It is the opinion of the ' ■ State ■ ■ Department■ Can be expected to function
satisfactorily, and is not likely to create unsanitary conditions ■ Cannot be expected to function satisfactorily..
DATE
appropriateNOTE: The health authority should complete the in
optionNOTE: Use of the reverse of this form is at the
reviewedI have the foregoing. the pertinent ComplianceInspection'-.. . rec6minend that the i;divld��i N�ait`er-supply system ,-
considered sacceptable■sewage-disposal considered ■ acceptable ■ not acceptable -
. .
SIGNATURE
[:]HUD A
■VA CHIEF APPRAISAL SECTION ORDESIGNEE
VA FORM 26-6395• APR 1982 ;- �, �• #, - SUPERSEDES VA FORM 26.6396. OCT 1976:..
HUD FORM 92573 WHICH WILL NOT BE USED.
C 0
= 0
Desert Sands Unified School., District
N BERMUDA DUNES r
RANCHO MIRAGE
82-879 HIGHWAY 111 6 INDIO, CALIFORNIA 92201.5678 • (619) 347-8631
INDIAN WELLS H
PALM DESERT
a
September. g, 1885
JLA OUINTA
"'gyp INDIO y�
Cityi of La Quinta
Department of Community,Development
. 78-105 Calle Estado
La Quinta, CA 92253
Re: 53-385 Avenida Madero, La Quinta
Gentlemen:
The developer of- the
above referenced Tot
-has mitigated its impacts
on our overcrowded schools by payment
of.the amount of $628
per unit to be appl i.ed to 'the.' cos.t..of
district educational ,factli:ties
made necessary by such_ new
development.
S'ncerely,
John D. Brooks
Assistant Superintendent
Business Services
JDB/`crm
•
r�R� '.A? F 9 r �eea •�
VIENTURA, Cf -,L vR0aA_95003
(M) f -S2- y27
TO
THE FOLLOWING WAS NOTED:
C 14
DATE
JOB NO.
PROJECT
LOCATION
� Ar
CONTRACTOR
PAZ
OWNER
WEATHER
TEMP. ° at AM
° at PM
PRESENT AT SITE
//VS ;
• � r • �Gi`+��• 4"i7.7s �JtS!![{Fi 7.�kt.f+7 � �, ",
x
TO
THE FOLLOWING WAS NOTED:. r
DATE
tZ
NO
✓
PROJECT - - - - - y'ft v s
_ ^ i
LOCATION
•
• % f
Oy,�,Nf�TRACTO/�R zz
CJ%
:OWNER •- - _
-WEATHER ..
TEMP. pat -_ AM
e
J
'pat PM
PRESENT A7 SITE
" � � t " �� r_°-
� ,,Lr+ .fir~'' _
I �,; -/'�%
��a'I � ./✓ -�_I � � �" �:
� ' � � •'� '''"{`fi',�'�~ �'�. '
• . .. -
_ loll r
tet, / ,. _
.- - - _i; •�
COPIES TO
lu
SIGNED'
Lor
� En�in�er�,lnc.
i
tl `mEG
EIV E®
OCT 2 91985
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPT
1731-A WALTER STREET • VENTURA, CALIFORNIA 93003 PHONE (805) 642-6727
October 17, 1985 13-15592-P 1
85-10-243
Tom Hartung
53-777 Ave. Villa
La Quinta, CA 92253
Project: 53-385 -Ave. Madero -La Quinta, CA
Subject: Report of Field Densities -House Pad
On..August 28, 1985 and September 16, 1985 a representative of our..
firm performed -density tests on the fill placed in the pad area on the
above referenced project. Tests were performed at random locations in
accordance with ASTM 2922-81; and ASTM 3017-78 Nuclear Density
Test Procedure. Tests performed as per authorization of Tom Hartung.
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 (907) of relative compaction has
been obtained within the areas tested. In areas of low density, the
soils were reworked and retested, so that the minimum 'required
compaction has been obtained. The maximum density -optimum
moisture was determined in the laboratory :in accordance with ASTM
1557-78, Method A, five (5) layer curve. Test results are as follows:
Soil Description Maximum Density -Optimum Moisture
Light brown very silty
very fine to fine sand 11 19.6 pcf 15.5%
VENTURA LANCASTER
(805) 642.6727 (805) 948-7538
BAKERSFIELD SANTA BARBARA PALM SPRINGS SAN LUIS OBISPO
(805) 327-5150. (805) 966-9912 (619) 328-9131 (805) 544-6187
October 17, 1985 -2- 13-15592-P 1
85-10-243
Limitations:
The .compaction operations were completed at the time our personnel.
were called to the site. The test results summarized in this report
present the moisture and density only at the location and depths tested
on the specified date. The summarized field and laboratory tests were
performed In accordance with engineering principles generally accepted
at this time and location. No opinion is expressed as to the uniformity
of the material, compaction, nor adequacy of the material to perform
its Intended function. No guarantee or warranty of the contractor's
work is made or Implied.
If there are any questions, please do not hesitate to contact this office.
Respectfully submitted, .
BUENA ENGINEERS, INC. Reviewed and Approved
Norman G. J ckson,1r, Raymo d E. Brannen
CE 28966
NGJ/.REB/kis
F1
Copies: 47 Tom Hartung
2 - City of La Quinta
2 -PS file .
1 - VTAfile
BUENA ENGINEERS,- INC.
REPORT OF RELATIVE COMPACTIONS
Job No. B -15592-P 1
CONTRACTOR: DATE: October 17j 1985 Report No. 85-10-243
ADDRESS: JOB & LOCATION: La f1uintal r+/1
TEST NO.
DATE
'TESTED
DESCRIPTION -
-
% MOISTURE
.IN PLACE
DRY DENSITY
IN PLACE
RELATIVE
COMPACTION
MAXIMUM
DENSITY
1
8-28-85
0.5 below finish grade Per Plan
3.8
101.2
85
119.6
2
8-28-85
1.5 below finish grade Per Plan
9.7
91.9
77
119.6
3
9-16-85
Retest -"I Per Plan
13.8
107,8
90
119.6
-4
9-16-85
Retest *2 Per Plan
13.9
109.0
91
119.6
WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH
COPIES: