0104-136 (BLDG)54715 Avenida Madero
0104-136
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
M920 if1 93Claf
t te `? f ;2Signature of Contract
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, Business & Professionals Code).
( ) I, as owner of the property, 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 Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm 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.
Mf 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.
STATIR YOM)
(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 h II rt%with comply with,!Aq ,
Pate: A p p l i c a n t . ,r"Reisions.
,
!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, 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 inspedtion purposes.
Sf t 0 ner/A en Date
Ia0 Igna ure ( w g
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0104-1-36 TRACT
lkOeS '. Pa4 i
JOB SITE
APN
ADDRESS -'ld.5 a . l+ srLK- .A MA DE
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PO DI ` : `141
5'1'3 l0 a. ' MA 1310-
:!'..Af F 3:4N`: r C.!>+, 92253
LA QV .A. ( A 92253
USE OF PERMIT
1`73 lair t:'L')AISo WALL T Ii,l::Ftta.f; NG a- iF,hW.),WN u 120 V X `,
51,30 Pf,,t')PAXf,1 F?Ii;P,t t3> IF. f;;I"4Y i '.7AT~a1; 1 £T
APR 1 7 2001
" 11
0 FT' WALL 1,nt.0D v CIT OF LA QUINTA
j', +tT.' 7ALL ;r(100j,,t I IINANCEDEPT
I
4 FT. W AU, 30,0 IX
6 '1rT,. WAIJ, 120.00 LP
)YM. XC" " 06' BrIEUKARY
C044 3T.R'UCT%ON MIS 1i •D- 00.418.000 3103,00
SUB TO ffil co 4M RIJIM014 Y41D MAN clu.01e. 08, 00
1K;Y.1A► :4: ERWI" ?K S1 UE..NOW S108#3f,)
RECEIPT
DATE
BY
DATE
l
I L D NSPECTOR
D
i.. ► 7 t j
INSPECTION RECORD
OiRERATiON
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
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs �il' Q Gy�
steel
Electric Bond .
Footings
Main Drain
Approval to Cover
Equipment Location
Bond Beam 8=� —�
Underground Electric
Final���� Q.IZ..
Underground Plbg. Test
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
COMMENTS:
'
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)
'IN
'JUN 12 ' 111 17:42 FIR
L
TbBiifonwtion
~moi
...........
Budd On
&Wlneerffig - Consulting - Testing *
I
TO 9-56e6072 P.01/01
'REPORT OF FIELD COMPACTION TESTS
TESTED FOR: CONTEMPORARY HOMES PROJECT: 5-47-7r5-AVENIDA MADERA
PO BOX 1041LA QUINTA 'CA
LA QUINTA,, CA 92253
DATE: May 25, 2001 OUR 'REPORT NO.,.073-10148-2
TEST DATA: (1) Very fine sand to silty sand. OPT. MOIST. = 10.5%
3 PG I 1 117.0 9.1 1122.2 112.01 95-7 1, A
4 all PC 1 117.0 8.9 121.3 111.4 95.2 11 A
1•
TEST LOCATION: House pad.
SE cornet. if
2 SW corner.
7--
3 NW corner.
4 I NE corner.
NOTES: TESTS PERFORMED PER ASTM D2922-96 & ASTM 03017-96 *COMMENTS: 1. FILL MATERIAL A TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN: Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOTCOMPLY
WATER CONTENT: Percent of d7 weight 3. ME COURSE WITH SPECIFICATIONS
PERCENT COMPACTION: se on maximum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST
density obtained on sample indicated by S. SOIL CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS
soil 10 number. e. OTHER E. MOISTURE BELOW SPECIFICATIONS
(1) ASTM D-1557, Procedure A
TEST INSTRUMENT: STANDARD COUNT M: D:
RPMARKI.q- PqT e3ie3 nnt- monitor the material placement. ADJUSTMENT DATA M: 0:
TECHNICIAN: Juan Nunez
THESE TEST RESULTS APPLY ONLY TO TME SPECIFIC LOCATIONS NOTED ANO MAY NOT REPRESENT ANY OTHER LOCATIONS OR FLCVATtONs-
REPORT; MAY NOT BE REPRODUCED. EXCEPT fW FULL, wITKOUT WRIT'VENPERMLSESION BY PROFE55IONAL CERACE INDUSTRIES. INC.
Respectfully submitted,
Professional Service Industries, Inc.
P21 A -10D.2 (4)F Professional . Service Industries, Inc. - 42-240 Green Way, Suite C - Palm Desert, CA 92211 - Phone -760/341-5790 - Fax 760t$41-5794
** TOTAL PAGE.01 **
TEST TEST SOIL ID
NO. DEPTH ELEVATION NUMBER
MAXIMUMO
LAD DRY
DENSITY
WATER WET
CONTENT I__ DENSITY
I DENSITY
COMPACTION
11
M S,
Spec 90t min
811 1 FIG 1
117.0
8.7 120.7
111.0
-CA
2 FG I 1
117.0
1 9.3 122.0
111-6
95.4
11 - A
3 PG I 1 117.0 9.1 1122.2 112.01 95-7 1, A
4 all PC 1 117.0 8.9 121.3 111.4 95.2 11 A
1•
TEST LOCATION: House pad.
SE cornet. if
2 SW corner.
7--
3 NW corner.
4 I NE corner.
NOTES: TESTS PERFORMED PER ASTM D2922-96 & ASTM 03017-96 *COMMENTS: 1. FILL MATERIAL A TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN: Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOTCOMPLY
WATER CONTENT: Percent of d7 weight 3. ME COURSE WITH SPECIFICATIONS
PERCENT COMPACTION: se on maximum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST
density obtained on sample indicated by S. SOIL CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS
soil 10 number. e. OTHER E. MOISTURE BELOW SPECIFICATIONS
(1) ASTM D-1557, Procedure A
TEST INSTRUMENT: STANDARD COUNT M: D:
RPMARKI.q- PqT e3ie3 nnt- monitor the material placement. ADJUSTMENT DATA M: 0:
TECHNICIAN: Juan Nunez
THESE TEST RESULTS APPLY ONLY TO TME SPECIFIC LOCATIONS NOTED ANO MAY NOT REPRESENT ANY OTHER LOCATIONS OR FLCVATtONs-
REPORT; MAY NOT BE REPRODUCED. EXCEPT fW FULL, wITKOUT WRIT'VENPERMLSESION BY PROFE55IONAL CERACE INDUSTRIES. INC.
Respectfully submitted,
Professional Service Industries, Inc.
P21 A -10D.2 (4)F Professional . Service Industries, Inc. - 42-240 Green Way, Suite C - Palm Desert, CA 92211 - Phone -760/341-5790 - Fax 760t$41-5794
** TOTAL PAGE.01 **