SFD (0207-004)52790 Avenida Martinez
0207-004
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
16158003 Z
r ,
Date ' = F 121 Signature of Contractor
OWNER -BUILDER DECLARATION
1113/0124 ;
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.
\,(% ) 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 OTATE FUND Policy No. 1342004-"
"(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
C 0e, I shall forthwith comply with those provisions.
Date: Applicant
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 inspection purposes.
(Owner/Agent) "> '' Date r • ,_
BUILDING PERMIT PERMIT#
0207-W
DATE VALUATIONa.iti LOT TRACT,
K 146,
JOB SITE
ADDRESS . m1% 1% i
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
REXTY, w ` 1 '
'ipraga Comm,uc nox 00, R", C.
83-300 TOURMAINZ Mr.
80-655 AVEME 43
IMAM) CA. 912201
CA 92201
(760),347-9755 55 O'. 0 5291
USE OF PERMIT
DING1.9Fks1,liSi Y DVIAa11 O
SVD 1731 S.F. PERMIT W2,,S NOT O
DUVENVAY APPROACH
T13.t•'i:C`1' COkkSMU OTIC -N 1.7,31.01,3F
C4€`i3tAO.WCAR.110RT 4—A.00 SF
EMMUID CCAS' 1r1F coigurRu moll
CONSTRUCTION FEE 103.000-4113.000 50611.30
PLAN CHMCC:'Y1 Lt $566.15
FU DEPOSIT 101-000-439-318. a 420-60
11/ ECk•Lt NICAx. YZE 1.01-00"21-0 00 $52.50
St1„' 0, 32
-
aft,i.,lt s;ITnldSlat9': ,, .ry.,.1,7 ;gE11011-000-4,2y.CtA iy3/00
PLUP1f.FJM1Y`. VEZ 101-M)-41.9 4000 x,122.751
STRONG MOTION "M -M. 91D 101-000.241.000 MAO
Ox.AWHO 1z1'.3? 101-000-423-000 $15.00
DWELOPER IMPACT SM. iZ405.00
PrI.ECIV PLA14 101-000-441-343 $100.00
?1340T 14AUD MAiTCIE=
►, 33 .f
x110113 PRE, -PAM F".1
_$1. fl•00
1.U9TAL FMCWXT TME 5 VUE NOW
CITyOF LAQUINTA
FINANCE DEPT
RECEIPT
DATE
r
BY
p
DATE FINALED
'
INSPECT
(
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-p
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
(J
Exhaust Fans
O.K. to Wrap-�Q�(�
F.A.U.
Framing
_
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 3_723
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
_ Q, Q
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power — 67
Final
Utility Notice (Perm)
COMMENTS:
REPORT OF FIELD COMPACTION TESTS
�t'OUR REPORT NO.: d ? ,/' `7y'L> CUEKT: —7Z � '
[� y
..
DATE: Q U'Z. PROJECT: -5-
NUCLEAR GAUGE INFORMATION AND
NUCLEAR
CALIBRATION
DAILY STANDARD
COUNTS
CALIBRATION NUMBERS
FROM SHEETS
VARIATION. PERCENT,+/-
GAUGE ADJUSTMENT
% VARIATION FROM
LAST USE
GAUGE TY •fR CAMPBELL
MOISTURE
MOISTURE:
M0LSTU RE
MOISTURE
ELEVATION
MODEL NO_ Lj
DENSITY:
DENSITY:
DENSITY:
DENSITY:
-ROCTOR INFORMATION
COMPACTION
MOISTURE
GENERAL LOCATION: `'
REQUIREMENTS, % j p
REQUIREMENTS,
I 7`I".0, -e (?f -l.
TEST
READING
QUOTIENT/
SOIL
TEST
ELEVATION
MOISTURE
WETIDRY
PERCENT
COMMENTS
N0.
PCF
ID NO.
DEPTH, IN'
• ' OF TEST
CONTENT,
DENSITY,
COMPACTION
%
PCF
_Zz ,z
112.7
r:
i
l
7•
e. -
TECHNICIAN: TECHNICIAN: �L
MMEMS 1 - .FILL ATERuaL (L. EST RESULTS COMPLY WITH SPECIFICATIONS
2 - BA FILL B-COMPAC'T TTOH PERCENTAGE DOES NOT COMPLY WITH smci cATTONS
3 - E COURSE C - RETFSOF"PREVIOUS TEST
4 - SUBBASE D - )AOLSTURE IN EXCESS OF SPECtnr-AT70N5
S - SOIL CEMENT E- MOISTURE BELOW SPECIFICATIONS
6 - OTHER'
TMBBLE CONSTRUCTION CO INC. 80.655 Ave. 43
Indio, CA 92201
760-347-9755
760-342-9825
March 6, 2003
Betty White
83300 TOURMALINE AVE
Indio, CA 92201
760-347-1285
RE:APN # 773332002
52-790 Avenida Martinez
City of La Quinta, CA 92253
Tribble Construction Co. need owner permission to install plywood three foot up in master bathroom
4040 window for City of La Quinta Building & safety until the temp. Glass comes in . It will take 7 to 10
working days for the glass to come in.
Sincerely,
William Tribble Construction Co., Inc.
Betty
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 52-790 AVENIDA MARTINEZ
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0207-004
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: BETTY WHITE
Building Official
Address: 83-300 TOURMALINE AVENUE
City: INDIO, CA 92201
By: KIRK KIRKLAND
Date: MARCH 7, 2003
POST IN A CONSPICUOUS PLACE