9904-106 (BLCK)w -
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O :D ch License # Lic. Class Exp. Date
r-- d U-)
W
oZ Date Signature of Contractor
O�
r,- U C:) OWNER -BUILDER DECLARATION
WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( 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 a empt under Section , B&P.C. for this reason
LOf
N ate C/ / Signature of Owner -� �' �� •� �'-
O rn
Q WORKER'S COMPENSATION DECLARATION
CD ZIM I hereby affirm under "penalty of perjury one of the following declarations:
LID O ( ) I have and will maintain a certificate, of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Section 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carver Policy No.
ob 5
r,a
Q
(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 3/700 of the Labor
Code; I shall forthwith comply with those provisions f
Date's %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 purpoes. i
Signature (Owner/Agent)Y'� I r - `%'F' r""'� Date 1�
BUILDING PERMIT PERMIT#
1)"4-106t�
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 51,W)AVENIi�a# 1��tlEWDOZ.A.
APN - -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
N A ,10 N4 HURNANIDEZ
t NMERl13iT11ME;R
51-5.40 A VENIDA. IVIENi: OZ.A.
LA, QULNTA CA 92253
( 2 - CBL#
USE OF PERMIT
GENERAL BUILDING
50 L_V, 0 GARDEN '1 ALL - CITY STANDARD
FIT. UIXI SO.00 LF
E"MA'iX M COST OF CONJSTKUCTJ:O
PEIVAUT FFE SUMAIARV
CONS;"1'l u(:rC(:)N3.rja,; IM -M-418-000 $31.00
S'UP-11YrA I, t`'ONS;MIR( —1100 AND PLAN 04—:CK
V31 PO
LESS PIU-PAIVI F'1IES
$0 w
TMAL PE':tMIT F#+.F.S MY,, NOW
$31.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
t
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
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
l3 '—
Main Drain
Bond Beam
- 6 —
Approval to Cover
Equipment Location
Underground Electric
Final
S
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)
4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51-540 Mendoza LA QUINTA, CALIFORNIA 92253
Mailing
Address F. 0. Box 4694
City Zip Tel.
Paint Desert 92250 3+60-1464
Contractor
Same
Address
State Lic.I City
& Classif. 9673797 Lic. # 1245
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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. - W�„n.
SIGNATURE DATE
OWNER -BUILDER DECLARATION'
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
permit to construct, after, krprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rde a signed statement that he is licensed pursuant to
Me 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 civil perwfty of not more than rive hundred dollars ($500).
❑ 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, euisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
bolds or improves thereon and who does such work himself or through his own employees,
provided that such kWmvements are not intended or offered for sale. If, however, the building
or knprovement is sob within one year of completion, the owner -budder will have the burden
of proving that he did not build or kmprove for the purpose of sale.)
❑ 1, 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, tabor 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 if the permit is for one hundred dollars ($100) valuation
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: ff, after making this Certificate of Exemption you should became
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building 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.
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.
Signature of applicant Date
Mailing.Address
City, state, zip
No.
BUILDING: TYPE CONST. OCC: GRP...
A.P. Number 773-143-003
Description
t Description S16
06346
Sq. Ft. 1360 - No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $78,886
PERMIT
AMOUNT
Plan Chk. Dep.
g
Plan Chk. Bal.
219.09
Const.
545.00
Mech.
53.50
Electrical
106.70
Plumbing
157.60
S.M.I.
5.53
Grading
20.00
Driveway Enc.
20,00
Infrastructure
1,736-68
TOTAL
*3,114.00 . —_ X
REMARKS
ter+. +�.-. s �,. ..u. y� • . .',0 04U s 7!
t w tliZ R I., .t U�fAL- t , 7-1 ;(hri 7V
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
9/20/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SE
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FOUND. REINF.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
OTHER APPJEQUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. I SO. FT. ®
TEMP. POLE /j /
! AfAt
WALL SO. FT. ®
GROUT
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
BOND BEAM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
LUMBER GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
MMECH.FEEPL.CK.FEE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
FINAL INSPECTION
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 6 12,-W,4UGROUND
PLUMBING1�%j
UNDERGROUND A.C. UNIT
COLL. AREA
SLAB GRADE `f /6Aw
ROUGH PLUMB.
BONDING HEATING (ROUGH)
STORAGE TANK
FORMS
SE
IC ANK
ROUGH WIRING DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE /j /
! AfAt
GROUT
WATER HEATER
SERVICE FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
FINAL INSP. cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING 1/ 710
FINAL INSP.
ROOFING
O
0�LATHING
' a
5
D U
10
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,fbjq/p/ • � �
MESH
INSULATION/SOUND D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
Alo'rl . �, SCHOOL FACILITY FEES
P(
�T' �?'
TO: City of Lia' QyGftt��eeCp� ""EJVr 9,441 DATE: Zl 9— gq
Department of ComcfiPA41ty ivelopme:nj o r
78-105 Calle Estado 91
La Quinta, CA 92253,
This is to certify that ',Q`-rvu: , ,
developer ofwhich is
located at within
this District, has paid school facility ees imposed pursuant to the
authorit generat d by Gpvernment C de Sec ion 53080 'n tha ount of
$o
covdring a total of square feet of -i ) residential' or��
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
616-4- 119;�
for DESERT SA S•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
r 4' Or• 4,0.
V
JAMES 0. WALLACE
Agricultural Commissioner
Director of Weights & Measures
OFFICE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEASURES
4080 LEMON STREET, ROOM 19
RIVERSIDE, CALIFORNIA 92501
(714) 787-2561
49613 Highway 86, Suite B12
Coachella, Ca. 92236
(619) 342-8291
CALVIN C. KAMINSKAS
Assistant Commissioner
CLEMENT BENVENISTE
Sealer
DATE (7 b CASE NO.R �9 L 2 o:�16 9-7 A
DEVELOPER'S NAME: A vv,- CCS
ADDRESS: -)4— 141.E 1�7 ( PINs tc's , 4 c
P��w.. VJcScr�
TELEPHONE: ( (,t?) 3 4. o 14 3 I
1,0--t 2,2- Q l 6 e, i_ 1 L 2 :5J,,J'(AA e A-V' - r�
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do -occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
T6-ric6itural Commissioner's Office
cc: Indio and Riverside Office
0-4%
Buena Engineers, Inc.
79-811 Country Club Drive, Suite 4
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
Client
Client
Client Phone
r��51
DATE
-
—1,97-/9-350
JOB NO.
PROJECT
/ 11
FIELD TESTING
LOCATION
\\
MOISTURE
CONTENT
CONTRACTOR
MAXIMUM
DRY
DENSITY
%
OWNER
C
WEATHER
TEMPT
TEMPDoat AM
at PM
PRESENT AT SITE
TEST
NUMBER
TEST LOCATION
LOTEELEVATION
NO.
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
DRY
DENSITY
IbsJCu. ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
lbs./cu. ft.
OPTIMUM
MOISTURE
CONTENT
%
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REMARKS:
70 81
CLIENT REPRESENTATIVE SIGNATURE
FIELD REPORT
/TECHNICIANS SIGNATURE