COMB (0592)PERMIT APPLICATION 17 76
City of La Duinta
Department of Building and Safety .
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if,work has been suspended or abandoned for a period of 180 days.
ADDRESS -
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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
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the.Business and Professions Code, and my license is in full force
issued, tshall 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: 11, after making this Certificate:of Exemption; you should become subject to the Workers'
OWNER -BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Law' for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt
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 to file a signed statement -that he is licensed pursuant to the provisionsof the Contractor's License Law
01 hereby certify that no excavation five (5) or more feet iri depth into which a person is required to descend. will be
(Chaptec9 (commencing with section 7000) of Division 3 of the Business and Professions Code)lir that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of.Section.7031.5 by any applicant for a permit
demolitiopp or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
subjects the applicantao a civil penalty of not more than five hundred dollars ($500.):
• C.A.C.)1—t' ;t""
❑ I, as owner of the property, or my employees with wages as their sole campensation,,will do the work, and the.
0 As owner -builder. I will not employ 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
CITY/COMMUNITY/STATE/ZIP
through his own employees, provided that -such improvements are not intended or offered for sale. If. however, the
❑ Division of Industrial Safety Permit No. ,
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that .-
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
A I, as owner of the property, am exculsively contraEting with licensed contractors to construct the 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
.
_.Contractor's License Law.).
Lender's Address --
j
01 -1 -am exempt under Sec. B. 8 P4(Attached Certificate).
I certify"that I have read this application and state that the above information is correct. l agree to comply with all
Date Owner /
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
iv "
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm -that I'have a ceruhcate of consent to elf -insure, or a
certificate of Workers' Compensation Insurance , or a certified "copy thereof (Sec. 3800° Lab. C.).
Policy. No. Company
0. Certified copy is hereby furnished. -
O Certified copy is filed with AN City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F, MI).14,-,4/
ADDRESS -
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CITY/COMMUNITY/STATE/ZIP
JOB SITE �Q
Y/COMMUNITY/STATE/ZIP
CITSWACE
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OWNER
CKI�.(
CONTRACTOR -FIRM NAME -
U�v�er
ADDRESS
CITY/COMMUNITY/STATE/IIP
PHONE N
LICNC N
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE OF PERMIT '
BL
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FSB
SS8
SSB
'RSB
OFC '
ZONE ORD N
LOT SZ ..
-
END
.SIDE' -
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have 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
construction, and authorize a'representative of the City of La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections'..
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPPRMT ns)[
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TOTAL
` FEE
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BLDG. DEPT. VALUATION
NO.
OPERATION
DATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms w4c L
/j �5/ ;, gi
34 Plenums & Ducts
2A
Slab Grade
3
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
/
37 Combustion Air
5
Bond Beams
7W-
38 Compressor
6
Roof Deck
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 vx
10A
fireplace T.O. ❑
NO ADDITIONAL INFO MAT ON
/f
_
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts) /?
12B Ceiling (Batts) 3 p
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
,,,���
20 Sewer S�ik�/< 7 7
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
_ REAR OF PROPERTY LINE
��ovSE
nn
PSL V P/I
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26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 3 T
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
i
TESTING INSPECTION :
1731=A WALTER STREET VENTURA, CALIF0RNIA.93003 PHO,NEJ.(805) 642-6727. .
February 21; 1984 B -14091-P1
84-2-194.
Bob Updike
77705 Calle Temecala
La Quinta, CA 92253
Projects 77770 Calle Monterey
La Quinta, CA
Subject: Compaction Report
On February 69 1984 a representative of our firm performed density tests on the
fill placed in the buildingarea on -the above referenced project. - Tests were
performed at random locations in accordance with. ASTM 2922-78 and ASTM
3017-78 Nuclear Density Test Procedure. Tests were performed as per
authorization of Bob Updike.
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 two
(2) density tests were performed. Test results' indicate a minimum . of ninety
(90%) percent 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. Test results are as follows:
Soil Description Maximum Density Optimum Moisture
Light brown silty fine sand 112.4 pcf 11.9%
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) 328.9131 (805) 544.6187 .
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