PLBG (0103-166)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
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 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).,,
O I am exempt under Section B&RC: for this reason
Dat e.�r .. ', '� - +' t Signature of Owner ti s,
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 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,
1 /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 shall forthwith comply with those provisions.
Date',)'�� 6! Applicant;
w
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an•employer to criminal penalties and civil fines up to $10011000, 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 tho building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. l
Signature (Owner/Agent)' f �• _- Date �
- BUILDING PERMIT PERMIT#
DATE VALUATION LOT 010-166 TRACT {
JOB SITE
APN
ADDRESS oYr 4Ad s 'XID k N ANN?.�:,� .R0
OWNER I 7
4
CONTRACTOR / DESIGNER / EN 1NEER
q/yy" � p y � p�¢y�q e��+.y�}
�.rns+.1,"NHAM S77C'iF.aF%'V.!`F �
ic
®�P�J'et A " l-}%/ 0
5.3470NMIDANA PHRO
A QUXTA. CA, f mµ.3
USE OF PERMIT
��-�"P4Fw'A,�.a°�'t�f~i1�T��;Br;E:2i'T�SL�'1��%i�7R'•"F;;p -,
�;"M L
PUMSPIC. FEE.. r0i i i �� �t�t�i "� Toga 3d►,�tt
D a
MAR 2 22001
CITY OF LA QUINTA
FINANCE DEPT
LESS
$0,00
`.MAL PER7�.�'9IMMS DUE NOW
VU.09
RECEIPT
DATE
BY
DATE FI LED /
�0��
INSPECTOR
�d'�lry�drii
• 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 Wali Insulation
Condensate Lines
Party Wali 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
Sewer Connection
3�yq/o L
Pool Cover
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
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
t
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From:
Date:'.
Address: " " L� )
(�IKIG
Account No.C..
^. Lot(s)
�...� r
Service Address t I %
1 % /may ^ r - /'2 0 tzrl
Tract
G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
r
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
❑-anitation Capacity Charge
!"?
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - - Bond
Assmt.
❑ Customer Deposit
f
❑ Other
TOTAL
Remarks:
Cash /—
/
Water Service
Check
�"
Cashier
Money
Order
05
Z
O
H
U
w
W
uW
Z
O
U
w
U)
Y
LL
Q
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cr
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION7? —a7 _ uIc
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM /
Applicant: Submit this form with four copies of a scaled plot plan (1.20 scale) drawn to County specifications required on the attached check list.
A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log q
Name (Owner. Agent. Contractor. Etc.)
r
ddress
MP0./&04 ?,Z/
G
L 7`6
State
C /� 1. /)-
Zip Code
49Z3 7 4
Telephone
l�/ 9 5 -6�00
'Job Property Add
Gt or. Coommunriy.a.+•
'Legal Description of Property. (Lot. PM. TR)
.Assessors Parcel No
Water Agenc4 or ell
�_.,.! 1 /
Use of Permit L(l�L'%lti![.ft-�•M'7 Planning Case N
Lot Size
'793 -.27 -017
/ � �n
�^
l ��,
SFD. MH Site Preparation Etc.
f
SignalureNf'9i plican - Date
' The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
l�d
Certification of Existing S.D. System required. ❑ YesIlk
WOCB Clearance required. ED Yes LTJ Nc
Soils feasibility report required. 11Yes e/
Special feasibility boring report required. ❑ Yeso'
Detailed contour plot plans required. ❑ Yes 0.�
Staff Specialist approval required. ❑ Yes V Lot Inspection Date
Soils/boring report/ by / /- Project N" Date
Soils Map Page / /, Soil -Type t, �C Approved by r✓� Date �'�r' UF�
/
Type of System: �
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
El Existing 19 ew ❑ Additional ❑ Replacement
Gals.
(2 Leach line sq. ft.
(eo o area)
Sidewall allowance
ft. Ft.
Install Line(s)—Ft. Long,
v�
Leach bed Sq.
o
ch
rock/Sq.
ft. /A
F with min. inches
Ft bottom L
per running
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit BI
Seepage Pit total depth
Applicable
N/A Overburden
Max. allowable depth
factor
1471
This application i pproved)jeraiedfor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section B a ove. A building permit ismnecessary for the installatio of the above -designed system.
1) Septic tank and sewer lines must be 50'�from any wells -410 ��,�� S
Leach lines be 100' from
(�2) must min. any wells including expansion area
10 l3 Seepage pits must be 150' min. from any wells including expansion area.
�T. i� (%�� .0 l ..:�..•^' -. f ,i✓ �'f ���'•t�t� L """"`C` <e-A.O� `r' .�. C�/k2? .
Signature OI Health Official / _ /) _ �`v •�:D� / i
RECEIPT NO. /J Issued by� Date G - it 00
District: ❑ Riverside ❑'Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH SAN 122 (Rev 8187)
Fitch Engineers Inc.
November 3, 1988
No V 7-1988
CITY OF LA QUINTA,
PLANNING & DEVELOPMENT DEPT.
-Mr.. Don Bruce
Meadow Land Development
P. 6. Box 921
Rialto, Ca. 92326
SUBJECT: Report of In -Place Tests- 52 415 Avenida Navarro
La Quinta, Ca.
Gentlemen:
In accordance with your request, this report has been prepared
to present the results of the in-place tests performed on the
fill material at the subject site by Fitch Engineers, Inc.
These tests were performed on 11/2/88.-
AVAILABLE
1/2/88.
AVAILABLE PLANS
To assist in determining the locations and elevations of our field
density tests and to define the general extent of the site grading
for this phase of work, we were provided with a grading plan by
contractor.
FIELD TESTING
Field density.tests were performed by a representative of Fitch
Engineers, Inc. upon completion of site grading. The density
tests were taken according to A.S.T.M. Test 1556-74 and the
location and results of those tests are shown on the attached
plates. The locations and elevations of the in-situ tests were
determined in accordance with their importance and the accuracy
and proximity of the survey control provided by other than Fitch Engineers
Inc.. representatives. Unless otherwise noted, their locations and
elevations were determined by pacing and hand level methods and
should be considered accurate only to the degree implied by the
CIVIL ENGINEERING — PLANNING — SURVEYING — DESIGN
P.O. BOX 4551 PALM DESERT, CA 92261
(619) 345.7667
-2 -
method used.
LABORATORY TESTS
A maximum dry -density determination was performed on a representa-
tive saihple of the soils used in the
compacted fills, according to
A.S.T.M, Test 1557-78p Method A. This method specifies that a
four (4) inch
diameter cylindrical mold of 1/30 cubic foot volume
be used and that the soil tested be placed in five (5)
equal layers
with each layer compacted by twenty-five (25) blows of a 10 pound
hammer with 18
a inch drop. The results of these tests as pre-
sented on Plate No. I were used in conjunction with the field
density tests to determine the percent of relative compaction of
the compacted fill.
This report covers only the work performed on 11/2/88.
Our opinions
presented herein are based on our observations and
the relative compaction tests results. Due to possible variations
in the uniformity.of compacted fills, we only warrant that our work
was performed in accordance with,the
currently accepted standards,
of practice and in such a manner as to have reasonable certainty
that the
mass grading complies with the job requirements. No
other
war . ranty, express or implied is.given or intended.
If you should have any questions after reviewing this report,
please do not hesitate
to contact this office.
This opportunity to be of professional service is sincerely
appreciated.
Respectfully submitted,
FITCH ENGINEERS INC.
WM. H. FITCH
A
R.C.E. 12571
Y.
Off• NAME 52 415 Avenida Navarro, La Quinta, Ca. JQg NO,
ELEVATION OR MOISTURE DRY DEN. SOIL REL. COM
TEST NO. DATE LOCATION DEPTH OF TEST 0/0 Ibs /cu .f t• . TYPE 0/0
Rl
11/2/88
See Sketch
-0.8'
8.7
109.2
119.1
91.7
.2
-0.5'
7.5
107.3
119.1
90.1
F.G.
9.9
110.5
119.1
92.8 M:
SOIL
PE #1= 119.1 lbs. cu
/ft. @ 11.8%
isture
'
f
t
t
r.
Plate No:l ` '"�`J
I
lit
DENSITY TEST -,his 5
—
V.- 2M
01
zy,
DENSITY TEST -,his 5
—
V.- 2M
01
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3'x£1;+:
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52 415 Avenida Navarro
La Quinta, Ca. 92253
By
G. Krause
DATE 11/2/88 21f,
cT
JOB NO.
NIS
Plate No.2