05365 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 0 CARQ_ANZA LA QUINTA, CALIFORNIA 92253
Owner
COACHMA A VALLEY LAND
Address 247 E. TARQUITZ #2
City Zip Tel.
PALM SPRIt+iGS 92262 1
322-1020
Address
STARR CONSTRUCTION
_IHM�
& Classif. 387934 I Lic. # 895
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
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. �
SIGNATURE - 'X DATE
OWNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fie a signed statement that he is licensed pursuant to
the 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 civilpenally of not more than five 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. ll, however, the building
orimprovement is sold within one year of conpletiwr, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or krproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec_ a_ & 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. (SSggcc- 3800, Labor Code.)
Policy No Comfy
❑ 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 permits for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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: H, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pemm't shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby 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
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify 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
ateMailing Address
City, State, Zip
WING: TYPE CONST.
P. Number
No.
OCC: GRP.:
€I5365
Description 30%#- 14 A.7L 1,45 .=:ft. StS
e
Project Description orn
Sq. Ft. No. No. Dw.
Size 1409 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
750,110
Plan Chk. Bal.
212,54
Const.
011
Mech.
CA
Electrical
in -Al
Plumbing
IS7,54
S.M.I.
S 140
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:E.
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
Issued by: Date2, I VAQ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
/V(,l LAB GRADE �- l -
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. 0
FORMS
SEWER OR SEPTI
��nn
(t7 � ROUGH WIRING.
///ttt777
MOBILEHOME SVC.
BAR SINK
POR. SO. FT, ®
GAS (ROUGH)
METER LOOP
GAR. SQ. F7, ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE '
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING
WATER PIPING
NOTE: Not to be used as property tax valuation
j� \
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c I
IBATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
kySETBACK —
GROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
/V(,l LAB GRADE �- l -
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
��nn
(t7 � ROUGH WIRING.
///ttt777
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE '
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
j� \
4 A
l
0
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND -/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
T4'it 4 4" * QuLiz -
P.O. BOX 1504 APPLICATION ONLY
SJR ' 890 0A` i2. 1q AJZ $ LA QUINTACCALIFORNIA 92253
030"qe1'/EG4-
Mailing .'/
Address a V7 . C T.q s� a / r
Z 't/iq V
City lZip ITel.
Zz4Z. 1 327--/a
IZip
State- Lic. L)ITy
& Classif. 3 7 9 .34/ Lic. # 8
Arch., Engr.,
Designer
Address Tel.
City (Zip ( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of bivi, 15n 3 of the Business�.andPrrdfessions Cod d my license is in full fore pnd
— o /'_C/ r' �Ll int
'�IIATUgE DATE
OWNER -BUILDER DECLARATION
I hereby affirrn that 1 am exempt from the Contractors License law for the following
reason[ (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, knprove, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
4visicn 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 appicant to a civil penalty of not more than five 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, Buisness and
Pidessions Code: The Contractor's License Law does not apply to an owner of property who
1,,*ft or irproves thereon and who does such work himself or through his own employees,
provided Mat such improvements are not intended or offered for safe. If, however, the building
or rrprovement is sold within one year of completion, the owner -builder will have the burden
of provig that he did not build or improve 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 Contractor's 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 alk6rcntificate
hereby affirm that 1 have a certificate of consenof
Worker's Compensation Insurance, or a certified copy thereof.. c 088e.)
Policy No Company
O Copy is filed with the city. ❑ Certified copy is hyreby furnished.
CERTIFICATE OF EXEMPTION FROM
! WORKERS' COMPENSATION INSURANCE
(This sermon need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of thg 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
Lars of Caldomia-
Date Owner
NOTICE TO APPLICANT. ff. after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
campy wih such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby 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
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
certity that 1 have read this application and state that the above information is correct.
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 Addmsc
City, State, Zip
BUILDING DIVISION
WING: TYPE CONST... OCC. GRP
P. Number % 7 1V'- /G / — 00 9'
gal Description -ZA07'14 rOG�13S- /1.0 , y / 9
Description
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New 91-- Add ❑ Alter ❑ Repair ❑ Demolition ❑
Valuation .
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
cInfrastructure
-FrY.OII<a CQlY'
t—'
TOTAL
LJ
AMOUNT
r
REMARKS
.sio7A�li i YAM S r i1 775, 08
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
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT, ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SQ. FT. ®
FINAL INSP.
WALL ' SQ. FT:
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SQ. FT. ®
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
-
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 13/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
HOUSE SEWER
%
GAS PIPING
PERMIT FEE
IT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK..FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Buena Engineers, Inc.
79-811 Country bub Drive, Suite 4
Bermuda Dunes, CA 9201 • (619) 345-1588 / 328-9131
Client Name
Client Address
Client Phone /
1. D
D
DATE
L z y / y
TEST LOCATION
JOB NO.
g1--13 Iq.-Pa If
PROJECT
FIELD TESTING
^�-
'LOCATION
DRY
DENSITY
IbsJCu. ft.
MAXIMUM
DRY
DENSITY
%.
CONTRACTOR
OPTIMUM
MOISTURE
CONTENT
/°
OWNER
WEATHER
TEMP, o at
at
AM
PM
PRESENT AT SITE
TEST
NUMBER
TEST LOCATION
LOT
NO,
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
DRY
DENSITY
IbsJCu. ft.
MAXIMUM
DRY
DENSITY
%.
MAXIMUM
DRY
DENSITY
lbs./cu. ft.
OPTIMUM
MOISTURE
CONTENT
/°
2"a
13.6
/b?-.l,Z
r -PL -7
7.1
loq , j
3
f r
t
REMARKS:
7i�C.P"'tzW45w ze/Z
90 oy .
CLIENT REPRESENTATIVE SIGNATURE
5239
TECHNICIANS SIGNATURE
wk
1