9808-132 (SFD)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
511.53 A13 813V00
`Date H ? t'y 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 isnot 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.
(V) 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.
E101.3:`S
(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
subjeci to the workers' compensation provisions of Section
3700 of the Labor
C108e, I shall forthwith comply with those; provisions.
�Date:1 f I I In Z 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 C
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.
Signature (Owner/Agent) � - Datet
PERMIT #
BUILDING PERMIT
98418-132
DATE VALUATION $91,140.10 LOT 14 TRACT 1.126
JOB SITE
ADDRESS 54-4FJ0.AVENNa�.i.F\ CAP."NM
APN 174-243-010
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MIA11311., INC.
'MIDI 13.1L, CMC.
P.O., BOX s 555 ,
P.O. BOX 1533
LA QL1fIVrA CA 9225.3
LA QJ19rA CA 9225�A
t"76(1)340-2726 CRU 2526
USE OF PERMIT
.URtil.R't�cbldl.S'J�t?l..�i.l�s i
8FD - PENOIT DOES 140T A7daUDR BLOCK Oil POOL
/
POAC;If1F'A110 02,00 8F
0f1R}\tfWCAAf 10R..!' 540.00 SF .
)~STiNUTED C=T OF W.N; "1'RUCI'1.Gri'
PE.40%flT Fi+alE SilMMAYdl`+ir
CQNSTRUCif0N F.U.' 10.1-1W-419-000 5601.50
Pt, K(TTr17K FrIf",
101-tl�pf'+(-439-3t� $%Z.34Mfl
0.1,4141 AL i''.7k 1011 •IDG _44 1-000
OJE ",RiCALT 101-000420-000 $129,33
PLUtVIBI NO FEE 10I -000- 5 4)00 $131 0
19TRC'>Aft7 Wl•rrc N Y.Ff _ ir,F,�rt'ri7 1t?t-tD+itt-?$1-{)lit) . !t8,1I
GRA 1P:CNG ME
114FIG.f1STtCi)t:'1'URE. ffiC: 625-1500-143-342 S1,it".92
P HIa '1SE PLAK 10tO(It)441-345 R«S Crt�
Fr i�Fipc?tifT d0I4M-43+x-'318-1250.6*
d
SUH— UT: L. C, ONS°!'F UCTION AND ('LAN C;M:(X
$3,46n 2()
LESS PRE -PAW FFM'S
_1250,
T'L
-AL
MI PERMIT FEF.S' DRE NOW -
$3,210.20
r
RECEIPT �•. `p
r
DATE BY `
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE'
I INSPECTOR
OPERATION I
I DATE
I INSPECTOR..
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade A/
Return Air
Steel
Combustion Air
Roof Deck
OX to Wrap
Exhaust Fans
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 /f - ?
Drywall - Int. Lath -Er
—Z—f
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 TestElectric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure -
Shower Pans
O.K. for Finish Plaster
Sewer Lateral -A- A Z4 r
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test 2_j
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:
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
f;
CERTIFICATE OF COMPLIANCE
Date 11/10/98
No. 17988
Owner NameMumbil, Inc
No, 54-460
City La Quinta
Tract #
APN # 774-243-010
Jurisdiction La Quinta
Permit #
Street Avenida Carranza
zip 92253
Lot # Square Footage
Type of Development Single Family Residence
Comments
Log #
Study Area
1415
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the •following
reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the arab ni of
1.93 X 1,415 or $ 2,730.95 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By ccNalley Independent Bank/Mumbil, Inc. Telephone 760 340-2726
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre
Signature
Payment Received $2,730.95
Check No. 171523
NOTICE: Pursuant of f[ssembly Bill 8081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to runfrom the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
_U 'N ME Travel Bob &'M.E. Fax 760-568-2967 Jan 05 21:37
17
2
/ G / Vi iJ GLS �b i %'7'�/
�i r � �� �rU � S � S. • iC%.�_ i �i .a
T ' �C/`i m � � co i �� c� '��rrz� C � 2 5�? / 5 �ct�o�a � q! o •�
S. J'" F c car 1ti w// ,tJ c:z r7 /� �r� Ci .s V/ 4:E�'/7 1 o/ 51oc)
7 - /�o 0 7" � r� div +ir 9 ��2_ . � � �/'rL I /'"" a d ✓
CLI
,g7�Z ` �—F
U 'N ME Travel Bob & ' M . E . Fax : ?60-568-296' Jan 05 20:02
BOB HO)H'FMAN , Structural Engineer
Field lnspection Report
Location, 54-460 Carranza, La Quinta Date; 20 January 1999
Dewription : New SF -D, one-story in final framing
Per Section 1702 of the Uniform Building Code, 1 have made a visit to the above
mentioned site as of this date. 1 have conveyed to the contractor, in writing, the
deficiencies. which 1 have observed. A copy of this report is enclosed. It is our
understanding,- that these issues will be resolved.
ef
QttOFCS�jG
4,
No._45 ;o
CAU
NUCLEAR GAUGE INFORMATION AND
CALIBRATION
........... .............................. _. __
CALIBRATION NUMBERS
FROM SHEETS
VARIATION. PERCENT,+/.
GAUGE ADJUSTMENT
REPORT OF FIELD COMPACTION
TESTS
MOISTURE:
MOISTURE:
OUR REPORT NO.:
C- Z <--
CUENT:
4-
DENSITY:
DENSITY:
DATE:,-
DENSITY:
PROJECT: S �O
e rn n
NUCLEAR GAUGE INFORMATION AND
CALIBRATION
DAILY STANDARD
COUNTS
CALIBRATION NUMBERS
FROM SHEETS
VARIATION. PERCENT,+/.
GAUGE ADJUSTMENT
% VARIATION FROM
LAST USE
GAUGE TYPE: it9b LAMPS ELL
MOISTURE:
MOISTURE:
MOISTURE:
MOISTURE:
'
MODEL NO.: /I
DENSITY:
DENSITY:
DENSITY:
DENSITY:
PROCTOR INFORMATION
i -
SOIL ID .t VISUAL CLASSIFICATION OF SOIL MAX. DRY DENSITY, PCF OPTIMUM MOISTURE. %
I
COMPACTION MOISTURE GENERAL LOCATION:
I REQUIREMENTS, % REQUIREMENTS, USS
TEST
NO.
READING
QUOTIENT/
PCF
SOIL
ID NO.
TEST
DEPTH, IN
ELEVATION
OF TEST
MOISTURE
CONTENT,
WET/DRY
DENSITY,
PCF
PERCENT
COMPACTION
COMMENTS
�t
•
M- Y
l t 7, a
o
M-
IIG,"7
20
.
M-
..
D
Nt-
-
'
D-
11 TECHNICIAN: 1 .
COMMENTSZJ T FILL �� A ERIAL ��EST RESULTS COMPLY WITH SPECIFICATIONS
2 BACIfI B=COMPACTION PERCENTAGE DOES NOT COMPLY VMi SPECIFICATIONS
�I 3 e BAS OURSE C =-RETFST.OF PREVIOUS TEST .
°' SU E O =-MOLMRE W EXCESS OF SPECIFICAMONS
/ 5 - SOIL CEMENT Ea MOISTURE BELOW SPECIFICATIONS
6 - OTHER
�-'p