9811-024 (CRES)N U)
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LICENSED CONTRACTOR DECLARATION
I herby 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: :'
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
( Tam exempt under Section B&P.C. for this reason
,Pate I t 't: i .'_ Signature of Owner ?.. fft_4*
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, asr•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 $100.00 or less).
(,)lcertify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
VEate:_ '' Applicant
Warning: Failure to secure Workers' Compens$tion overage is unlawful and
shall subject an employer to criminal penalties alid•elvil 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 purposes.
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Signature (Owner/Agent) r �� E . —�y �»+� Date LL —Z --i
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PERMIT # CONTROL #
BUILDING PERMIT 99111-024
DATE, ! VALUATION ��' �� () r:,. LOT TRACT - 8598 ® CJ 9 8
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JOB Sift fat -U87. AL'E1�IDA BERM�lDAS APN 77 .225-6,17
Anf)RFSR
OWNER
N I UCK E N AfCANICTAO
540£+2 .t101.E'N1DA B6 RNIUDAS
LA. QUTN-I.,A Cry 922,53
USE OF PERMIT
CONTRACTOR/DESIGNER/ENGINEER
ADDITION - 62,4 !�.F. Dt-:TACf.*3J) T%10 -CAR GARAGE
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PIEIMMIT �+'°FT S1tiMMAkV
PLA14 CHECK i%.E13 101-00 0-439-318 93.60
(77i4,VSTRIICT10NFFF 10)_t' -111i9 -(i o S144.00
Iil.l?C.1"fttCAL fiV 1.01-011'7.420-000 $27.4,
Tf'RONO Iv cyrtcw Fr-. g - ,fll3wi l 1.01-tWO• 241-000 1; 1, Z2
(fiu1UP40 F031 1.01-000-423-0110 `S20.06i
SUB -TOW, CON`11UG`T3t1:N AND "f%f.,l1.N C H:F,CK.
LESS VRE-PAID FEES
RECEIPT I DATE I BY
INSPECTOR
g. c�til's.+vii
$296,10
,$0.00
$2,86. fit
z 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 - - q
Exhaust Fans
O.K. to Wrap 4- Q -
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
BLOCKWALL APWOVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Showier Para
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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
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Final
Utility Notice (Perm)
COMMENTS:
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OUTkILAND
EOTECHNIC L77 FOUNDATION ENGINEERS AND MATERIALS LABS
January 27, 1999 Project No: P99008
Alice Lee
P.O. Box 2
La Quinta,CA 92253,
Subject: Comtpa& 9. Test Results
Garage Pad
Project: 54Avenido Bermudas
La Quinta, California
Dear Ms. Lee: : %
This report presents the results of density testing performed by a representative of our firm on
January 26, 1999.;at the above referenced project. In-place density tests were performed at random
locations by•Nuclear methods*(ASTM D2922-91 & ASTM D3017-88) at referenced locations on
the attached sheets. The tests were made under the responsible charge of a registered civil
engineer in conformance to the test method referenced.
Approximate locations of the tests are presented by paced measurements. A total of three density
tests were performed. A moisture -density relationship (ASTM D1557) for the soil is also
summarized on the attached sheets.
DISCUSSION
• Before our personnel arrived at the jobsite, the surface of the pad had been placed and
compacted.
• The test results indicate that a minimum of 90% relative compaction has been obtained
based on ASTM D1557 maximum density within the areas tested.
• The purpose of the tests was to determine compliance with the minimum requirements of
Ahe,City.of La Quinta.
780 NORTH FOURTH STREET • EL CENTRO, CALIFORNIA 92243 • (760) 370-3000
79-607 COUNTRY CLUB DRIVE, SUITE 5 • BERMUDA DUNES, CALIFORNIA 92201 • (760) 360-0665
7975 RAYTHEON ROAD, SUITE 210 • SAN DIEGO, CALIFORNIA 92123 • (619) 467-4900
J -
Alice Lee - Garage Pad Project No. P9908
LE%UTATIONS
The test results summarized in this report present the moisture and density only at the locations
and elevations tested on the specified dates. The density testing was performed according to the
generally accepted, geotechnical engineering standards of practice that existed in the Coachella
Valley of Riverside County at the time the report was prepared. No opinion is expressed as to the
uniformity of the material, compaction, nor adequacy of the material to perform as intended. No
guaranty or warranty of the contractor's work is made or implied. The test locations are
approximate, determined by pacing and sighting from distinguishable field features. In doing our
work, we have relied on topographic and surveying information provided by others.
With any m nufacfiired.product, there are statistical variations in its uniformity and in the accuracy
of tests used to determine its quality. As compared to other manufactured products, field
placement of materials usually presents large. statistical variations in its uniformity and in the
accuracy of the tests results. Thus, even with careful observation and testing, all parts of the
constructed product may not comply with the job requirements. Therefore, our opinion means that
there is only a statistically -based probability that the densities obtained comply with the job
requirements.
Native soils below the garage pad were not investigated or tested by our firm. No warranty is
made as to the stability/density of the native soils.
This report is issued with the understanding that the owner or his representative has the
responsibility to insure that this report is submitted to the appropriate governing agencies. Please
review the test results and contact our office with any questions or comments.
Sincerely Yours,
SOUTHLAND GE TECHNICAL, INC.
--- 4 , -
Karl A. Harmon
Staff Engineer
Southland Geotechnical, Inc. Page 2
SOUTHLAND GEOTECHNICAL
COMPACTION TEST SUMMARY
(Nuclear Methods ASTM D2922 & D3017)
Client: Alice Lee
Project: 54-082 Avenida Bermudas, Garage Pad
Project No.: P99008 -
Report Date: January 26, 1999
LEGEND
Soil Type
Description
USCS
Maximum
Dry Density (pcf)
In Place
1
Brown Fine Sand
SP -SM
Matr'I
1 11.5
In Place
Dry
Relative
Specified
or
Test
Moisture
Density
Compaction
Compaction
Soil
No.
Location
Elev.
(%)
(pcf)
(%)
(%)
Note
Type
0126-01
Garage pad at corner
FP -12'
12.0
108.6
94
90
P
1
0126-02
Garage pad 'at
FP
11.0
110.9
96
90
P
1
5'Nx5'E or. SW
corner
0126-03
Garage pad at
FP
8.4
115.0
100
90
P
1
5'Sx5'W on NE
corner
LEGEND
Soil Type
Description
USCS
Maximum
Dry Density (pcf)
Optimum
Moisture (%)
1
Brown Fine Sand
SP -SM
115.0
1 11.5
Note: FSG - Finish subgrade BG - Base grade PZ - Pipe Zone TT - Top of trench F - Failure
NSG - Native subgrade FG - Finish grade MT - Midtrench FP - Finish pad P - Passed
Submitted by:
SOUTHLAND G TECHNICAL
Karl Harmon
Staff Engineer
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THIS WALL AND CEILING TO BE 3068sc
5/8" TYPE "X" GYP. BD. (1 -HR \
FIRE RATING) FOR FUTURE
ADJACENT ADDITION < 1
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CEILING WALLBOARD TO BE
PLACED UPON R/C CHANNEL
® 16" 0/C
CEILING HT. 10'-1''
D2 — — — — 18080 O.H. DOOR— — —
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www.hammerpumping.com
760/360-7448 7601321-7448 FAX 760/324-6434
Customer Name
A 1,.
Address (� 7
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Additional Service- Required ❑Recommended
Description/ Remarks/ Drawings
it Card -- MC / VISA #
P.O. BOX 2448 - Cathedral City, CA 92235-2448 - LIC# 661018 JOB INVOICE
J08 DATE: J TIME IN: TIME LUT: TECHNICIAN #1 TECHNICIAN] 02 - HELPERIS)
ORDERED 8Y: r P.O. M START DATE; END DATE:
JOB LOCATION
REASON FOR
SERVICE
BACK UP
CONTRACT
MAINTENANCE
❑ REPAIR
MAINTENANCE
ESTIMATE
CONSTRUCTION
❑ OTHER
I hereby authorize Hammer Pumping, Inc. to charge my credit card for the above charges.
I understand that by signing below I am agreeing to all charges incurred on this ticket and
that the work was completed to my satisfaction. /
lonature for lob completion .
COMMENTS
[]Leach System Failing ❑ Roots ❑ Excessive sludge/grease
SERVICES COMPLETED
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OWNER:
SAKAMOTO
54-082 AVENIDA BERMUDAS
LA QUINTA, CA 92253
564-3861
DATE
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