0102-196 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division hof the Business and
C14 co
W Professionals Code, and my License is in full force and,,effect.
O 5 ch License # Lic. Class p. Date
I-(ZY u7r- LLJ
/
'- 6'453:5
Z I-- i Datel.Ci?..�F>~1.
-�'' � •• � Signature of Contractor
w W OWNER -BUILDER DECLARATION.,
I hereby affirm under penalty of perjury thdrl am exempt from the Co ractor's
~ � License Law for the following reason: j ,
Z_ ( ) 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).
( ) I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
C 0)
FL Z WORKER'S COMPENSATION DECLARATION
C < cc hereby affirm under penalty of perjury one of the following declarations:
LO
H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
m_ Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
O LOQ Section 3700 of the Labor Code, for the performance of the Work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carver Policy No.
0 STATE FUND
J (This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
3 ' subject to the workers' compensation 717
provisions of Se ion 3700 of the Labor
Datde+-tI forthwith
Applicanly With jose�vns
����_,;►
;..
Warning: Failure to secure Workers' Compensation coverag s,�,yy/I l vy, a�
shall subject an employer to criminal penalties and civil fines ul fb'$r2nd
!Safety
, In
addition to the cost of compensation,.damages as provided for in Se06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building
for a permit subject to the conditions and restrictions set f6rth 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
�1 any permit issued as a result of this applicaton agrees to, & shall, indemnify
map & 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 relatingto, the building
construction, and here y authorize'repr6entatives,of,this Clty t enter upon
the above-mentioned p operty for inspe Ion rposes.
Signature �(Owper/,Agent).--,X�-� Date ?'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ()102_196 TRACT
JOB SITE
APN I
ADDRESS
'OWNER
CONTRACTOR / DESIGNER / EN 1NEER
'WIA A R J.:.P NC1.T
UNDEi , i3MrIpr�et
F0 D0,X_ 430
51.3` 0AMID,A,W3DMM, W,Jr.rE 2, R1v .
1A Q'1769"TA CA g'P23
LA, QUMICA Ch 92253
(760)564--1866 CLO wiq
USE OF PERMIT
`SSt`1.°t - PERMIT DOES Att:3'.f INGLUDe 9LCSC;r 'SNd#iAJ".,,N0US)Rd•J,hP'7+RO C11
DRIVFWAY
7"UC'T CONSTRIUC"T;iON 4,1n,09 SP
PORCFr'MATIO 600.00 8
ClARAGM fi,*,.3A
.100 SF
E«M04A'1<°.r .D tMg3WE OF CONST., RUL"11(1N
19),166169
11a 0(l1Z-oCVdbt0a[/!3.--�4Bi3�?ry8--3:1jfyl6�041.
F8s
y3 4�D14.0bNj0
�Lti'/..tP
�►jpl�t(.a13I1'�1,9 ��'/j y,
���h/�3.:A8V iC.U7.,LM 1• FA44 E �.J F-`��EO'Xb � j -AA�� � 9 �3. W U
MUCz Rtt..A ,1i'lM 101.0 70.420• (?00 Md. 17
P1.IJMBINQ;PT?,'a 101.000-419-0100 $24775
S`1'Y1C:3'NO.t19CJ1'IOU:i+ .K... XMID 101.000-241.1100 $;i X
DfNWMXVER d:AftRAC".:!' FEES �1,9�1,Co
,t3RT 114 PUBLIC PLAC;C O ' .t�P�rl-I~ �0 &'"Ot7i7- d3��C}OiD St�iJ X93
• -. ,"-.`°yin
' SUB -Te AL Ct,lNSSd'C,CJ4. 0.1 .Cii•`.D �/.1✓tIL ..C.['4L,'! '.L0.
Nf4,8,19.03
LROSS M -P AW FEES
-<XI,r o.00
YERMUFM IME1. now
53,87&03
UN
1 3 2001
RECEIPTF
FINAN
TA BY
E -
DAT FINALED
E -&'Z-7i
INSPECT R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
"1 13.01
Underground Ducts
Forms & Footings
'1_t3 . p 1
Ducts
Slab Grade
-13 .01
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
..S• p
5
�/fL
Exhaust Fans
F.A.U.
Framing �, •�- O 2
pL
Z p v.T
Compressor
Insulation
,y=//_p Z
�; 5 • S7-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines -
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
PiR1-3
Final
Final
/2_
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
1p • ,'j ,? r /
s T
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
,Z�..3✓� °�/3/oz 6 �'`'_
Utility Notice (Gas)
Ea s d i ,e.
<1 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
Zo ez--
Final
Utility Notice (Perm)
"Y
Slodden Engineering
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date
Job No. 7 2
FIELD MEMO
Project Name Client:
Site Address ; $A .► h. r=
Job Phone
Work Done j
IG= {
Test Summary / Footings Inspected
Test
No.
Location
Elev.
Dry
Density
Moist
%
% Relative
Compaction
Ref. Max
pcf
Moist
%
1
�
Comments
`Field Tech. Super. or Agent
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service.
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
(760) 777-7075
APPLICATION
FLOOD PLAIN DEVELOPMENT PERMIT
BUILDING SITE LOCATION
FLOOD ZONE 'AO" - DEPTH 1
21 / A C� CAI.
• (�"�'
COMMUNITY- PANEL NUMBER
060709 0005 B
PAD --7-7 D r� ^ O ®3
Map Revised: 811911991
APPLICANT INFORMATION SECTION
APPLICANT NAME
APPLICANT
OX i1_c .
ADDRESS/T���e�
(MAILING ADDRESS, NOT THE BUILDING SITE)
44 o i tj -[-A Z e!�A- Z S 3
DAYTIME TELEPHONE NO.
�(
INSTRUCTIONS
1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the
Applicant Information portion of this application and submit it to the Engineering Department along with the
required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and
Safety Department for plan checking.
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance
• Copy of the proposed Precise Grading Plan for review and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction.
• Submit a completed FEMA "Elevation Certificate" form to the Engineering Department.
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF 2 APPROVAL
STEP 2 OF 2 APPROVAL
The Precise Grading Plan submitted for this application has been
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive a building permit upon satisfying all other Building &
Safety Department requirements.
-61--ow
Al --,2
/AUTHORIZED SIGNATURE DATE
AUTHORIZED SIGNATUREDATE
La Quints Engineering Department
La Quinta Engineering Department
FILE: Upon Step 2 approval, original goes in 'Flood Plain Development Permit" file; copy goes to Applicant
PETE BILLINGTON & ASSOCIATES
Planning, Engineering, Surveying
TELEPHONE
(760) 323-4573
FAX
(760) 323-2690
Date: July 12, 2001
Building Department
City .of La Quinta .
78495 Calle Tampico
La Quinta, CA. 92253
Reference: 78-215 Calle Cadiz
Gentlemen:
966 VELLA ROAD
PALM SPRINGS, CA. 92264
On July 12, 2001 a field survey was made to verify the elevation of a building pad constructed on
the above referenced property.
Pad Elevation is 101.5
Elevation shown on the approved grading plan is 101.5
Additional Comments
Sincerely,
Pete Billington
;&Ass
Pete Billington
PB/ct
File
NPL LANA\
a� 0 o
a
NO. 4152
Exp. 06.30-04 k
i8 s
ql �
a
4
i la -41L fix
'r
�,Ajr I Info n w t i o n
t.O%-PJF ToBuildOn
Engineeift - GQMWftkV - Testing
f
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: LENDELL VENTURES PROJECT, 78-215 CALLS CADIZ
PO BOX 450 LA QUINTA, CA
LA QUINTA, CA, CA 92253
DATE: May 31, 2001 OUR REPORT NO.: 073-10154-2
TEST DATA: (1) Fine silty sand. OPT. MOIST. = 11.5k
TEST TEST
No. ELEVATI(
FG
2 FG
FG
4 all I FG
L
MAXIMUM
SOIL ID I LAS DRY
NUMBER DENSITY
1 110.0
1 110.0
1 110.0
1 110.0
WATER
9,3115.6
-- ._..
--
5.9
1110.9
95W Min
DENSITY
COMPACTION
10.6
116.4
11.1
1
1116.2
TEST LOCATION: Building pad.
NE corner.
2 NW corner.
3 SE corner.
4 I sw corner.
NOTES: TESTS PERFORMED PER ASTM 0292246 8 ASTM 03017-98 'COMMENTS; 1. FILL MATERIAL A. TEST R4LILTS COMPLY WITH SPECIFICATIONS
4 NOT COMPLY DENSITIES SHOWN, LbS6rr cubic loot 2. BACKFILL
A KF&RSE S. PERCEN EOMPACTION DOES
I I
A CONTENT Perc I of dry weight 3 13AJF CO WITH SPECIFICATIONS
WATER Mr
PERNINCTOCOMPACTION: Ba30 on maximum dry 4'SU C. RTOFPREMUSTE
densityr,dinjen, 5� SOILCAD. MM81IRREE IN LE0%ESPSE0FTfE-CIFN1(tTION1S
soil D ux !don Sample indicated by 6. OTHER E. BE CtFICATIO
11
(1) ASTM D-1557, Procedure A
TEST INSTRUMENT: STANDARD COUNT M: 0:
REMARKS: PSI did not monitor the material placement- ADJUSTMENT DATA M: 0:
Respectfully submitted,
TECHNICIAN: Vinnie De Souza Professional Service Industries, Inc.
THFEETE31 RESUL73 APPLY ONLY TO THE SPECIFIC %.Or-ATWONSNOTEO AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ULeVAnO"S-
4EPORY,- MAY NOT OF 41PRODUCED. EXCEPT IN FULL V.ITWDtrr %Wl"ENPERMSSION BY PROFE5SJOA1A1OERVtCf INDUSTRIES. IAC.
Fir. —00-2 (-),
Professional Service Industries. Inc. - 42-240 Green Way, SON C - Palm Detert, CA 92211 - Phone 76Of341-5790 - Fax 76041-5794
** TOTAL PAGE. 01 **
I-'elgo
S"-
COMMENTS*
PERCENTSpec.
95W Min
DENSITY
COMPACTION
105.8
96.2
1
A
104.7
95.2
1
A
105.2
95.
•1
�1
104.6.
95.
A
TEST LOCATION: Building pad.
NE corner.
2 NW corner.
3 SE corner.
4 I sw corner.
NOTES: TESTS PERFORMED PER ASTM 0292246 8 ASTM 03017-98 'COMMENTS; 1. FILL MATERIAL A. TEST R4LILTS COMPLY WITH SPECIFICATIONS
4 NOT COMPLY DENSITIES SHOWN, LbS6rr cubic loot 2. BACKFILL
A KF&RSE S. PERCEN EOMPACTION DOES
I I
A CONTENT Perc I of dry weight 3 13AJF CO WITH SPECIFICATIONS
WATER Mr
PERNINCTOCOMPACTION: Ba30 on maximum dry 4'SU C. RTOFPREMUSTE
densityr,dinjen, 5� SOILCAD. MM81IRREE IN LE0%ESPSE0FTfE-CIFN1(tTION1S
soil D ux !don Sample indicated by 6. OTHER E. BE CtFICATIO
11
(1) ASTM D-1557, Procedure A
TEST INSTRUMENT: STANDARD COUNT M: 0:
REMARKS: PSI did not monitor the material placement- ADJUSTMENT DATA M: 0:
Respectfully submitted,
TECHNICIAN: Vinnie De Souza Professional Service Industries, Inc.
THFEETE31 RESUL73 APPLY ONLY TO THE SPECIFIC %.Or-ATWONSNOTEO AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ULeVAnO"S-
4EPORY,- MAY NOT OF 41PRODUCED. EXCEPT IN FULL V.ITWDtrr %Wl"ENPERMSSION BY PROFE5SJOA1A1OERVtCf INDUSTRIES. IAC.
Fir. —00-2 (-),
Professional Service Industries. Inc. - 42-240 Green Way, SON C - Palm Detert, CA 92211 - Phone 76Of341-5790 - Fax 76041-5794
** TOTAL PAGE. 01 **
I-'elgo
S"-
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
78-215 CALLE CADIZ
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: A.P. LENCH
---& j4.L
Building Official
Address:
City:
Bldg. Permit No.:
Land Use Zone:
P.O. BOX 450
0102-196
RL
LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: DECEMBER 6, 2002
POST IN A CONSPICUOUS PLACE