001279 (SFD)011
LICENSED CONTRACTORS DECLARATI
(commencing with'Section 7000).of•Divi
and effect.
License Class Lic. Number
Date `• Contractor
OWNER -BUILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractor's Licerjse'Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires'a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for .
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of is.
3 of the Business and Professions Code) or that he isexempt
thereirom'and the basis for the.alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant 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, Business and Professions Code: The Contractor's License
Law doesot 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. If, however, the
rbuilding orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
.._ ❑ t, as owner of the property, am exculsively contracting with licensed contractors to construct 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. (Attached Certificate).
Date / Owner " ' L e-- / ! ! G% °•
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
'certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company .
❑ Certified copy is hereby: furnished.
❑ Certified copy is filed with'the City Building Inspection Department or City Department.
Date Applicant
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety -
This permit becomes void if work not commenced within 180 days from date of issuance. OR; if work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if :..
ON; I hereby *affirm that I am licensed under provisions of'Chapter 9 the permit is for one hundred (8100) o, less. I certify that in the performance of.the work for -which this permit is '
sion 3 o the Business and Professions.Code, and my license is in full force - .. issued, l shalhnot employ any person in any manner so as to become subject to the Workers'Compensation laws of
California.
APPLICANT NAME (L. F. MI) J4C_1y �,�•.1 7�y,��.�,,,, -
ADDRESS 51-505 Ave.�:Martinez
J ca
CITY/COMMUNITY/STATE/ZIP la Quintal, CA 92253
JOB SITE ADDRESS/SPACE 51-075 Calle Palcm
CITY/COMMUNITY/STATE/ZIP la �nta, CA 92253
BOKY,0
PAG
PRC/��
C
sq, ft.
TWN
RNG
SE
S
TRACT
LOTlpO
MOD
SB
-
TRACT NAME �y�w
OWNER NAME (L. F. MI) Appli.ant
CONTRACTOR -FIRM NAME applicant '
Y_e
ADDRESS ab
CITY/COMMUNITY/STATE/ZIP abme - ..
PHONE . '
-
LICNC a
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
i
PHONE 1
113.00
LICNC
GraduxFep�
USE OF PERMIT �1' �yK7 e family i1welling
BL
-- - o---
ZON
-
FSB
SSB
SSB
RSB
(25�
DEPOSIT PA3D
ZONE ORD I
-LOT SZ
-`TOTAL :
FEE
11640.08' .
END
SIDE
Date Applicant
.NOTICE TO APPLICANT: If,'aftermaking 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:permit shall
be deemedrevoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap3.2, Grp 2, Art 2, Sec 341. Title 8.
C.A.C.)
❑ As owner= builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
❑,Division of Industrial Safety Permit No.
Date Applicant
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• Civ. C.):
Lender's Name
Lender's Address
I certify that I havesead 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 county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application arid state that
the information given is correct. 1 agree to comply with all state laws and county ordinances relating 'to buidling
construction, and authorize,a representative of the City of La Ouinta Department of Building and Safety to enter
upo the property for which I havelpplied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPVPRMT � � � � � �
� YST�OS
S.F.D•
Permit to con.�tnict 2238 sq. ft.
of house
plus 528 sq. ft. of porch and 977
sq, ft.
of garage as per approved plans.
Mech. Fee
33.00
Plan (heck Fee
412.90
Const. Fee
490.50
Elect. Fee
93.10
SMI Fee
8.58
Plumbing Fee
113.00
GraduxFep�
39.00
-- - o---
450.00
FENCE NOT IMC IAXIM
1,640.08
ON THIS PEMM
(25�
DEPOSIT PA3D
1,390.08
-`TOTAL :
FEE
11640.08' .
A1862
BLDG. DEPT.
7 8- 1 3 _ Q 8—�
VALUATION 122,415.00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
❑
OP'NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick RSI
Value .
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb a
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final ^
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28' Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final v t
+'f �,el "js:"..!'; ... r,. .�� - .. .r..� a •,r.s'���.• .....: i;,'�-•c'�- L: ... <�.....a-,7;. 1v -;'!"' i.�*"�, � '... � -. -• ,.. ar•°'�-�..x.. .i, _. .. ,.».. '+l _- s �.
I16
Receipt No. •k. � t'��� � �4 + r Issued By
F
District: Riverside ❑ Indio ❑� 'Hemet ❑ Dater
-DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/84)
FNr
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH-
, PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
'Applicant: Submit this form with three copies of a scaled plot plan drawn to coiunty specifications required on the
'attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside. ,
Name
Mailing Address'
_
..4 7 �,.� c
�', d (5 o
City ',.
State)
Zip Code, r
Phone
. N-tA VC76,
� . �' A L. (F' � , � '
�p v ?, to c
S7'&
,
'Property Address q t'City
5+
or Community., r� !�
62U1(m7a
'Legal Description of ,Property (Lot, Parcel Map, Tract)
Q75` CAI-L6.PAC.pMAj
L til'
%!?� �✓.K-fs•�=*^ [�J ci/l + ,"
`Assessors Parcel No. ' /
4 1' /
Water Serving Property From
�
�r fG.0 �U
Lot size .
11,
i
'
•L.�.�iix, l v 7.f21. fr /�. C//c.�=.
� �'` '
Signature of Applicant •*, m Date
,i '•
e A -The above information must be verified from Building Application ---------------
Staff Use - Do Not Write Below This Line
-� Initial ' Date '
' ' _ .. r. '!tyk �f „ ' //�,�J/% yam• t^ ;
•4WQCB Clearance required' � •'_ Yes ❑ No ❑�
,. ❑ 1 %
•Soils feasibility report required r�• Yes No ❑
Detailed boring report required Yes ❑ No 0
Detailed contour plot required "Yes ❑ No dil
Commrents:
t.♦
Soils or boring report by Date
_ •�
,Approved
by Date
`. �7-,.tet J
Soils Map Page Soil -Type Tract File No. S Other
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
t� e„
Type of System
New Addition • Replacement
�-�
�G��..�;�s-;�`'�i'4
ate° ❑ ❑
Leach line sq. ft. of bottom area a trench G'
Leach bed (sq: ft. of bottom area bed) -
Seepage Pit Diameter
S 6'E
Number of Pits • j
Seepage Pit Depth Bxl.
` -
Total Depth of Pit
, f ,
•d.
d
Location of. System' s
.,._ f (!� t
4
.+''- (/•t:�.trs�!
Additional Requiremen/`.y�
A permit is approved%denied forthe-design of a subsurface disposal system as indicated on the accompanied plot plan -
using the requirements set forth in Section•B above. A building permit is necessary for the installatiori of the above
-designed s�y/rst�e(ym/.fff• /// /j (J/// 1 x/.�`
Al
xy;
• Signature of Health Official 't j �, . •, �"l, Date
+.mac.- - .� r ••�-tya, 3 I
I16
Receipt No. •k. � t'��� � �4 + r Issued By
F
District: Riverside ❑ Indio ❑� 'Hemet ❑ Dater
-DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/84)
FNr
March 18, 1991
To Whom It May Concern:
The structure located at 51-075 Calle Paloma in La Quinta is in a
"AO" depth one foot Flood Zone, according to the F.E.M.A. flood
map, panel numbers 060709 0005 A.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Tom Hartung
Building and Safety Director
f
TH:es
LTRTH001
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
*RZCEIVED
Sue"Im" �ier��rc.
$EP as 15
CIT Y OF !A OUINTA
TESTING-" •`: INSPECTION
1731-A WALTER STREET • VENTLIRA, CALIF0RNIA'93003
PH0NE_(805) 642-6727
August 16, 1985
Joo No. B -15486-P1
85-8-231
Manuel Abarca .
'RECENED
51-505 Ave.:Martinez
La: Quin-ta, CA 92253
SEP 2 6 1985
Project : 51-075 C a.l l e 'P a 1 Om a
OF LA QUINTA
COMMUNI Y DEVELOPMENT DEPT
La Quinta,. CA
Subject: House Pad
Report of Field Densities
on July 25, 1985 a representative ofour-
firm .p.erformed density
tests -on the fill placed on the bu'flding
pad o.n-the above refer-
enced project. Tests were.performed at
random locations in ac-
cordance with :ASTM D'2912-81 and. ASTM D.3017-781
Nu;c-lear Density
Test.:Procedure: Tests. performed as per
autti,orization of Manuel
Abarca.. `
The estimated locatioms_of the:`te.sts are
presented on the attached
plan with their results-being•,summarized
on the attached test re-
port sheet. A .total -p -f two `(2) d-e,tvs4ty
tests w;ere performed.
Test results indicate a minimum of, ninety
p-ercent (90%)* of relative
compaction has.been obtained within the;.a'reas
tested'. The maximum
density -optimum moisture was determined
in•.the laboratory in accor-
dance with AST'M:..D 155,7-78, Method A, five
.(5) layer ;curve.
Classification ; Maximum Density -,Optimum Moisture
Light brown slightly silty
very fine to fine sari -d 1091.3
p c f 13.1%
:VENTURA
LANCASTER;
(80:5j 642.6.727
(805)`948.7,538
THOUSAND OAKS BAKERSFIELD SANTA .BARBA RA
PALM SPRINGS SAN LUIS OBISPO
(805) 495.8484 5),#77'5160 (805) 966-9912;
- (714) 328=9131 (805) 544187
August 16, 1985 Job No. B-15486-P.1
85-8-231
LIMITATIONS
The compaction -operations. were completed at the t me�'our•,per.sonnel were call-ed'
to the site. The :test results summarizedrin;this repor p"resen;t the moisture
and density only at'-.the 166stions and depth tested on: '*he.' "specified date:
.,.
The summarized field.a� hd`laboratory'te'sts were performed in accordance with
engineering g g principles generally accepted attthis time and. location.• No opinion
is expressed as to the.uniformity of .'the material,..compaction nor adequacy
of the material to perform its intended function.$ No guarantee or.warranty of
the contractor's work is made or implied.
Respectfully submitted,
BUENA ENGINEERS, INC. Reviewed.and•'-approved
Norman G. Jackson, 'Jr; Raymon` E. Brannen
C.E.: 28966
NGJ/REB/kls
Copies:
4 Manuel Abarca {
2- City of La Quinta.
2- P.S. file
1- Vta. file
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BUENA-:ENGINEERS;:-INC,. -
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FILE NO.j�=1J 48�-p1