9909-206 (BLCK)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
6291 fiv ' C-29 . 09.130,120!
`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: f,
( ) 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 a exempt funder Section B& ,.C. o this reason,
ate 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..
(� 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.
STATE FUN"'D
I M9.99
(This section need not be completed if the permit valuation is for $100.00 or less).
(3)' 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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,.t shall forthwith comply with thole provisions', l'
Date: -j' 12-`r� Applicant -3-l'
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
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 pr erty;for inspection purposes. f
Signature (Owner/Agent),t•- �`�'� ' �•�-%� Date 1�
BUILDING PERMIT PERMI9909-120
DATE VALUATION '�l1{ }QRS LOT TRACT
JOB SITE
ADDRESS 50-•4993 ORCHARD LANE
PN
1
tii M
OWNER i
CONTRACTOR/DESIGNER/ENGINEER
!t�'�"+/° C -03912S f'R�XG"'t"ir�N LU,
1R1J.C.Ef,TI.AYy OR, MASf3MR Y'
7&365 WGIMAY I I 1
42-200 BEACON HILL, SIT;. A
LA QXIf%IA CA MS�3
'AIA11 DESERT CA 92211 2211
{7WM3. 111:"_ CRU 1246
USE OF PERMIT
GEN R11w, 813i IIDN6
.�.�? L.I.; �° is kvibiN�i�'�R�l� 73d��'�d•>�(�til;1 `1�fs�.i..
G .,FT. En'X L 213,00 L
g� gay •w�.r`+/��r �y�•p��.;�T,�.rg+p /�,�,g
E �l'i�t,��1,EMC 3 X AAF+�--ONi;b Y1i�.00.t'MYL�i.
PERMIT FEE' SSINt��.AR
�.'ti.YI�FS'fd�tsrN'3'J.rs� FEIN, Ufl-d}flt�•/�ltsdH}fi �81.4f3
S:f;J�, ' S' J��, 7.� �_�P,IA•tt?°� 75. ! r! i�Ji'.r J r'II� KAN CHECK
$8 i (in
LESS .FIRE..,t��.Il.r :FEES
s0.i}()
9r 4,Y6"; l', PERMIT FE:7 N 9YRSINi NCs'W
• � } k'f rt
RECEIPT
DATE
BY f
V
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K. to Wrap
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
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
—tea
Main Drain
Bond Beam
�� •—mo ,�°
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final Q/:
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
Waste Lines
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
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)
t
.
'
222
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. DATE
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BUILDING &SAFETY DEPT.A
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SUBJECT.._: /0 RETA1'vmjc WALL PAGE 2 OF 7
PROJFCT_. LOT.: ;4 P, M. 28935 DATE:
MATERIAL SPECIFICATIONS &.GENERAL.NOTES
MATERIALS -
Concrete: f'c = 2500 p.s.i. @ 28 days.
Re -bar per. ASTM A-615 Grade 40
Block Grade A per ASTM C-90
Mortar 1 part cement, 1/4 part lime putty cr hydrated lime.
3 1/2 parts sand per ASTM C-270.
Grout 1 part cement )
3 parts sand ) for 4" & 6" Black
1 part cement )
2 1/2 parts sand ) for 8" & larger Block
2 parts pea gravel)
Grout shall be of fluid consistency.
Cement Portland Cement per ASTM C-150
GENERAL NOTES
-------------
1. Solid grout all cells in retaining portion and all cells
containing steel.
2. All footings shall be poured on undisturbed natural ground or on
undisturbed engineered compacted fill.
3. Wall shall be laid true & plumb.
4. Provisions shall be made for adjoining construction.
5. All splices shall be 48 bar diameters.
SUBJECT
/O
PAGE .3 OF 7
PROJECT._
Lor 4, P�" • 28935
DATE 5,- 29 - 99
5'TiM
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SUBJECT.__ /O' RflAbyhVG WALL
PAGE 4 OF 7
PROJECT__=___.LO.T._._¢._.__._.P..M• ..28935.
._DATE 5-28-99
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PAGE 5 OF 7
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SUB,TEC�-.....5 4" REtA/NTNG WALL W1 �Y SURCHARGE PAGE Z OF 4
LUT Fr - DATE
PROJFCT Lor 5 : PM: 28933
-
MATERIAL -SPECIFICATIONS -&- GENERAL _NOTES
MATERIALS
Concrete: f'c = 2500 p.s.i. @ 28 days
Re -bar per ASTM A-6.15 Grade 40
Block - Grade A per ASTM C-90
Mortar 1 part cement, 1/4 part lime putty o- hydrated lime.
3 1/2 parts sand per ASTM C-270.
Grout 1 part. cement ) for 4" & 6" Blo=k
3 parts,sand )
1 part cement )
2 1/2 parts sand ) for 8" & larger Block
2 parts pea gravel)
Grout shall be of fluid consistency..
Cement- Portland Cement per ASTM C-150
GENERAL NOTES
-------------
1 Solid grout all cells in retaining portion and F-11. cells
containing steel.
2. All footings shall be poured on undisturbed natural ground or on
undisturbed engineered compacted fill.
3. Wall shall.,be laid true & plumb.
4. Provisions shall be made for adjoining construction.
5.'All splices shall be 48 bar diameters.
SUB,IECT__..S�.4 ,BETA/�//NG GVALL w/rH 3 jgC, ,4,eae PAGE 3 OF 4
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'$ s With proper validation
this form constitut
es an CITY OF LA QUINTA
.'" encroachment permit is y .4. %q, . .
APPLICATION FOR PERMIT- ;
PUBLIC WORKS CONSTRUCTION (ENCROACFMENT)
� s
t. �4er
S
For the -construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Imp. ovement Permit — Class II I
DATE:_ March 25, 1999 Minor IraprovementRermit Class IV
LOCATION OF CONSTRUCTION Parcel Map 28935 — The Estancias
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Re—grade lots Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Rough grading
SEE ATTACHED CONDITIONS.
DIMENSION OF INSTALLATION OR REMOVAL See plans. SEE APP30VED PLANS.
NOTE: ;OTS 3 AND 4 ARE NOT
SIZE OF EXCAVATION, IF NEEDED Import approx. kPPROVED FOR GRADING
15,000 c.y. AND WILL BE BY SEPARATE
APPROXIMATE TIME WHEN WORK WILL BEGIN April 1. 1999 ?ERMIT.
APPROXIMATE TIME OF COMPLETION May IL 1999
ESTIMATED CONSTRUCTION COSTS 93,380.00
.(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City,.its authorized agents, officers, representatives and employes, harmless -from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any acciden,:, loss or damage to persons or property
happening or occurring as a proxigiate result "of any work undertaken under the permit granted pursuant to this *application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the,time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for.any additional replacement necessary as thp-result oLthis work. _ n
igna re of Applicant or 4gent
.TPW Conctr t tion 78-365 Highway 111 (1309 La Qui'tta CA
Name of Applicant (please print) Business Address Telephone No.
-Nttpvo Engineering- 79-811 Country Club Dr. Bermuda Dunes, CA -
Name of Contractor and Job Foreman Business Address Telephone No.
438834 157
Contractor's License No. City Business License No,
Ameriyan State Insurance 01—CE-400185-1
Applicant's Insurance Company ' Pol cy Number
FEES: Subdivision Improvement Permit — Class I II
Public improvements: 3% of estimated construction costs
-Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
2925 1
i
Inspection Fee $ 2.801.40
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PERMIT VALIDATION
5 ,
Permit Fee 100.00
PERMIT NO. 79 5
gXgg y As—built Deposit 1,000.00
DATE APPROVED 3/25/99
.Znmw Plan Check Credit (750,00)
•3/25/00
EXPIRATION DATE
TOTAL: $_ 3,151.40
Z
DATE ISSUED' /�
Receipt No.
By
Received by Date
Administrative
Authority
Recorded by
Telephone: (619; 777-7075
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AMENDMENT #1
ENCROACHMENT PERMIT,#2925 '
This permit amendment removes the grading restriction imposed by the original permit
regarding lots 3 and 4 due to design revisions that were riot yet complete at the time of
permit issuance. The revisions are now complete -and approved.for construction.
The original fee calculated for this permit was based on-performing`all of the work
shown on the grading plan, therefore, noladditional fee amount is needed for the work
authorized by this. amendment.
INSPECTION RECORD
f
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
— . ,oU
Main Drain
Bond Beam
j
Approval to Cover
Equipment Location
Underground Electric
Final
_
_ _ �p
Underground Plbg. Test
Gas Piping
PLUMBINGf APPROVALSGas
Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
I Pool Cover
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fb(tures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power