0622 (SFD)LICENSED CONTRACTORS, DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class - Lic. Number
Date Contractor,
PERMIT APPLICATION
City of La Ouinta
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 it
ON: I hereby affirm that I- am licensed under provisions of Chapter 9' the permit is for one hundred.($100) o. less. I certify that in the performance of the work for which this permit is
s
ion 3 of the Business and Professions Code, and -my license is in.full forces issued, Ishall not employany person in any mannerso asto become subject to the Workers' Compensation Laws of
California.
OWNER -BUILDER DECLARATION:' I hereby affirm that I am exempt from the Contractor's License 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 filea signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 o f the.Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any. violation of Section 7031.5 by any applicant for a permit. , .. .
subjectslhe applicant to a civil penalty of not more than five hundred dollars ($500:):
0 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 does not apply to an owner of property -who builds, of 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
buildingo mprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that .
he di not build or improve for the. purpose of sale.).
0.1. 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 -
Coniractor's,License Law.).
0 1 am a empt;urnder Sec .'> B. 8 P.C.'(Attached Certificate).
,. Date /t Owner' '
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
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department
Date Applicant
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OWNER NAME (L. F. MI)
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USE OF PERMIT
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END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to.the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or9his permit shall
be deemed revoked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or more feet in depth idto 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. (Chap 3.2, Grp`•.2 Art 2, Sec 341, Title 8,
r C.A.C.)
0 A 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.
0 Division of Industrial Safety.Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 4hereby 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
certify that I have,read 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 and.statethat ..
the information given is correct. I 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 Ahe=property (or which I hale applied for this permit far the purpose f aking, inspections: e t- '
�L! I'K 1. r-.1 •h • �" 7 f 1 . G
Signature of Applicant or Agent ! • Date
Print Applicant/Agent Name
_ VALUATION +`t �� t�
BLDG. DEPT,.
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.
❑
NPON
ADDITIONAL INFORMATION
111
-74)
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts) S''lATE
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
yzz LIZ Z-71#-
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
y
PSL %j' PSI
"1
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000
STREET NAME `►��" `
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring -7////
29A Grounding Wire /7.
29B Bonding
30 Fixturest
31 Service
32 Final
�loEnginenrs,inc.
• N3rW- i wn ,
1731-A WALTER STREET 9 VENTURA, CALIFORNIA 93003 PHONE (805) 642-6727
May 15, 1984
Bob McCallum
P.O. Box 457
La Quinta, CA 92253
Subject: 52-520 Ave. Juarez-Krepelin Property
La Quinta, CA
Compaction Report
Gentlemen:
84-5-173
Job No. B -14252 -P1
On April 6, 1984 a representative of our firm performed density tests on the fill
placed in the building area on the above referenced project. Tests were performed at
random locations in accordance with ASTM 2922-78 and ASTM 3017-78 Nuclear Density
Test Procedure. Tests performed as per authorization of Bob McCallum.
The estimated locations of the tests are presented on the attached plan with their
results being summarized on the attached test report sheet. A total of two (2) density
tests were performed. Test results indicate that a minimum of ninety percent (90%) of
relative compaction has been obtained within the areas tested. The maximum density -
optimum moisture was determined in the laboratory in accordance with ASTM D 1557-78,
Method A, five (5) layer curve.
Classification
Medium brown silty fine. to medium
sand
Maximum Density -Optimum Moisture
108.5 11.0
VENTURA LANCASTER
(80 5) 642.6727 (805) 948.7538
THOUSAND OAKS BAKERSFIELD SANTA BARBARA PALM SPRINGS
(805) 495-8484 (805) 327.5150 (805) 966.9912 (714) 328.9131
SAN LUIS OBISPO
(805) 544.6187
May 15, 1.984
LIMITATIONS
84-5-173
Job No. B -14252-P1
The backfilling and compacting• operations were completed at the time our personnel
were called to the site. I The test results summarized in this report represent the moisture
and density only at the location and depth tested on the specified date. The summarized
field and laboratory tests were performed in accordance with engineering principles gener-
ally accepted at this time and location. No opinion is expressed as. to the uniformity of the
material, compaction nor the adequacy of the material to perform its intended function.
No guarantee or warranty of .the contractors work is made or implied.
Respectfully submitted,
BUENA ENGINEERS, INC.
9V -CIL
Norman G. Jackson, Jr.
NGJ/NGH/pj j;
Copies: 4 - Bob McCallum
2 - City of La Quinta
2 P. S. FiLe
1 - Vta. File
Reviewed and Approved
Norman G. Hallin
C. E. 7370
L,-��-M7
Engineers,lnc.
CONTRACTOR:
ADDRESS:
REPORT OF RELATIVE COMPACTIONS
Job No. B -14252 -Pl
DATE: May 15, 1984 Report No. 84-5-173
JOB $ L-OCATION: 52-520 Ave. Juarez -Krepe Lin property,
WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH
COPIES:
BUENA ENGINEERS, INC.
t
TEST NO.
DATE
TESTED
DESCRIPTION
%MOISTURY
E
DR DENSITY
RELATIVE
MAXIMUM
IN PLACE
IN PLACE
COMPACTION
DENSITY
1
4/6/84
1.0 from grade
15.0
99.7
92
108.5
2
4/6/84
: finish grade
16.0
106.2
98
108.5
WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH
COPIES:
BUENA ENGINEERS, INC.
0
0
vC Ju)9 !i E z
'T /i c --
BUENA
BUENA ENGINEERS, INC.
DATE: 6-:g.LOW FILE NO.(; -1 y t,pl