0208-218 (SFD)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. ClassExp. Date
17
^
Date �� •�� Signature of Contractor �
41Y�� � ...•JJJ� //
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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
Date 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 0T,4,T1,pLjNI3 . Policy No. 044 000202r/
t
(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 sOUtd become
subject to the workers' compensation*prroFvisions of Section 3700 of the Labor
Code,,.l shall forthwith comply with hose' p,!.ovisions.
Date A2 -4N k Applicant r'�r.sr �� ••_
Warning: Failure to secure Workers' Compensation co erage 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. s
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 presentatives16F t is"City to enter upon
the above-mentioned property f6r inspection, purposes.
Signature (Owner/Agent) / dam Date oLl _ems
`BUILDING PERMIT PERM T#
'�
DATE VALUATION $qyy ry/�ry �qy� LOT TRACT ��� q
�'�•�.Y •'-�f.:3L S1 5 $ 34M17y'' 0 I.�a.1.J.[�. 167
JOB SITE
ADDRESS rA.�sMA,sJd'�c^.fir
APN
�iroh
OWNER
CONTRACTOR / DESIGNER / EN &NEER
All, .A,,'i1 MC IT C3Cs?VS9 BI'J.eD�' 41 WC
ALL "M 190,
: `11 J�t�7Y�DA d�,�,'�'• .3Ia' �
'I W- 93 ar?i�.�?i��`�fI�7•�.A AVENUE.
•�'y7.•15-Ln�.��p��.5�gf �w A 1• ,' f
R`.i•Al,. M .Lr'E �. CA 9221 E
e9 y
.C'�.F*Lsa��1. ,1.�,Ce� E.[C.1 cwJ'.�. -)22 d 1
C16 200-0277 C"Blit 3714
USE OF�yPERMIT
y�
1790 SX, SPT MMIT ).?S;WS'a+ NOT 1'4CLUt��, BLOCK a IAL), POOL, sort
W33•Wr WAY l'aPiPROACH,
TRACT CONSTRUCTION
Ct..Fik"AGWYi':AU. ORT ' 4:M.00 SY
En -MMD COST VIP CoArmuc-flov,
lo' -s.70,4.0
C`-OMTRUCITION rPPZ 101 .000- i T"Aw, S660115 i
PLAN CHT -AX M' E OOJ49.13
FRE DEPOSSIT 101*000-439-318 -$2s0.00
un" aU re�a Yep�t-�x
MIMTRICA1,11M 101-000-420-000
FTIUAitR.FNCT 101-000419-000 $128.13
STl'tQMMOT3.ON PF9 . USID 101- G00049, -000 $10.37
ISE` K4FER IMPACT r"la 'AA $440.0.0
1 PRET SE PLAIT 1,_0t °000-.44.14345 $100,00
S1J�?a-TO°M Ct1N4RtJC"tIO)fAND PLAN C.Fl +`1C.
t"b'4,047.80
Y"S PRE -PAID FTTS
42150100
?
- T 2 91001
rcff
YOFLAQUINTA
EIAIA CP OF:
RECEIPI
7,; ."� ! y �'�,ar. Vic" �-(
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDINGY
APPROVALS
MECHANICAL APPROVALS
Set Backs
C1
Underground Ducts
Forms & Footings
Ducts -
Slab GradeReturnAir
Steel
-
Combustion Air
Roof Deck
3 • o
Exhaust Fans
O.K. to Wrap'
p
F.A.U.
Framing
i��, D
Compressor
Insulation
�/ O
' 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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
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
Z
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)
DEC 05 '02 13:22 FR
AWv-JFAF1,IInformationr,,.,V60& ;
On
Engineering - Consufflng - Testing
TO 9-7777011 P.02/03
• REPORT OF FIELD COMPACTION TESTS
TESTED FOR: MARK TUVELL PROJECT: 52523 AVENIDA JUAREZ
42-335 WASHINGTON STREET LA QUINTA, CA
BOX F418
PALM DESERT, CA 92211
W
DATE; November 22, 2002 OUR REPORT NC..: 073-203X9-2
TEST DATA: (1) medium grained silty sand. OPT. MOXST.
MAXIMUM COMMENTS'
TEST TEST SOIL 10 LAB DRY WAYIE R WI.T DRY PERCENT Spec 90%, Min
NO. DEPTH ELEVATION NUMBER DENSITY CONTENY DENS ITY DENSIly COMPACTION
1 8 FG 1 113-0 8.3 111.8 106.0 93.8 1 A
.811 FG, 1 113.0 10.1 112,2 10119 90.2 1 A
3 sit FG 1 113.0 10.5 113.7 102.9 91-1 1 1 A
4 8" Fa 1 113.0 10.3 114.1 103.4- '91.5 1 A
. ............. ...
TEST LOCATION: Building pad.
West side
South side
3 East side
4 North side
NOTES.- TESTS P . ERFORMED PER ASTM D2922-96 & ASTM D3017-98 *COMMENTS: 1. FILL MATERIAL A TEST R LTS COMPLY WITH SPECIFICATIONS
2. RAGKrI B. R TION DOES NOT COMPLY
DENSITIES SHOWN: Lbs. per cubic foot �' MPA,�
WATER CONTENT: Percent of dW weight 3. BASE C�IJFSE � IWAT ON$
PERCENT COMPACTION: Base on maximum dry 4, SUBBASE C. RETEST OF PREMOUS Ey
D. r ECIFICATIONS
:C
density obtained on sample indicated by 5. OIL CEME 4T
soil ICF number. 6. OTHER CATIONS
(1) ASTM D1557-00 METHOD A
TEST INSTRUMENT; STANDARD COUNT M: D:
REMARKS, PSI did not monitor the material placement. ADJUSTME14T DATA M: D:
Respectfully submitted,
TECHNICIAN-' Vinnie De Souza Professional Service Industries, Inc.
THESE YCCT AF-2ULTV APPLY ONLY TO TWE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELVATIONK
REPORTS MAY NOT Be REPRODUCED. eACEPT IN FULL, WIT14OUT WRITTEN PERNSSIO14 BY PROFESSIONAL SERVICE INDUSTRIES. INC.
Professional Service Industries, Inc. - 42-240 Green Way, Suite C - Palm Desert, CA 922'1 - Phone 760/.341-5790. Fax 7601341-5794
031 A-1 00,2 (4)F
DEC 05 '02 13:22 FR TO 9-7777011 P.03iO3
A PC A i Infojmation
1x71 eT-Bui& On
Engineering • CoesuJdng • Testing
REPORT OF FIELD COMPACTION TESTS
TESTED FOR:
MARK TUVELL
2
PROJECT:
52-495 AVENIDA JUAREZ
East side
42-335 WASHINGTON STREET
North side ••
LA QUINTA, CA
BOX F418
PALM DESERT, CA 92211
DATE:
November 22, 2002
OURREPORTNO.:073-20318-2
TEST DATA:
(1) Medium grained -silty sand. OPT.
MOIST.
= 12.0*
TEST
MAXIMUM
LAS DRY t
WATER
W 1T
DAY
PERCENT
COMMENTS'
Spec - 90% Min
TEST
SOIL10
NO.
DEPTH
ELEVATION
NUMBER
DENSITY
CONTENT
DEN UTY
DENSLtY
COMPACTION
1
811
FG
1
7.15.0
10.3
115.5
104.7
91.0
1 - A
2
.871
FG
1
115.0
12.7
119.2
105.8
92.0
1 - A
3
8"
FG
1
115.0
3.5
113.4
109.6
95.3
1 - A
4
8')
FC
1
115.0
3.7
1C7.5
103.7
90.2
1.- A
TEST LOCATION: Building pad.
I
West side
2
South side
3
East side
4
North side ••
NOTES' TESTS PERFORMED PER ASTM 02922.96 & ASTM D3017-96 *COMMENTS: 1, FILL MATEI UAL A TEST ER�gLICLTS COMPLY iMTH SP IFICATIONS
W TER CONTEN per cubic welght3. 9AASE CLISE a PWIiFCi 5 ECIOFICATIONS DOES N07 COMPLY
PERCEN VlOUS TEST
oC�Mub tn�Y 0 o: Basesample onmaximum
dry
6, S#htREMENT 0 MOI UR F EL FIRC PECF SPEC( S SONS
* (1) ASTM D1557-00 METHOD A O
E.TEST INSTRUMENT: STANDARD COUNT M: D'
REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: 0:
Respectfully submitted,
TECHNICIAN: Vinnie De Souza, Professional Service Industries, Inc.
THESE TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATION i OR ELEVATION >.
REPORTS MAV NOT N REPRODUCED, EXCEPT IN FULL. W)THOUT WRITTEN PERMISSION BY PROFESSIONAL SERVICE INOLISTRIES, INC.
** TOTAL PAGE.03 **
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
March 11, 2003
RW'90407E
Mr. Dave Fisher
1s' Bank
Re: Mark Tuvell - Address Corrections
Dear Mr. Fisher:
(760) 777-7000 '
FAX (760) 777-7101
Please be advised of the following address corrections per the above request:
NEW ADDRESS
C5-2`523 Ave. Juarez
5-2=519 Ave. Juarez
48-670 Ave. Fernando
OLD ADDRESS
52-515 Ave. Juarez
52-495 Ave. Juarez
48-770 Ave. Fernando
If you have any questions, please contact me at 777-7015.
Thank you.
Sin a ely,
Greg But r
Building & Safety Manager