9604-017 (SFD)LICENSED CONTRACTOR DECLARATION ,. BU����IVG PERMIT
�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 DATE 4f •!roG VALUATION ',tqG.631) LOT
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
JOB SITE
V31 ADDRESS 53 -lin, AV0411)A jV;V1RFZ
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:
( ) 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 � sued' M.ylf workers' compensation insurance car. ie &policy no. are:
Policy No.
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
,,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 property for inspection purposes.
R
Signature (Owner/Agent) Date
P.O. BOX 389
.t,A QUINTA. CA 922:5;3.
(619).'5€�c 4604
USE OF PERMIT
PERMIT#
9(04-0117
APN
CONTROL#
TRACT43 3064
CONTRACTOyyR++/ DESIGNER / rENGINEER
j { q
77936 ,ALS ENWA IVIUN`,I'liMN A. i'1
i A, QU19111. CA. 922:53
(619)564-4604 . CBY 0 2261
S.01i, .Ponnxt dom ncA ijidude 140x1, watt,; E+tr gc►A
PORGIVPA110 49,00 W,
TRACT CtWX.MUCTION 1, 37:+.00 Sr
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fit: C"112t a1 'r ;F
101-4 0-4204)(9)
$129.34
sa)ai..'IMMIN01. E
$.140,75
MU111 i1i r, ER, Rills iJ
101_00024.1_m
$,9.6£
¢N'C'R&TrRlilw`7W1,t�"#sRi
215 -11tH) -443-34
V, 955,51
r'.32R-CISL PLAN'
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SUB -TOTAL CONS"MUCtION AND MAN CHECK
ESS
TOTAL VE301ff VE0.*.VUE NOW
ECEIPT i. -y DAT,E BY DATE FINALED
INSPECTOR
,
96.634.00
$3442.25
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
//
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
/f,
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1$
Drywall - Int. Lath
/
Final '
Final
/o
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Mg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
11,111116
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:
I
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 AZ-5w(�
V/
Utility Notice (Perm) I I f
Notice:
Document Cannot Be Duplicated
Date 4/4/96
No. 14312
Owner Name Esequiel Coronel
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
No. 53-225 Street Avenida Juarez
Cit, La Quinta
Tract # Lot #
Type of Development Single Family Residence
. Comments
Jurisdiction
APN # 774-032-017
La Quinta
Permit #
Log #
zip 92253 Study Area 111
Square Footage 1573
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports,
covered patios/walkways, residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. `It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 x 1,573 or $ 2,705.56
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Coronel Construction Telepl�b ne '`S 64-4604
Name on the check ' "r, ;; = ✓
By Dolores A. Ballesteros r.
Superintendent
Fee collected /exempted by Pauline Pearson Refund $2,705.56
Check No. 1139
Signature
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
JAMES O. WALLACE
Agriculhaal Commissioner
Director of Welghts & Measures
OFFICE OF THE
AGRICULTURAL COMMISSIONER
P.O. BOX 1089
RIVERSIDE CA 92502-1089
PHONE (909) 2753000
FAX (909) 2753012
83-612 Avenue 45 Suite 7
Indio, CA 92201
(619)863-8291
CALVIN C. KAMINSKAS
Aulstont Coffvnlssioner
DAN RILEY
Sealer, Weights & Meosurm
(909) 27630.'!0
FAX (909) 276-4728
DATE Z - l 5 — 9G CASE NO. P (f w S o 2 -
DEVELOPER'S
DEVELOPER'S NAME: (� c.s►,,o 1.
'ADDRESS: S / _15'Y
r TELEPHONE : 6/ 9- 5;--6 y -y90
y
Dear Developer:
After reviewing" your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be
notified imwediately.
Thank'you .for protecting and preserving the Coachella Valley's pest -free
environment.
Agricultural CommissioneoP4.s Office
ccrv.,Indio and Riverside
J
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of
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ftft� of 14a(Quinta
�itil?�in� rznd �'�fe#fir �i�i�iDn
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was 'in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 53-225 Avenida Juarez
Use Classification Single Family. Dwelling Bldg. Permit No. 9604-017
Group R-3 Type Construction VN Firs Zone Use Zone R-3
owner of Building Fsequiel Coronel seeress P.O. Box 389
La Quinta, CA., 92253 Daniel P. Crawford Jr.
By$
Date: June 7, 1996
Building Official
►a!T 10 A 001119?IE000! PIACt
Environmental
Geotechnical
Construction
Consulting • Engineering • Testing
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: ZEKE PROJECT: 53225 AVENIDA JUAREZ
CORONEL CONSTRUCTION LA QUINTA
P.O. BOX 1238
LA QUINTA, CA 92253
,. DATE: April ,01, 1996 OUR REPORT NO.: 073-60049-2
TEST DATA: (1) Silty Sand OPT. MOIST. = 9.0%,.
TEST
NO.
TEST
DEPTH
-ELEVATION
SOIL ID
NUMBER
MAXIMUM
LAB DRY it
DENSITY
WATER
CONTENT
WET
DENSITY
DRY
DENSITY
PERCENT
COMPACTION
COMMENTS'
Spec. 90% Mil
1
811
F. G. *
1
128.0
9.2
133.7
122.4
95.6
1 - A
2
811
F. G. *
1
128.0
7.8
133.0
123.4
96.4
1 - A
3
811
F. G. *
1
128.0
8.2
132.0
122.0
95.3
1 - A
4
811
F. G. *
1
128.0
7.9
134.2
124.4
97.2
1 - A
TEST LOCATION: Pad
1
North east
2
South east
3
South west
4
Center
NOTES: TESTS PERFORMED PER ASTM D2922-91 & ASTM D3017-88(93) 'COMMENTS: 1. FILL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATION
DENSITIES SHOWN: Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY
WATER CONTENT: Percent of dry weight3. BASE COURSE WITH SPECIFICATIONS
PERCENT COMPACTION: Based on maximum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST
density obtained on sample indicated by 5. SOIL CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS
soil ID number. 6. OTHER E. MOISTURE BELOW SPECIFICATIONS
* (1) ASTM D-1557, Procedure B
TEST INSTRUMENT: Campbell, MC -1, M17061912 STANDARD COUNT M: D:
REMARKS: PSI DID NOT MONITOR THE FILL PLACEMENT. ADJUSTMENTDATA M: 00 D: 00
**F.G. = Finish grade**
Respectfully submitted,
TECHNICIAN: Marshal Hislop Professional Service Industries, In,
THESE TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS.
REPORTS MAY NOT BE REPRODUCED, EXCEPT IN FULL, WITHOUT WRITTEN PERMISSION BY PROFESSIONAL SERVICE INDUSTRIES, INC.
1.nf yr inection To Build On
PSI A•100•I (3)F PSI •42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 619/341-5790 • Fax 619/341-5794