0109-046 (PLBG)H
(V LU
W
�a�
W
OZt�
co O o
H
IW— CL
Z
c?)
N
ON
U <
—
o�Z
��O
X W W —
mUU
O
rn H
`t Z_
ob ::)
r CY
J
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 Businems'and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
i
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). f"9
O I am exempt nder Section B&P.C. for this,•.reason r9
Date // X� i Sianature of Owner ":x'1..1
RKER'S COMPENSA
I hereby affirm under penalty of perjury one of the following..declarations:
() I have and will maintain a certificate of consent to selAi'risure 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
'(v) I certify that in the performance of the work for which this permit is issued,
IP'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 provisionsof Sectio 00 of the Labor
Code, I Rh
y111,forohwith comply with those; pr9v Bins. o,..
Warning: Failure to secure Workers' Compensat?or""vcoverage is unlawful and
shall subject an employer to criminal penalti-WA ' civil,fines up to $100,000, in
addition to the cost of compensation, damages as•pr'ovided 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 s
application.
1. Each person upon whose behalf this application is made & each person of
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,inspecti ri purposes.AA
•'
Signature (Owner/Age t %¢' Date `� �'� %l .•
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT �.3 feyLe TRACT
xtlSw�Ftftu maxi V
JOB SITE
APN
ADDRESS
53-14R AVFWf DA DIAZ
OWNER
CONTRACTOR/DESIGNER/ENGINEER
5.214 6AVETTIDA DIAZ
LA QUIrWrA CA 92253
() C`;f of
USE OF PERMIT
A14MMC
j .
%&gIC TIJX NINM n,4TiWER. HOOK-UP
VALUAVON UK Do I's
PETAOT FRI.' t;r'`Ir.UM ARY
1'lA Ali%f O FEE • 59WER 101•000 -419 -WO
9i?B-,�''�37"YU. CO3+TW.RT Crf 100 1'iM PILM {:.HEC'Ti,.
$30.00
e 0 .iS
$0.00SEP
D
yt.,;�.�7B }jyk{':i.���(•T.aIM.)
062001
CITY OF LA QUINTA
FINANCE DEPT.
a
RECEIPT
DATE J
f ./ ti
: BY
DATE FINALED
INSPECTOR
7 1�,, / a�
:
r.
{i
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
1
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
-•f=ootings
Main Drain
Bond Beam
Approval to Cover
Equipment Location -
Underground Electric t
Underground Plbg. 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
Sewer Connection
/_
�<� r
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
Final — C�
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
,Rough Wiring
LoW Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I:
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX (760) 77,7-7011
l OWNER'S SIGNATUR��
5-3-/v 9 6oc_ V:rZ
PROPERTY ADDRESS
0/0�-
PERMIT NUMBER(s)
I a
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: k
Address: i'i vL o'
Account No. ( Lot(,)
Service Address I +A, X;
• Meter(s)
• Service(s)
• Backflow(s)
• House Laterals)
• Detector Check(s)
• Meter Surcharge
b --sanitation Capacity Charge
• W.S.B.F.C.
• Temporary Construction Meter
• Turn on Charge
0 Uncollected Account - Name
• Inspection Fee - Tract -
Fee -
• Plan Check Fees Water I Sewer -
Tract -
0 Bond Payment _A.D. -_Bond
• Customer Deposit
• Other
lln, nompqfl
TOTAL
Remarks: i.'
0 COPY to:
Cash......
1.,;:'if
Check
Money
Order
Water Service
z
Cashier
GVW D - 438 (11189)
TEAGUt #*1 ASSOCIATES
45 -848 -Queen Palm Lane
Indio, CA 92201
(760) 342-3383
(760) 342-4456 - Fax
Sold To
Michael Velasauez
53148 Avem a Diaz .
lLa Quinta, CA 92253
. ( -t
Date
9/12/2001
Re �P
Tele No. I
Check No.
Payment Method
Project
Cash
Description
- Qty
Rate
Amount
Pumping service - Pumped 1,000 gallon septic tank located at
250.00
250.00
,53-14$ Avenida Diaz, La Quinta, CA
2-1q
M
Total $250.00
LEIGHTON and ASSOCIATES
' ^ INCORPORATED
VA42SOIL ENGINEERING GEOLOGY GEOPHYSICS
TO:
ATTENTION:
SUBJECT:
GROUND WATER
April 6, 1987
Glover Construction
73-925 Highway 111
Palm Desert, California 92260
Mr. Dick Glover
HAZARDOUS WASTES
Project No. 5870152-02
s-3- /yY ,0 1.4 2 -
Report of Compaction Tests (2), Single Family Residences,
Lots 17 and 18, Avenida Diaz, La Quinta, California
As per your authorization, we have performed four compaction tests on each lot.
The test results and approximate test locations are detailed in the attached
sheets (Plates 1 and 2). The maximum density and optimum moisture was determined
as per ASTM D1557-78. The field density tests were performed in accordance
with Nuclear Gauge method, ASTM D2922-78.
The scope of the work was to perform compaction tests only and not soil
engineering.
Should you have any questions regarding this report, please contact us.
Respectfully submitted,
LEIGHTON AND ASSOCIATES, INC.
Q �� 17.
Paul
Hoe i Kenneth T. Klebba, RCE 37631
Super is Tec ni ian Chief Engineer � Q r3vESS
r�
PH/KK/mu
0
Distribution: (3) Addressee KLA
LQ
Attachments: Plate 1, Compaction Test Summary
Plate 2, Sketch �w t-? 9-30-86
— i
2 Work Authorization Forms
74-240 HIGHWAY 111, PALM DESERT, CALIFORNIA 92260 \\���
(619) 568-0993
IRVINE • WESTLAKE/VENTURA • DIAMOND BAR/WALNUT • SAN BERNARDINO/RIVERSIDE • SAN DIEGO
PALM DESERT 0 SANTA CLARITA/VALENCIA 0 CARLSBAD 0 TEMECULA/RANCHO CALIFORNIA
DAILY
FIELD REPORT
No:
,loD Name:
Project No.: c,%1 o\5 2 -02
Date: 4. 4
8
Location: AV �� A\PAZ.
Weather:
Day: S o��
Contractor:
Foreman:
Field Technician: P N
Miles :
Hours:
Equipment Working:
Inspection / Testing of.
fZ) IRv5%Lo\14G PIND S
Test
No.
Test
Location
Elevation
or Depth
Soil
Type
Optimum
Moisture
Field
Moisture
Maximum
Density
to�.o
Field
Density
too 5
Rel.
Comp.
°14
Loi 1# 11
F•G-1`t
A
t5.0
20.0
2
N
I13
10-5
5.9
124.5
122.5
9Ln$
3
(^
A
15.0
20.5
101.0
95.9
9 0
4
N
20-0
96.1
90
5
L o Z11' 18
10 (0.1
9`)
6
y
21.3
97.9
91
13.3
981
92
5
18 9
101
95
Summary of
Operations: F G.
SO\L QoU"I F%NE
\NVri S\Ll SKNU GRA.
L K 3oRN1oR `X\t'x\MUm 4R..
pFNS\i� l07 •O •C.'E•
15.0'. t�
SO I L
\V1 IE 0 S v.\-10 w 0Rv\k3 E LA+zt
w
Lt\8tRV\Ab2- cAN otz
ocNSC•V 1% 5• %\% s R�
Supervisor:
Engine r:
Geologist:
Todays Yardage:
Yardage to Date:
e LEIGHTON and ASSOCIATES
17975 Sky Park Circle, Suite E, Irvine, California 92714 Tel: (714) 556-1421 556-1422
100A (4.77)
OrrP
A o
� m
R,y�O
tri • O Z
n P
U)
O .V
' rn n
-0 r -4
0
L"
ao
0
al
N
0
1a
I
N
.
.
r
0
03
J
Ln
r
0
w
00 .
1a
I