0836 (GRD)I
k 'LICENSED CONTRACTORS, DECLARATI
ip `(commencing with Section 7000) of Divi
and effect.
License Class '' Lic. Number � i
Date Contractor
.OWNER-BUILDER'DECLARATION: I hereby affirm that 1 am exempt from the Co ntractor's.License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any c-ty or county which requires a permit to
construct. alter, improve, demolish, or repair.any structure, prior to its issuance, also requires the applicant for '
j such permit to file.a 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.of•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
subjects the 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, or 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
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving -that
he did not build or improve for the purpose of sale.). -
0' I, as owner of the property, am exculsively contracting with.licensed contractors to construct the project (Sec::,.
l 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
Contractor's License Law.).
0 1 am exempt under Sec. B. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 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
PERMIT APPLICATION
City of La Duinta
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 if
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
sion Sof the Business and Professions Code, and my license is in full force issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of
California.
APPLICANT -NAME (L, F. MI)
ADDRESS - - -
710
CITY/COMMUNITY/STATE/ZIP
SPACE ®�/� •'
JOB SRFIfS/S
6v— 3
Y/COOMM UNITTYYi/S
CTATE/ZI P
Box
7
PAG ;PRC
33 0/?
C
-
TWN
RNG'
SE
S
TRACT
LOT
6
r. TOTAL " • `
FEE • `
�' �' Ga
�� '
MOD
SB
TRACT NAME ..
OWNER NAME (L F, MI( ,
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE •
LICNC •
'
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
PHONE •
LICNC •
-
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
RSB
OFC
• ZONE ORD,•
LOT SZ
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, yDu must forthwith comply with such provisions or this permit shall:
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0[hereby cbrtifythat noexcavationlive (5)ormore feetindepth into which aperson isrequired todescend, will be +
made in connection with work'authorized by this permit, and that no building structure, scaffolding, falsework, or
edemolition dr dismantling' thereof, will be more than.thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341. Title8,.4*
C.A.C.)'
0 As owner-builder'JI 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 Qivision of Industrial SafetyPermit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby 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
I 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 f have read this application and state that
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 Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPWRMT
�F�C �4G.o�ov�/j ��• � �(/
• 7
LLJ
r. TOTAL " • `
FEE • `
�' �' Ga
�� '
VALUATION XS (J!%.Pe
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.
❑
NPO.N
ADDITIONAL INFORMATION
SEWAGE SYSTEM'SIZE.& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 *Finish Grade
INSULATION Thick R"
Value .
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents-
ents19
19Sewage 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
P/L P/L'
STREET NAME'
26 Power Pole
27 Conduit
28 Service Entrance '
29 Wiring .
29A Grounding Wire
29B. Bonding
30 Fixtures
31 -Service
32 Final
Bum Enoineers,lnc.
RECEIVED
MAR 311986
CITY OF
LE
UINTA
COMMUNITY DEVELWPMENT DEPT
1731-A WALTER STREET • VENTURA, CALIFORNIA 93003 •
March 20, 1986
Ron Piekaar
54-385 Diaz
La Quinta, CA 92253
Project: 52-360 Ave. Diaz
La Quinta, CA
Subject: Report of Field Densities
House Pads
PHONE (805) 642-6727
B -16117-P1
86-3-290
On February 25, 1986 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 D 2922-81 and ASTM D 3017-78 Nuclear Density Test Procedure.
Tests were performed as per authorization of Bob Cullen.
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%) relative compaction
has been obtained within the areas tested. The maximum density -
optimum moisture were determined in the laboratory in accordance with
ASTM D 1557-78, Method A or C. Test results are as follows:
Soil Description USCS Maximum Density -Optimum Moisture
Medium brown slightly
silty medium to coase
sand SP 129.0 pcf 8.9%
VENTURA
(805) 642.6727
LANCASTER
(805) 948-7538
BAKERSFIELD SANTA BARBARA PALM SPRINGS SAN LUIS OBISPO
(805) 327.5150 (805) 966-9912 (619) 328.9131 (805) 544.6187
March 20, 1986 -2- B -16117-P1
86-3-290
1. The project is located on Avenue Diaz in La Quinta, California.
2. Prior to our arrival at the site the grading had been completed.
3. The purpose of testing was to observe compliance with the City of
La Quinta requirements.
The test results summarized in this report present the moisture and
density only at the locations and depths tested on the specified
dates. The summarized field and laboratory tests were performed in
accordance with engineering principles generally accepted at this time
and location. No opinion is expressed as to the uniformity of the
material, compaction, nor adequacy of the material to perform its
intended function. No guarantee or warranty of the contractor's work
is made or implied.
If there are any questions, please do not hesitate to contact this
of face.
Respectfully submitted,
BUENA ENGINEERS, INC.
i\N41T
Norman G. Jackson, Jr.
NGJ/CSH/pjj
FP -10
Copies: 2 - Ron Piekaar
2 - City of La Quinta
2 - PS file
1 - VTA file
Reviewed and Approved
�. �. QROf ESSI pNq!
Craig S. Hill �Q�c� �G S Fy
Soil Engineer ti P yj G�
BUENA ENGINEERS, INC.
Cr.V CE 38234
Em 3/31/89
�F CANE5V
'BuenG EngineersAm.
"' 'F ENGINEERING
REPORTOF •TIVE COMPACTIO
CONTRACTOR:
ADDRESS:
Job No. B -16117-P1
DATE: March 20, 1986 Report No. 86-3-290
JOB a LOCATION: La Quinta, CA
TEST NO.
DATE
DESCRIPTION
% MOISTURE
DRY DENSITY
RELATIVE
MAXIMUM
TESTED
IN PLACE
IN PLACE
COMPACTION
DENSITY
1
-25-86
Per Plan 0.5 BFG
2.7
120.5
-100
129.0
2
-25-86
Per Plan 1.5 BFG
7.3
120.5
93
129.0
BFG = Below Finish Grade
WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH
COPIES:
BUENA ENGINEERS, INC.
28
INSULATION E . R T IF I CAT I ON
4
-
Suoa—s.on Lot Nmoer
DESCRIPTION OF INSTALLATION.
ROOF
,Material Brand Name
Thickness (inches] Thermal Resistance,(R Value)
EXTERIOR WALL
FJ'&& OL4--)�x-6 co
Material grand Name
• Thickness I; Thermal *Resistance IR_ Value)
CEILING
Batt or Blanket 2"Ind ,`Jame
Thick Hess fincnesi Thermal Res.sianc? iRvalLel
_nose Fill Type (—j 9—/ rL4 fe;S Brand Name 717k/L w1c,
%A;nimum Thicl—ness (;ncheil Number of hags '.Netght lb
ner ag
Co,,elea 2 36t 00 Thermal
-�"63 Ift .Z2 Resistance iR Value)
FLOOR,ELEVATED
Matr,al Brand Nam
.1-CkneSS finches) Thermal Resistance iR Value)
FLOOR,SLAB
Maler.al I�Z70,4,U^ grand:Name
Thickness Onhes, Thermal Res.sizince ;R V31ue1
'.V,dth (inchesi
FOUNDATION INALL
Material Brand Name
• 1'hicKocr.s :incnesi 71"!""al %,a-uel
DECLARATION
he,eov cert.tv :nat zme juove insuiation-3s -'allecl in Z'le buiiCing 31 the 300ve :OC30on in conlor-ance .%:tn :me
current regQ!at.ons setting =nergv Conservai,on S:j,dards for new residential budoings :!ocatefl -m `-tle of :me
Ca i ifo,"d Code).
"-4
eq i rite t j6-loer) '_.cense
]�r
VV signAre ana T,zte :are
Suo-Comzijc:or linsuiation -%owicator) L.ecmse Vu hoer
28