000946 (BLCK)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
r
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class 'Lic. Number
Date Contractor�t—
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 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.):
4 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 lir
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt 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.
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. 8 P.C_(Attached Certificate).
'Date " 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
APPLICANT NAME (L. F. MI) larxbai*QxrpmW
'L^�
ADDRESS P.O. BM 1000
CITY/COMMUNITY/STATE/ZIP La Qlainta,CA 92253
JOB SITE ADDRESS/SPACE
V*a hhimit m Stx set
CITY/COMMUNITY/STATE/ZIP La X�nw/ CA 92253
BOK
PAG
PRC
C
SME Fee 1.58
TWN
RNG
SE
S
TRACT
LOT
TOTAL
FEE
$ 263,10
MOD
SB
TRACT NAME
OWNER NAME fl. F. MlJack Clark ►1. Young
CONTRACTOR -FIRM NAMEAppI1cCjllfv
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE N 345-2888
LICNC 0
ARC/ENG FIRM NAME
POPliant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE 0
LICNC
USE OF PERMIT
[l,,,,' 7
Block
BL
ZON
FSB SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, 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.
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 or this 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 into 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,
C.A.C.)
0 As 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: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued JSec. 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 I have read this application and state that
+y - the information given is correct. 1 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
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
APPUPRMT DATE
P n o q 4 8 9-21-84 H=.
Penni t to CcI nstxuct 900 L.F. of
syix► ll foot high concrete block waas
pe 8� plans STS city ordinanoes.
C)olnstracticn Pe mit 158.50
Plan Chock 103.02
SME Fee 1.58
l
TOTAL
FEE
$ 263,10
BLDG. DEPT.
VALUATION 22,500.00
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
e/`�
1T , /��
I
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)
14T Final
PLUMBING APPROVALS
15 Ground Plumb
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
P/L PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
OUCA
TO
THE FOLLOWING WAS NOTEDr t }
DATE -�
JOB ANO.
PROJECT
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CONTRACTOR
• OWNER'.
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SIGNED r
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Mu IE Enalneers nE.
CEC
ACCTG
1731-A WALTER STREET VENTURA, CALIFORNIA 93003 PHONE (805) 642-67.27
December 3, 1984 Job No. B -13832=P1
84-12-12
L.M.L. Company
P.O. Box 1000
La Quinta, CA 92253
Subject: Duna La.Quinta/Washington St. wall
La Quinta, CA.
Compaction Report
Gentlemen:
On November 13, 1984 a representative of our firm performed den-
sity tests.on'the finish grades for the wall along Ave. 50 on the above
referenced project. Tests were performed at random locations in accor-
dance with ASTM 2922-78 and ASTM 3017-78 Nuclear Density Test Procedure.
Tests performed as per authorization of..Lloyd Watson.;
The estimated locations of the tests are presented as station.
numbers with their results -being summarized on the attached test report
sheet. A total of three (3) 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 Maximum Denstiy-Optimum Moisture
Medium brown.silty fine.sand 115.7 12.9
VENTURA
LANCASTER .
(805) 642.6727
(80 5) 948.7538
THOUSAND OAKS BAKERSFIELD
SANTA BARBARA PALM SPRINGS SAN LUIS OBISPO
(805) 495.8484 (805) 327.5150
;805) 966.9912 (714) 328.9131 18051 544-AIA7
.December 3, 1984 Job No. B -13832-P1
84-12-12
LIMITATIONS
'The backfilling and compacting operations were completed at the
time -our personnel were called to the site. The test results summa-
rized 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 generally 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 quar-
antee or warranty of the contractors work is made or implied.
Respectfully submitted,
BUENA ENGINEERS, INC.
Norman G. J ?ksron,. Jr.
NGJ/REB/pjj
Copies: 4 - L.M.L.
2 - City of La Quinta
2 - P.S. File
1 - Vta. File
Reviewed and Approved
Raymond E. Brannen
C.E. 28966