0672 (MISC)PERMIT APPLICATION `
• 1 t' City of La Ouinta
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..:
• fa::. .�-,.:: •: _.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN: ATION INSURANCE: -This section need not be completed it
'LICENSED CONTRACTORS.. DECLARATION:'I ,hereby.:affirm .that I am licensed under provisions of Chapter 9 ; '
- the permit is for one hundred ($100) o, less. I certify Ih.t:in the performance of the work for which this permit is :.
(commencing wiftSection 7000) of.Division 3 ol.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 theWorkers'Compensation Laws of
and effect. , t'
California.
License Class.- • Lic. Number _ _
Date Applicant.
.Date` - - Contractor
NOTICE TO APPLICANT: If, after making this Certificate'31 Exemption, you should,become subject to the Workers'
OWNER -B. „ '
UILDER DECL'ARATION:..I hereby affirm that I am;exempf from the�Contractor's License Law for the..
- Compensation provisions of the Labor Code, you must -mrthwith comply with such provisions or this permit shall
%-
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to •
be deemed revoked. •
=
• construct.:alter; improve; demolish, or repair any structure, prionto.its issuance, also requires the applicant -for
DIVISION'OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: - , . • ,
„ such permit to file a signed statement that he is licensed pursuantto.theprovisionsofthe Contractor'sLicense Law _,
0A hereby certify that no eicavation five (5) or more feefiin depth into which a person is required to descend, will be'
(Chapter9tcommencing with section 7000) of Division3 of the Business and Professions Code)or that he is exempt ,
made in connection with work authorized•by this permit: and that no building structure, scaffolding, falsework, or '
;therefrom and the basis for.the alleged exemption. Any violation of Section 7031.5 by any applicant fora permiP',
demolition or dismantling thereof, will be more than thiry-six (36) feet high. (Chap 3.2, Grp 2,'Art 2, Sec 341; rifle 8,',,
,,I :subjects the applicant to'a civil penalty of not.more than five hundred dollars ($500.):.. `
C.A.G.) ' "ywc"•
❑ I. as owner of the property, or my employees with wagesas their sole compensation; will do the work, and IbE
❑ As'owneebuilder,'I: will not employ -anyone to, do work which would require a permit from the Division of'.•
structure is not intended or offered for sale (Sec., 7044,. Business and.Protessions Cade: The Contractor's License ,
. Induslrial.Safety, as noted above.vnless'such person I as'a permit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon,•arid�who does such work himself or.
-...;.
through his own employees. -provided that such improvements are not intended or offered for safe. IL however, the ..
0 Division of Industrial Safety Permit No.
building or improvemni is sold within one year of completion, the owner -builder will have the burden of proving that
Date Applicant r
:, -
he did not build or improve for the purpose of sale.).. • 1. - ,
'
r
CONSTRUCTION LENDING AGENCY: I hereby affirm that here is a construction lending agencylor the performance.:., '
• , ❑ I; as:owner.of theproperty. am ezculsivel contractiri with licensed contractors to the project (Sec: ; ,.
Y g. P I
oLlhe work for which this permit is issued (Sec: 3097; ;iv. C.)•
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
e •-••, • -•
Lender's Nam '
'• builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the,
. , -
°Coniractor's License Law.).
Lender's Address
' O I am exempt'under Sec. B. & P.C. (Attached Certificate).,,- ..
I certify that I have,read:this applicationand state that INe aboveinformation is correct. I,agree to comply with all; .
Date Owner
city and county.ordinances and state laws.relating to bu lding construction, and hereby authorize. representatives ;
of this county to enter upon the above=mentioned prop• rty.for inspectionpurposes. i
• WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora ^:
'..certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
=Signature of Applicant of Agent Date'
Policy No. Company
-CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OFINTRY:.Icertify Ihave read this application and stalethat• ' r
O Certified copy is hereby. furnished:
the information given is correct..l,agree to comply with all state laws and county ordinances relating, to buidling ,
•❑ Certified copy is filed with the City Building Inspection;Depailment or, City' Department. .,
. 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 perrtif for the purpose of making'inspections' "
Date Applicant
' . •
Signature of Applicant or Agent " Date
' — L•
Print Applicant/Agent Name r -i
APPLICANT NAME.(L;'F' Mq
ASR - 7.33
CITY/COMMUNIT-Y ,E/ZIP
JOB SITI E A✓GV ACE Cf7 A
CITY/COMMUNITY/STATE//ZIP!'
BOK .,
PAG..
PRC
'.0
..
TWN
RNG
SE
S
TRACT
.LOT
-
,MOD
SB
TRACT NAME •• '
OWNER NAME (L. F. MI) s
CONTRACTOR -FIRM NAME .. .. -. r
ADDRESS
CITY/COMMUNITY�//S•.TATE/ZIP
PHONE
tL• NC
ARC/ENG FIRM NAME' ,.
1
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE OF PERMIT
BL
ZONI
-
.FSB
r
is SB •
SSB
RSB
OFC . -
ZONE ORO' N
� LOT SZ 'END SIDE .r..
. APPUPRMT. ry /DATE/ - ?'
/r 7/"/
a
R 1E S
• ate•.
• • A
' APR 0,W.
ON of La Quirata
i
'TOTAL- •'° x/y p• , O U
• � � FEE • r
, m _ ♦+ALUATIONf x/7/00, DU ,
BLDG. DEPT.
. .t
NO.
OPERATION DATE- INSPECTOR
NO.
OPERATION DATE
INSPECTOR'
BUI'LDINGAPPROVALS,,
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
t ,
4
Grout Blocks
37
Combustion Air,
'
•5
..Bond Beams
38
Compressor
6.
Roof Deck
39
Appl. Clearance
" t
7
Framing
40
Fire Damper
8
Vents
41 1
Smoke Detection Device
> °
9
Garage Fire Wall
42.
Commercial Hood
10
Fireplace P. L.
❑
43
Final
s.
10A
fireplace T.O.
❑
OWN
NO. ADDITIONAL INFORMATION
_ _
I �
/ I� q[
4
'
_
+v
`
SEWAGE SYSTEM SIZE &`LOCATION'
11 Exterior Lath.
12
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
16Water 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
IT -
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P _
_
STREET NAME
P/L
r
26 Power Pole
27 Conduit
28 Service Entrance.
29 ..Wiring.
29A Grounding Wire
29B Bonding,
30 Fixtures
31 Service -
32. Final
UMUU 'Engineirs,lni.
TESTING INSPECTION
1731-'A WALTER STREET VENTURA, CALIFORNIA 93003•PHONE (805) 64.4-6727
84-5-265
May 18, 1984 Job No. B -14342-P1
Desert Affordable Housing
Holiday Inn
'15.-494 Palm Dale Rd.., #139,
Victorville,. CA .92392
Subject: 51-700 Ave. Vi1La
La Quinta,. CA
Compaction Report
Gentlemen:
On May 10, 1984 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. ace ordance'with ASTM 2922-78 and ASTM 3017-7E Nuclear Den-
sity Test Procedure.. Tests performed as per authorization of M. M. "Skill Jaglowski
with Desert Affordable Housing.
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 (907o) ,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 Density -Optimum Moisture
Light brown silty very fine to
fine sand 94.7 14.7
VENTURA LANCASTER
(805) 642.6727 (805) 948.7538
THOUSAND OAKS BAKERSFIELD SANTA BARBARA PALM SPRINGS, SAN LUIS OBISPO
(805) 495.6484 (805) 327.5150 (805) 966.9912 (714) 328.9131 (805) 544-6187,
84-5-265
May i8,'1984 Job No. ' B -14342 -Pl ,
LIMITATIONS
The backfilling and compacting• operations were completed at the time our personnel
were called to the site. The test results summarized in this report represent the moisture
and density only at the location and depth tested on the specified date. Tae summarized
field and laboratory tests were performed in accordance with engineering principles gener-
ally 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 guarantee or warranty of :the contractors work is made or implied.
Respectfully submitted,
BUENA ENGINEERS, INC-. Reviewed and Approved
PorG. Jacks n,. Jr. rman G:. Hellin
C. E. 7370
NGJ/NGH/pJJ
Copies: 4 - Desert Affordable Housing
2 —City of La Quinta
2 - P. S. File
1 - Vta. File
BUENA ENGINFFRS iNr
� I . ' � s -
' f :-,..
l � f � • t � 1
� I ! i i S + R 1 4
S � S.
, , y .. , ,
�
c$In,
t
t
:: • t , i ;
f (.:
BUENA ENGINEERS,
INC.
DATES^Q-6y.
FILE NO.(3-�yJ`!1
J
� D 74A ENGINEERS, INC.
-
1731 -A Walter Street
VENT URA, CALIFORNIA 93003
(€05) 642-6727
TO
THE FOLLOWING WAS NOTED:
DATE
'r -
JOB NO.
PROJECT ,.
LOCATION J�
/7'
CONTRACTOR
OWNER
WEATHER
TEMP. U at AM
° at PM
PRESENT AT SITE
G TSS/ C ,Z,/ /I -Z /2-
,A,/ /V �/17 /' r`Z2 ,i 42 , ;n/
COPIES TO
SIGNED '�