11694 (SFD)4
4
P.O. 4 No. 11694
BOX 150
Building 78-105 CALLE ESTADO
Address 51--880 Herrera LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Leonard i.eier
BUILDING: TYPE CONST. OCC. GRP.
Address A.P. Number 773173-'007
City Zip Tel.
1 Legal Description
Contractor Project Description SFD
M.V.H. Construction Co.
Address
77029 Iroquois
City Zip Tela
Indian Se&13, ([A 92210 345-7266
State Lic. City
& Class if. B-1 Lic. # Sq. Ft. 1400 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New 0 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
Permit does not .include block walls or
City Zip State Dool
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby afflrF 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. � :7. .A•r-s..�...w f-"i.�.. _i % ».�,,��.lr',
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated
771.00
reason: (Sec. 7031.5,Susiness 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 PERMIT AMOUNT
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 Plan Chk. Dep. 250.00
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). b 4
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 576 „ tj
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,- Mech.
provided that such improvements are not intended or offered for sale. If, however, the 'building 5 5 . r%
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 1
of proving that he did not build or improve for the purpose of sale.) -
0 I, as owner of the property, am exclusively contracting with licensed contractors to.con- Plumbing 144 0 0
struct 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 S.M.I. A fin
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) . • -
Grading 2n , 0(1
O I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure 1,858. 37
Preclse Plan 25.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
Copy is filed with the city. (3 Certified copy is hereby furnished.
TOTAL 3,279.17 3,029.17
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner 5o as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
FOUND. REINF.
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM. FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
i
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SPARK ARRESTOR
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE /PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
"tMeFl`411 SEPTIC TANK3
UGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER L60P
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ Plus -X$-=$
LUMBER GR.
FINAL INSP.
FRAMING 3 e®
FINAL INSP.
ROOFING 3 /1 3
y
/
j7 / Cf 3 C/?
/dC�J" CC
a`
J
Gl
REMARKS:
VENTILATION)
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
�` L� P.O. Box 1504 APPLICATION ONLY
Building ���L/) i 78-105 CALLE ESTADO -
Address LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address A.P. Number
City Zip Tel.
Project Description
(4.
Address
SAn,•e_
City Zip Tel.
State Lic. City
& Classif. / Lic. # Sq. Ft. No, No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affi m hat I am licensed under provisions of Chapter 9 (commencing with Section
X000) of Divisil of the Business and Pro(essi_onsode, and my license is in 1 11 force and
effect � fi _C /_.20 — f)
SIGNATURE Cv ------ DATE
OWNER -BUILDER DECLARATION Estimated Valuation
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 PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1? I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
Provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year Of completion, the owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
istruct 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 S. M. 1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
I l I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec, 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL -DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. ISSued'by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building -
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
'` BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. $
UNITS
SLAB GRADEMy
2ND FL. SO. FT, CL
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOSILEHOME SVC.
BAR SINK
GAR. SQ. FT.
POWER OUTLET
ROOF DRAINS
FOUND. REINF. t
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. 0
OTHER APP.IEQUIP.
REINF. STEEL
WALL SO. FT. 0
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SPARK ARRESTOR
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ IIA c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR @ ?Ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATIONISOUND
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
Of
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEMy
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. t
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 1/20/93 1 Type of Permit I La Quinta
No. J 11970 Permit #T -
Owner
Owner Name Leonard Meier Log
No. 51880 Street Avenida Herrera
City La Quinta Zip 92253 Study Area 110
APN # 773-173-007 Tract # I J Lot # 0 Square Footage 11400
Type of Development Single Tamily Residence No. of units
Comments
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 1.58 x 1400 or $ 2,212.00 have been paid to D.S.U.S.D. for
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 Leonard M. Meier Telephone
Name on the check
By
Assistant Superintendent, Business Services - '";k,t
Fee collected /exempted by Vickie J. Durrett ,�.`� L
Payment Receive? f cis
Signature
Clieck'�No. 110:
Collector. Attach a copy of county or city plan check application form to districtcopy for all waivers:
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy'�ecoiintirig=
y
.{�.r`� •'r '. n!`.•_. �'�i fr%f r�'.`r.�,' •'"1��ii//�^-rrd':,rg7.,''r ;. .. �:r"' ;'r �. .,,. ... .. r' ylnr" ar•.. r'."1. 'C1��. a4�. ,
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No.
DEPARTMENT OF ENVIRONMENTAL HEALTH
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies'of a SCALED plot plan (1-20 SCALE) drawn to County speculations as indicated on the attached check list.
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside.
Approval- of this application shall remain valid for a period not to exceed one year from date of approval.]
09:14CO04 E
.`..•.92
LOG # VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldeAiodPAPPLICATION $153•
Agent, Contractor, Contact Person"'Phone
Address City State+' D Zip
i �Cle
44
v
Owner
Phone
AddressCity State Zip
Job Property Address
City
State
Zip
Legal Description Prop. (PIN, Tract, Lot) V Ni
I-Av
G
Lot Size
Water Agen (WellUse
of Permit PIP, CU, etc.
Other
C® oO
Dwelling, MH Site Prep, etc.
nature of Applicant
Date
CATEGORY REV CODE FEE
CATEGORY REV CODE FEE
SUBSURFACE DISPOSAL (per system) 1238 $153.00
❑ SITE EVALUATION UPON REQUEST 7349 $120.00
(NO PLOT PLAN)
MULTIPLE PARCELS WITHIN SAME LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. 1st 4 Parcels (Each) 1238 $153.00
❑ PRELIMINARY ELECTIVE EVALUATION
b. Each Parcel after 4 7344 $ 55.00
(Attach DOH_SAN-53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $ 55.00
❑ HOLDING TANK ' 7351 $119.00
❑ SITE EVALUATION In Conjuction with Critical Area 7346 $197.00
❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
❑ GRADING PLAN REVIEW DETAILED 1238 $104.00
❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00
❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑ COPIES (LAND USE) 7786-81 $ .50
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes No
Certification of Existing S.D. System Required ❑ Yes No
WQCB Clearance Required ❑ Yes No
(Attach Form DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required ❑ Yes No
Special Feasibility Boring Report Required ❑ Yes C No
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes C No
Grading Handout Provided ❑ Yes I No
Staff Specialist Lot Inspection Required ❑ Yes C No
Maintenance Booklet Provided ❑ Yes ❑ No Lot Inspection Date Initials—
nitialsOL
OL
C/42 / Soils Percolation: Boring, Report by �1 k' Lic/Project #: Date ,'t '+' •.
j
rSoils'Map Page -SOII Type Approved By . is Date l''
IN �'o ysiems :
' iType of.System(s).
No. Dwelling Units
(1) Septic Tank
Soil Rate f� .
cre�ee/sand j : "
} i
Holding Tank ❑Replacement
'"ew
Bedro ms, Fixture Units
. a
reaseinte❑
pl�ntTrap�
(,
f`�
; ❑ Addition j')t
u,nEtingxs
dI LIlI ✓vim
`
Gal
i i Ij I �' ; l 1,
,Sq::Ft,l t "
To l Lip�a� t
I Sidewall Allowance i.
; f f'- l 3's �: ;,
Leach Qed sq 'ft
Bottomt�fea
r
Ft }
i ,
t;', r r ft. sq., . per running ft.
Install Une(s) ft long, i ft v}"a enth+
,
-of
,nlet
Depth ❑ NA
Tasted -'
min. ' 'inches rock below drainlines
-
}
Proposed Bottom Tested Depth
--r-
L.eachiines/bed special design for slope:
(3) Pit Diameter
N0. Pits
Pit Below
Seepage Pit Total Depth
Inlet (BI)
(TD) I r
Other:
Applicable
i
❑ 5 — V6
r•
/
Max. Allowable Pepth
rZ��_.._ —..
N7A , .OJe6rder?Factor _
_._.-
.._.-. ..__...
_.._ . _ _,.._.
.K
Well Review Approved: Signature Date Well Drilling Permit #
. . .. .. .Date . ... ... .... . . ..
rGrading "' ,•••_..I _..__
Plan Approved:.,
9 PP ,., Signature ..�....-.,�,;o s••,..e�t ti,
aa ttT g
S, rytrjb..l a. F i' 'i.fl''i"' 4ii u �:r.Y•, O.3ii.:?... G'Y��:.�•.r L t•..L w�t._r �I;�.L• .. •.�' a .a •a.7 :�!.� } _ t ,
REMARKS:
i'ti^jk Ai.r�l , 1_. 'N i, _, . ,;y. ,. r •,.. ,Y_.M t_.-•..-.. .a... ,r—_ ., _..._ ..�.r..-
i• 1
'•�.'1111 .'?',•,'.li.. '.1 '1'. I .l 'Ir „i1.1•', l�I � .•a 111'11" .rbc
17
This application is PROVE DENIED•for the category checked'In'SECf10fJ'B above,'regarding the designof'a"'subsurface disposal system as indicated
0 o� tlie,a(:companle . ,,Using the requirements set forth In SIf&ION,C above. A building permit is necessary for the installation'of the above, designed
system. No construction is narmMpri in tha rano{rad reserved 100s/o exo, argon area I
-.Septio-tank must'be 100 minimum from any wells ..,
(2� Leach lines must be, 100' minimum from any wells, including expansion area
5eepa a pitsmusY be 150' mi imum from any, wails, including, a ansion area
9..
y .I.
Jeb r :t>et;,
Signature of Health Official Date
• 1� r O.
4' O
CASH'
' HECK NO.
rt ECEIPT..h1OE. = (:: I r2! 2 `_ ` Issued..BY - + Date—
r
"�RICT`"a""—"C! fliverside I.r)dj Vic, 01-16rnet —`-❑—'Perris' { ❑ Rancho'Califi----------- 0 --Blythe' �--'
'BI`DISTRIBUTION: WHIT:Er•:Ottice'file•-..P?NELLQIN—Appilcant'A'_'PINK=Bldg: Dept:.':_ GOLDENROD—Plans/Recarda ,..;
EARTH SYSTEMS CONSULTANTS S.C.
BUENA ENGINEERS�DIV.
79-811 B Country Club Drive
Bermuda Dunes, CA 92201 • (619) 345-1588
Client Name
Client Address
r
Client Phone
I
DATE
Z -ZZ -913 ✓
TEST LOCATION
JOB NO.
PROJECT
-5/ -880
LOCATION
FIELD TESTING
CONTRACTOR
REFERENCE CURVE
OWNER
WEATHER
TEMP. o at AM
0 at PM
PRESENT AT SITE
OPTIMUM
MOISTURE
CONTENT
%
e 1f A-
-TEST
NUMBER
TEST LOCATION
LOT
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
lbs./Cu. fl.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
IbsJcu. ft.
OPTIMUM
MOISTURE
CONTENT
%
e 1f A-
5
e #3
REMARKS: rz :4jLl
'Jelp7el,P a .'
CLIENT
FIELD REPORT
ATIVE SIGNATURE TECHNICIANS SIGNATUREy� ® 59 }
.s
f'
I lI
cli
(rT.rj,P
Tit� of 14a Ouinta
jluitbtn� anb �sdfet� 31illi'leithin
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 51-880 AVENIDA HERRERA
Use Classification SINGLE FAMILY DWELLING Bldg. Permit No. 11694
Group R3 Type Construction VN Fre Zone Use Zone SR
Owner of Building LEONARD M. MERCER Address. 77029 IROQUOIS
City INDIAN WELLS, CA 92210 LONNIE DAY
By;
Dote; JUNE 3, 1993
Building Official
POST IN A CONSTICUOUS PLACE
II Amillm