0870 (SFD)0
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
'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.that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of 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'CompensationLaws of,
and effect. t _ ( California.
II.1icense Class !� ' Lic. Number
Date ' ✓.� Z o i�t1 Contractor % .l /, yf'.' C-/...•.5 r�«f
! .
74
OWNER -BUILDER DECLARATION: I hereby affirm itiat l 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
V 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 7031.56y any applicant fora 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. It. 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.
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).
f Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate'ot'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 InspectionDepartmentor City Department.
Dale
v
APPLICANT NAME (L. F. MI)
onroe
B. M
ADDRESS P.O. Bozo 1100 -
CITY/COMMUNITY/STATE/ZIP
La Ouinta. CA 92253
JOB SITE ADDRESS/SPACE -
53-140 Eisenhower
CITY/COMMUNITY/STATE/ZIP
Ta £N -Alin -,A _ rn q 5�
BOK PAG PRC ..0
(74 ,' I .
as ner anarcm�d n1an.
"
TWN
RNG
SE
S"
.TRACT
LOT
244.40
(est. Fee'
MOD
SB
43.13
TRACT NAME
OWNER NAME (L. F. MI)) • '
be
CONTRACTOR -FIRM NAME . JolJnsm Omst�tim
�
ADDRESS -
53-740 Avenida Ramirez
CITY/COMMUNITY/STA_TE/ZIP ta' CA 92253
PHONE
L 0
LICNC/
Of La Qui
ARC/ENG FIRM NAME ..
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE II
LICNC
USE OF PERMIT
Single -f- silly dwelling
BL
ZON
FSB
I SSB
SSB
RSB
OFC
' ZONE ORD .
LOT SZ
END -
SIDE
M
E
Pt
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:
!' 0'1 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 -
demolitiorfor dismantling thereof; will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, 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 Safpty Permit No.
Date - Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the workifor 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 I have read this application and state that
the information given is correct. l 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 propertfor which I have applied for this permit for the purpose of m« kmg,inspections. -
tr
Signature of Applicant or Agent Diie
Print Applicant/Agent Name
APPL/PRMT�%
RJ
DATE
7 -7a -a S.F.D.
Permit to ccnstnrat 1592 sq. ft. of
sincrlL-family dwellinor and 91 sq. ft.
of porch and 430
scr. ft. of garage
as ner anarcm�d n1an.
Mach. Fee
22.00
Plan Ck. Feet
244.40
(est. Fee'
376.00
F-. pctk Fee
43.13
SMI Fee
5.64
lPlim+bim-T Ftp
50„50
Pron. T)Mnel. Flee
450.00
L 0
1,191.67
(250„00) PD.. 7-16-84
941.67
Of La Qui
e TOTAL
FEE
911 . fi7
Li
BLDG. DEPT.
VALUATION 80,62+.80
NO.
OPERATION DATE T 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
fjjq1yq39
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.
❑
NON ADDITIONAL INFORMATION
Sr
�'� (iI1'II�y a oOP
C 7 �t� Ps 1
u �
1iIa*L( (97.15 pr Py
SEWAGE SYSTEM'SFZE &LOCATION
11 Exterior Lath
Internal Lath '
12CJ
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb 1,24
16 Water Piping
17 Rough Plumb i
18 Vents
19 Sewage Disposal
20 Sewer Q %
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final -,20 G
Tank Pit
L. Line
ELECTRIC, APPR VALS
REAR
id0 Q iv
P/L
STREET NAME
OF PROPERTY LINE
P/L
26 Power Pole
27 Conduit
28 Service Entrance
29. Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32- Final
NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
'������y / Subdivision Improvement Permit — Class III
DATE: Minor Improvement Permit Class IV X_
LOCATION OF CONSTRUCTION —3
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION
Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION 14"10-4ml�.�E S � -,4 �%�(�/ I
DIMENSION OF INSTALLATION OR REMOVAL
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN �/-Jr
APPROXIMATE TIME OF COMPLETION ZQ/�419V
ESTIMATED CONSTRUCTION COST $ X34250 - O'J
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
PAI 19,07-i`'/ s 1,dO5
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees,' harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Ruinta and to pay for any additional replacement necessary as the result f—this work.
v C
Si nature of Applicant or Agent
,PICS ToN�t/.So�ti 5..3-7-0Q e4owle,6Z
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No.
City Business License No.
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111 .4 0®
Public improvements: 3% of estimated construction co tse_6®
Private improvements: 3% of estimated constructior-c
Su
2 ®g j�'jc �41
Minor Improvement Permit — Class IV: See attached schedullQ���J '0 lr " 'f
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
ao.00
PERMIT VALIDATION
PERMIT NO. 19411 /
ATE APPROVED 7k6100Y
EXPIRATION DATE
$ of A, 00
Date
DATE ISSUED ^� Q _8
Administrative Authority
Recorded by 11 TELEPHONE: (619) 564-2246
a
i
RECEIVED
9 C i 101984
CITY OF LAUINTA
COMMUNITY DEVEL PMENT DEPT
$T�
On. ct- ft-� a
BUILDING & SWETY DEPARTMENT
CITI! OF PALM OIEF sEriT
S O U T H E R N C A L I F R N I A SOIL AND TESTING, I N C.
6280 RIVERDALE ST. SAN DIEGO, CALIF. 92120 • TELE 200-4321 • P.O. BOX 20627 SAN DIEGO, CALIF. 92120
7 4- 8 3 1 V E L I E W A Y P A L M D E S E R T, C A L I F. 9 2 2 6 0 • T E L E 3 4 6- 1 0 7 8
6 7 B E LA T E R P R 1 S E S T. E 8 C O N D I D O, C A L I F. 9 2 0 2 5 • T E L E 7 4 6- 4 5 4 4
August 14, 1984
Rick Johnson
45169 Paseo Sereno
Indio, California
Attention: Mr. Rick Johnson
SCS&T 35079
Report No. 1
SUBJECT: Report of In -Place Density Tests, Proposed Bob Monroe
Residence, 52140 Eisenhower Dr, La Quinta, California.
Gentlemen:
In accordance with your request, this report has been prepared to present
the results of the in-place density tests performed on the native and
compacted fill material at the subject site by Southern California Soil
& Testing, Inc. These tests were performed on August 14, 1984.
AVAILABLE PLANS
Grading plans were not made available to us to indicate the elevations of
our field density tests and to define the general extent of the site grad-
ing. Therefore, we have provided a hand sketch indication the graded
areas and the locations of our tests.
SITE PREPARATION
Prior to our arrival, the site had been grubbed and approximately two (2)
feet of fill had been placed. It is our understanding the site is to be
developed by the construction of a wood framed one story single family
S O U T H E R N C A L I F O R N I A S O I L A N D T E S T I N G, I N C.
SCS&T 35079 August 14, 1984 Page Two
dwelling.
FIELD TESTING
Field density tests were performed by a representative of Southern
California Soil & Testing, Inc. after completion of grading. The density
tests were taken according to. A.S.T.M. Test 1556-74 and the location and
results of those tests are shown on the attached plates. The locations
and elevations of the in-situ tests were determined in accordance with
their importance and the accuracy and proximity of the survey control
provided by other than Southern California Soil & Testing, Inc.,
representatives. Unless other wise noted, their locations and elevations
were determined by pacing and.hand level methods and should be considered
accurate only to the degree implied by the method used.
LABORATORY TESTS
A maximum dry density determination was performed on a representative
sample of the soil used in the compacted fill according to A.S.T.M. Test
1557-78, Method A. This method specifies that a four (4) inch diameter
cylindrical mold of 1/30 cubic foot volume be used and, that the soil
tested be placed in five (5) equal layers with each layer compacted
by twenty-five (25) blows of a ten (10) pound hammer with an eighteen
(18) inch drop. The results of these tests, as presented on Plate No.
2, were used in conjunction with the field density tests to determine
the percent of relative compaction of the compacted fill.
CONCLUSIONS
Based upon our* observation and the .rel,ative 'compaction test -results, it
is our opinion the site grading was performed substantially in accordance
with Chapter 70 -of the Uniform Building Code and local grading ordinances.
This report covers only that work performed on August 14, 1984.
Our opinions as presented herein, are based on our observations and the
relative compaction tests results. Due to possible variations in the
S O U T H E R N C A. L I F 0 R N I A SOIL AND TESTING. I N C.
SCS&T 35079 August 14, 1984 Page Two
uniformity of compacted fills, we only warrant that our work was performed
in accordance with the currently accepted standards of practice and in such
a manner as to have reasonable certainty the percent of compaction of the
compacted fill material complies with the job requirements.
No other warranty express or implied, is given or intended.
If you should have any questions after reviewing this report, please do not
hesitate to contact this office.
This opportunity to provide our professional services is sincerely
appreciated.
Respectfully submitted,
SOUTHERN CALIFORNIA SOIL & TESTING, INC.
Reviewed by:
J. Daniel Brewer, Project Engineer Rober R. Russell, R.C.E. #32142
JDB/RRR/dc
cc: (3) Submitted
(1) City of Palm Desert Bldg. Dept.
(1) SCS&T San Diego
S O U T H E R N C A L I F O R N I A S O I L A N D T E S T I N G. I N C.
I
FINISHED FLOOR ELEVATION=100
LEGEND:
® IN PLACE DENSITY TEST LOCATION
*SOUTHERN CALIFORNIA
SOIL & TESTING, INC.
I
NO SCALE
BOB MONROE RESIDENCE
BY: C. Putnpy DATE:
JOB NUMBER: 35079 Plate No. 1
SCS&T 35079 August 14, 1984 Page 1 of 1
FIELD DENSITY TESTS REPORT
TEST NO.
LOCATION
ELEV. OF TEST
(FEET)
MOISTURE
( PERCENT)
DRY UNIT WEIGHT
( LBS. /CU. FT)
SOIL
TYPE
RELATIVE
COMPACTION
( PERCENT)
DATE OF TEST
1
North z of pad
99.26
9.9
109.6
1
92.9
8-14-84
2
South 2 of pad
97.76
10.7
108.2
1
91.7
8-14-84
SOIL TYPE OPTIMUM MOISTURE MAXIMUM DRY DENSITY
SOUTHERN CALIFORNIA
( PERCENT) ( LBS. /CU. FT)
SOIL & TESTING, INC. 1 11.9 118.0
6280 RIVERDALE STREET
8AN DIEGO, CALIFORNIA 92120