0208-355 (SFD)LICENSED CONTRACTOR DECLARATION
I. hereby affirm under penalty. of.perjury that I am licensed under provisions of
Chapter 9 (commencing with" Section 7000)' of Division 3. of the Business and
Professionals Code, and ,my License Is in full force and effect.
License # Lic. Class Exp. Date
Date A2, — "a Signature of Contractor
.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am' exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of �the'property, am exclusively, contracting with licensed
contractors to,construct;the project (Sec. 7044-1_Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date oSignature of Owner
WORKERS COMPENSATION DECLARATION
I hereby affirm under: penalty of perjury one of -the following declarations:
( ) I have and will. maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
SPion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier IFtd11'`1 Policy No.
(This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code; I shall forthwith comply with those provisions.
Date. Applicantf2 +- 1 -
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest. and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the, conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this applicatiomis made & each person at
whose request and for whose benefit work is performed under or pursuant, to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agiee:to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter`upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 1A, ate
✓`� �S'' o4 gr•�r
BUILDING PERMIT. PERMT#
f., / tE�ISf2.�
DATE • (VALUATION LOT ii TRACT
JOB SITEAPN
ADDRESS +�c4•N GE DIMt
."
-
s
OWNER CONTRACTOR/DESIGNER/ENGINEER
. 1
WKS 1 1►e9T3;1M PARTHr_'L`�.�, ERP I:dW0-d7CDWiT:J•10PrM:P11$';t' WC
832.204 :1".C(GHWAY 111 SU'rl:a C-201 3fr 0 -,8i-f rn;,RV'LY '94, AX1W Af,)
IND110 CA 92201 mC71Jvr*Ala C1xS'&PC: ° CA n561
USE OF PERMIT A6 / Ai s7
ic3i?.i�vt�a� $czs' . �T 3-7
SSY14 ��,�+"3'. ai?'dt9fal" l?'1�3t4ity'�" fiZpm1FJS��r1C�. f�fna�All:t�' 17i'yS�:3+1f;3"t' .. �.
MCLUDE BI:.. OK WAUA FENC EA kOQtrMD 9P A, A SEl'AUTZ PigWIT
1S REQUIRLYD K31t THE DRIV EtWA,.'4' APPROACH.
CUSTOM C ONSI TR.UCTION 31S"m.09 8V
PORC'rt3f?ATIC) 423.30 5F .
0ARA F1C:9:RI'ORT X1,00 SF
91VfTNWfXD ((Fr 6183 CIC NSTR•d7P10PI
521X0.70
.70
CC)NN YRP: CT)ON FT F.. 101-000.418-000 $1;,43x1,30
PECAN C1.3'iCCK FEW,1C1f-Ji?f3-�a��3:tf3 Si;l°7'1.'fiR
'FEE
1?00.01;i' 101.000.4.219-318 _010100
AAuC:NF.e�,}E°:Rf,.1��ft; 9Q1-Ce��d«9-tYt1f? �13y.�'U
<<.
RUICTRICAL FEE r:IU1a100-426-wo 3217,41
PLiiM"iR o Me 101 •000-419-000 $240,73
C1RADI'NQ FEE? 101 x000-4,231-006
DEVELOPER IMPACT FKV
J PtT HiQ PUBLIC PLACES —RASIK 270-000-4454,NI00 014.58 �.:
*jm-7"'i"Jur. cC3Al`s J"ituC:,"nox AND P1 A ? 1• r,
DEC 0 51001
CITY F NAIVOF Qum
RECEIPT ff l
BY ,v'''
I DR F D'
IN
TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
/-)
Combustion Air
Roof Deck
Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
S a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
3
Final
Final
POOLS - SPAS
BLOCKWALWPC
VAL
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
_ I
Waste Lines — _
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
FinalUtility
Notice {Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
_
Temp. Use of Power
Final
Utility Notice (Perm)
��
<r'oacihella Valley Unified School District
P.O. Box 847, Thermal, CA 92274
(760) .398-5909 — Fax (760) 398-1224
Project Name:
Owner's Name: WN
Project Address:
Project Description:
APN: 764-040-007
ngie
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
ArKOUNT
LEVEL ONE AMOUNT:
LEVELTWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CFECK k:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Tract #: 28983
Date: December 2, 2002
Phone No.. 8U!)-4U8—III!)
Lot #'s: 44
Type of Development: Residential XXXXXX Commercial Industrial
Total Square Feet of Building Area: 3974 sq„ " ft.
Certification of Applicant/Owners: The person signing certifies that the above info on is correct and
under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/devej/ope�
Dated: Sign
this statement
***************************,****************i***********a****************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJEC'4HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 3974
Amount per Sq.Ft. $ 2.16
Amount Collected $ 8,583.84
Building Permit Application Completed: Yes/No
By: Carey M. Carlson
Asst: Supt., Business Serv.
r � "
Certificate issued by: ` ' E1 vi ra Mattson Signature: 5A-x7-2-.,�)
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days saarts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/cettificate of compliance 09/30/02
Sladden Enginleering .
6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523-0952 fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (766) 772-3895
October 23, 1998
Terra Nova Planning & Research, Inc.
400 South Farrell, Suite B-205
Palm Springs, California 92262
Attention: Mr. John Criste
Project: Tentative Tract No. 28983
The Palms Golf Club
APN 761-150-001
County Geologic Report No. 968'
La Quinta/Indio Area
Riverside County, California
Projeci. No. 544-8025-A2
Ref: Geotechnical Investigation report prepared by Sladden Engineering
dated October 7, 1998; Project No. 5448025-A 1
This memo was prepared in order to provide the additional information requested by Mr. Steve'
Kupferman, the Senior Engineering Geologist. for Riverside County. The questions concern the
above reference Geotechnical Investigation report and are summarized in the county review letter
dated October 21, 1998. The requested items are addressed below in the same order as presented
in the review letter.
1. As requested, the calculations performed during our evaluation of liquefaction potential
have been summarized in tabular form and are attached to this memo. The calculations were
performed considering maximum ground accelerations of 0.408 and 0.50g. Our calculations
indicate that the majority of the silty sands encountered near or below the present groundwater level
are generally considered too dense to be susceptible to liquefaction. Safety factors of over 2.0
were determined for all but one of the samples. The only sample that indi-ated liquefaction
susceptibility based upon sampler penetration resistance. (boring 3 CD 30'), contained silty/clay
layers which is a logical explanation for the lower blowcounts.
"2• Although groundwater was encountered at a depth of 25 feet or more within our borings,
the potential rise in the groundwater level (to an elevation of 15 to 20 feet below existing grade)
was considered in our analyses. Our analyses indicate that the liquefaction potential is negligible
even when considering possible groundwater level increases.
Based 'upon our review, it remains our opinion that the potential for liquefacticn within the soils
underlying the site is negligible. The sand layers encountered below the groundwater surface
appear too dense to be susceptible to liquefaction. In our opinion, specific liquefaction related
mitigation measures should not be necessary.