002464 (BLCK)Building
Address 53-296 MmItCUM
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing I
Address P.O. BDA 1368
City lZip ITel.
Contractor
Address .
IZip ITO.- - .
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S 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.
SIGNATURE DATE
OWNEWBUILDER 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 oounty,,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 f�ie a signed.sfatement 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 (E500).
O 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, Buisness 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. If, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. + B. & P.C. for this reason A M
Jf
Date Owner! • - .ate �.' f% i
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
O Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the pemrt 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
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name _.
Lender's Address
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.
1 certify that I have read this.applfcation 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 city 'to enter the above-
mentioned property for inspection purposes.
Signature of applicant 1 / + r x t Date
Mailing Address
City, State, Zip I i
HARD COPY I
N0. 002464
BUILDING: TYPE CONST -.00C: GRP.
A.P. Number 77"33-001,t 002
Legal Description lot 1 2.
Project Description S.P.D.
Sq. Ft. No. No. Dw.
Size • Stories Units
New ❑X Add ❑ Alter ❑ Repair ❑ Demolition ❑
95 lin. ft.. 5 --foot thigh
302 lira 'ft. 6 --foot high, sttxaa fere.
Estimated Valuation 2,94.70
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal..i�
Const.�.5�
Mech.
Electrical
Plumbing
S.M.I.
.
Grading
Driveway Enc.
Infrastructure
TOTAL
64.02
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from. Property Line
FINAL DATE INSPECTOR
Issued by: Date 7-17-86 Permit
Validated by:
Validation:
A5978 7 17
64,Ll2 N
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE:d
PERMIT FEE
I
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
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.
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH'GRADING
FINAL INSPECTION
CERT. OCC.
/
�ULFENCE FINAL Q ,1 Z{
I V N•5 WUNA I UHt511141I IALS_
GARDEN WALL FINAL
tx%fIEp
Ir
H BERMUDA DUNES r
RANCHO MIRAGE
►' INDIAN WELLS ti
PALM DESERT -b
%P LA OUINTA
J10 INDIO y�
Desert Sands Unified School District
82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (619) 347-8631
April 1, 1986
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
Re: 53-296 Montezuma
Gentlemen:
The developer of the above referenced lot
has mitigated i:ts impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational faci'li.ties made necessary by such new
development.
Sincerely,
-� rL 9. V-1 j...'
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION - -
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 specifications required on the attached check list. A non-refundable filing fee of
$30 is required when the application is submitted. Check must be made payable to the
County of Riverside
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
City
State
Zip Code
Telephone
*Job Property Address
ty
*Legal Description of Prpty. (Lot, PM, TR)
*Assessor's Parcel No.
Water Agency
Use of Permit
Lot Size
SFD, MH Site Prep Etc. _
Planning Case # ' -o�6r
��
.P
,
Signature of Applicant Date
*The above information must be verified from Building Application
STAFF USE - DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System reqd. Yes ] NoC•']� ��� 3 746
WQCB Clearance reqd. Yes[ ] NO[•� _
Soils feasibility report reqd. Yes[ ] NoC/I
Detailed boring report reqd. Yes[ ] NorA
Detailed contour plot plans reqd. Yes ] No F/3' _
Staff Specialist approval reqd. Yes[ ] No[el Lot Inspection Date
Soils/boring report by Proj. # Date
>
Soils Map Page �� / Soil Type JX Approved by 12 Date 3 -/ 7 P '
i
Type of System:
No. of Bedrooms (1) Septic Tank
Soil Rate jecluired
Existing New dition Replacement
1 Gals.?
(2) Leach line sq. ft.
Sidewall allowance
Install Lines)
Leach bed
(Bottom t-rench area)
ft. rock/ Sq. Ft.
Ft. Long..,. Ft. wide
Sq:'�t. of
per running ft.
with Min. 77r'-ipches rock
bottom,
N/A CY7�'
below drain lines
area
Leach lines/bed-special design
(3) Pit Diameter
No.
Pit
Seepage Pit total depth
for slope-:�Qp`plicable
! 6' C V7/
Pits
BI
N/A Overbu`iMen-_factor
%
I
/ij
Max. allowable depth
•EPA A I 44A E2 �. z - sru,fe
This application iprow did for the design of a subsurface disposal s;stem as
indicated on the accomp plot plan using the requirements set forth in Section B above.
Abuilding permit is necessary for the installation of the above -designed system.
Abri) Se t� ictank and sewer lines must be 50' from any wells
Leach lines musE-_be 100'min.fi omrany wells including expansion area
i Seepage 2its.must be 150' min. from any wells including expansion area
Signature of Health Official Date
RECEIPT NO. 4 7-310 3 y 60 Lssuea oy / , _.i it
District: Riverside C ] Indio C .Hemet C ] Perris[ ] Rancho Cali
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept.
Calif
DOH SAN 122 (Rev. 2/86)
Blythe C ]
GOLDENROD -Pending File
r Cf�
S
Eumm'D Enviil LiemAnc. -
1731-A WALTER STREET •
May 9, 1986
R& C E h VKID—
MAY 19 1989
UINTA
COMMUCOF LANITY DEVELOPME T DEPT
VENTURA, CALIFORNIA 93003
Pomona Malley Equipment Company
P.O. Box 457
Le Quints, CA 92253
Project: 53-296 Avenida Montezuma
La Quinta, CA
Subject: Report of Field Densities
Residential House Pad
PHONE (805) 642-6727
8-16053-P1
86-5-147
On April 14 and 16, 1986, 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 accordance with
ASTM D 2922-81 and ASTM D 3017-78 Nuclear Density Test Procedure.
Tests were performed as per authorization of Bob Callum.
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 three (3) density tests were performed. Test results indicate that
a minimum of ninety (90) percent relative compaction has been obtained
within the areas tested. The maximum density -optimum moisture were
determined in the laboratory in accordance with ASTM D 1557-78, Method
A or C. Test results are as follows:
Soil Description USCS
Light brown very
fine send SM
VENTURA
(805) 642.6727
BAKERSFIELD SANTA BARBARA
(805) 327-5150 (805) 966-9912
Maximum DensityOptimum Moisture
101.5 pcf 18.29
LANCASTER
(805) 948.7538.
PALM SPRINGS SAN LUIS OBISPO
(619)328-9131 (805)544-6187
May 9, 1966
-2-
8-16053-P1
86-5-147
1. The project is located at the corner of Calle Monterey and Avenida
Montezuma in La Quinta, CA . .
2. Prior to our arrival at the site the area to be tested had been watered
and compacted.
3. The purpose of testing was to observe compliance with City of La
Quinta requirements.
The test results summarized in this report present the moisture and
density only at the locations and depths tested on the specified dates. 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
adequacy of the material to perform its intended function. No guarantee or
warranty of the contractor's work is made or implied.
If there are any questions, please do not hesitate to contact this office.
Respectfully submitted,
BUENA ENGINEERS, INC_
�JJ
Norman Jackson, Jr.
NJ/CSH/mt
F-11
Copies: 4 - Pomona Valley Equipment Co.
2 - City of La Quinta
2 - P.S. file
1 - VTA file
Reviewed and Approved
/S / o99,OFESS/n.
Craig S. Hill y�� PSG S. tijFti`�
Soil Engineer
U CE 38234
Exp. 3/31/89
�lgTE
OFVIV CRl E�R�\P
BUENA ENGINEERS, INC.
P
•n NG1NEfRING'
1
CONTRACTOR:
ADDRESS
REPORT OF RELATIVE COMPACTIONS
Job No. 8-16053-P 1
DATE: May 9, 1986 Report No. 86-5-147
JOB & LOCATION: La Quinta, CA
TEST NO.
DATEDESCRIPTION
':. MOISTURE
DRY DENSITY
RELATIVE
MAXIMUM
TESTED
IN PLACE
IN PLACE
COMPACTION
DENSITY
.1
4-14-86
Per Plan 2.0 BFG
14.9
101.1
100
101.5
2
4-16-86
Per Plan 1.0 BFG
19.5
99.3
98
101.5
3
4-16-86 j
Per Plan FG
18.3
97.8
96
101.5
1
BFG - Below Finish Grade
FG - Finish Grade
I
WE CERTIFY THAT THESE TESTS WERE PERFORMED IN CONFORMANCE WITH
COPIES
BUENA -ENGINEERS, INC. ,
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