001077 (BLCK)PERMIT APPLICATION
City of La Quinta
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,180days..
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-CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This secti000eednot be completed if s
' *LICENSED CONTRACTORS- DECLARATION: I herebyaffirm that I am licensed under: provisions of Chapter 9 •
the permit -is for: one hundred ($100) o, lessr,l 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 asto'become subject to the Workerkofnpensation Laws of
and effect.
,! California.
('^
f'
- License Class Lic. Number
/ Date �} ` T .Applicant ''- ✓ f
-'•Date - Contractor - -
.NOTICE TO APPLICANT: It, aftermaking.this:Certificate of Exemption, you should becomesubject'to the -Workers'
OWNER -BUILDER DECLARATION: 1 hereby affirm that 1 am exempt fron' lhe:Coniractor's License Law for the
Compensation provisions of the Labor Code; you.must forthwith comply with such provisions or this permit shall
be. deemed revoked. "
following, reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
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construct, alter, improve.'demolish, or repair any structure, prior to its issuance, also requires the applicant for:
DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed st.atemenuthat he.is licensed pursuant to the provisions of the Contra.ctor's License Law
q 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be'
(Chapter 9(commencing'with section, 7000) of Division 3 of the Business and Professions Code) octhathe is exempt'
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsew6rk, or .
therefrom and the basis for the all exemption: Any violation of Section 7031.5 by anyapplicant for a permit
demolition or dismantling tfiereof,'will be more than thirty-six (36) fee 'high. (Chap.1.2: Grp 2, Art 2, Sec 341, Title B.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C)
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the ..
p As owner -builder, I will not employ anyone to do work whichwould require a permiL1rom the Division of
structure. is not intended or.offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License •.
Industrial Safety, as' noted above, unless such person has aAperniit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work,himseltor
No. r
through his own em Io "eesr provided that such improvements are not intended.or offered for sale. If however, the
have the burden that :.
❑ Division of.lndustrlal Safety.Permit -�
/r f / j f� �L Li �� / ��
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buildngorimprovemntissold within one year ofcompletion, the owner,builderwill ofproving
he did not build or improve for the purpose of sale.). �:,
Date'• Applicant
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CONSTRUCTION LENDING AGENCY: I hereby affirm that Ihere is a construction lending agency for:the performance`
11 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:
ofthe work for which this permit is issued (Sec. 3097, Civ. C:). V
7044, Business and Professions Code: The Contractor's License Law does notapply to an owner of property who
Lender's Name -
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant 4o the
. t,
Contractor's. License Law.).
Lender's Address
�( ❑ 1 am exempt under Sec. -' .':B: B.P.C. (Attached Certificate). -:.
I certify that I have read.this application and slate that the above information is correct. I agree to comply.'with all '
/
Date / Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives '
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of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self -insure. or a
• ' certificate of Workers' Compensation insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that'
O Certified copy is hereby furnished. . .
the information given is correct. I agree to complywith all state laws and county ordinances relating'to.buidling. -
o Certified copy is filed with the City Building Inspection Department 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 1 have applied for this permit for the purpose -of making inspections.
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME W. F. MI) '
Air. Ramero
ADDRESS
52-401 Avenida -Obregon
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
52-401 Avenida Obregon
CITY/COMMUNITY/STATE/ZIP '
La Quinta, eA 92,953
BOK
773
PAG
03"001
PRC
C
-
TWNi
RNG
SE-' -
."S
TRACT
LOT'
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Constr. fee
MOD
SB
-
TRACT NAME
OWNER NAME (L. F. MI)
Alt. Romero
CONTRACTOR -FIRM NAME - -
Owner /aui ldkm
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONE.
564-4666
LICNC N
,ARC/ENG FIRM NAME -
ADDRESS -
CITY/COMMUNITY/STATE/ZIP -"
PHONE N
-
90 7
LICNC N
USE OF PERMIT
80' of 61 High Redwood -Pence
BL'
ZON
'FS8.
SS8
SSB
RSB -
OFC
. ZONE ORD N.-.
LOT SZ
-£ND
., -SIDE: " X
Print Applicant/Agent Name
APPL/P.RMT
12-4-81L
.. -.
ALDG'
Permit to construct 801 of 61:
high Redwood fence, as per all
applicableobui.lding codes and
ordinances.
Plan Check fee
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Constr. fee
17.50.•
'SMI fee
.50
l •rte
FEE
-
90 7
w 4 VALUATION 1'j 0 0 0 0 0 0.
*. BLDG. DEPT. t
NO.
OPERATION DATE
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
39
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.
❑
OP'NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
t2A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water 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
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32• Final