001052 (RER)PERMIT APPLICATION
City of La Ouinla*
Department of Building and Safety
APPLICANT NAME (L. F. MI)
Ybiave &scimw 0=mny
ADDRESS
73-338 RW M
This.permit becomes void if work not commenced within 180 days from date'of
issuance. OR, if work has been.suspencled or abandoned fora period of 180 days. -
-CITY/COMMUNITY/STATE/ZIP
'La Quinta, CA 92253
-CERTIFICATE OF EXEMPTION FROM.WORKERS'COMPENSATION INSURANCU This section need not be completed iF
-CERTIFICATE
.AICENSED'CONTRACTORS DECLARATION: 1-hereby..affirm that I- am. licensed: under provisions of Chapter 9
i the.pir�mit is. forone hundred ($100) o, less. I certify that in the performance of the work for which this permit is,
z .(commencing with Section 7000) of Division 3 o the Business and Professions Code, and my license is in full force...
- issued,:) shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number,
Date Applicant
,,'Date - Contractor.
NOTICE TO APPLICANT: If, after m.aking,this_Urtificati. of Exemption, you should become subject to the Workers,.
OWNER -BUILDER DECLARATION: .1 hereby affirm IhaI1 amlexempt from the Contractor'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.
construct, alter, improve, demolish, or repair any structures prior to.its issuance,*'also requires the applicant for
DIVISION OF INDUSTRIAL.SAFETY PERMIT CERTIFICATION:,
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contra.ctors License Law,
01 hereby certify that no excavatiorffive (5)'or.more feet in depth'into which a person is required to descend, will be
•(Chapter, 9 (c9mmencin g with se6iion 7000) of Division 3 of.the Businessand Professions Code) or that he is exempt,
made inconnection with -work a6thorized by this -per - rmI; and that no building:structure, scaffolding; falsework,,or.'
w
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a.permit
'applicant
demolition0 I - cl:Oiantling thereof,4011:156 more than thirty-six (36) feet high..(Chap 3.2. Grp,Z Art 2, Sec 341, Title 8,
subjects the O.):
to a civil penalty of not more than five hundred dollars (S500.):C.A.C.)
1, as owner of the property, or'my employees with wages as their. sole compensation, will do.the.work, .and the
0 As owner -builder: I will not employ. anyone to do -work which would require a permit frorn'the Division of
• structure is not intended or offered for site (Sec. 704, Business and Professions Code: The Contractor'�s License
Industrial Safety, as noted above, unless such person has a}permit to do, such work from.that division.
Law does not apply.to an owner of property who builds, or improves thereon, and who doe&iuch work himself or
0 Division of Inclustrial'Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. If. however. the
SL
building orimprovemnlisso within one year of completion, the owner -builder will have the burden of proving that
Date Applicant
he did not build.or improve.for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: Ifiereby affirm that there is a construction lending agency for the performance
1, as owner of the property, am exculsivelycontracting with licensed.contractors to construct the project (Sec:
^ of the work -for which.this permit is issued (Sec. 3097, Civ. C.).
7044.*Business and Professions Code: The Contractor's License Law does not apply -to an owner of property who
Lender's Name ' ..
builds'or improves thereon, and who contracts for such projects with a,cofitractor(s) licensed.pursuant to the
Contractor's License Law.).
Lender's Address
0 I'am exempt under Sec. B. & P.C. (Attached Certificate).
I certify that i have read this application and state that the above information is correct. I agree to comply with all
"batiOwner I '. I.. . . .
city and county ordinances and state laws relating -to building construction, and hereby authorize representatives
SIDE,
of this county to enter upon the.above:mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.)r
Signature of Applicant or Agent Date
Policy. No. Company
CERTIFICATE OF CO . MPLIANCE AND AUTHORIZATION OF ENTRY:, [,certify I have read this application and state that
0 Certified copy is hereby furnished.
the,information given is correct. I agree to comply wilh,alFstale! laws and county ordinances relating to bu idling'
0 Certified copy is filed with the City Building Inspection Department or City Department.
construction, and authorize a:representative of the City of La Quinta Department of Building and Safety to enter
'which
upon.the prop6rly for l,havi'a0p!ied for this permit for the. purpose of making inspections.
Date Applicant
.. . ^ . t-11
a, u, pliNI t Sr Date
Si ' f e of Ap AgW
0
APPLICANT NAME (L. F. MI)
Ybiave &scimw 0=mny
ADDRESS
73-338 RW M
CITY/COMMUNITY/STATE/ZIP
Palm Desert, CA 92270
JOB SITE ADDRES&SPACE
53-325 Avenida 0bregm
-CITY/COMMUNITY/STATE/ZIP
'La Quinta, CA 92253
SOK
P
PRC' -
C
RNG _[SE
TRACT
I LOT
.1 MOD
.SB
TRACT NAME
OWNER NAME (L. F. MI)
Derit: of Hudd
CONTRACTOR -FIRM "ME .. — . . . .
Prev.- Cwner
ADDRESS
Job site address
CITY/COMMUNITY/STATE/ZIP
La Qwiinta, CA 92253
PHONE 0
LICNC #
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE R
LICNC 0
USE OF PERMIT
Fire llama oge repair
SL
ZONFSB
SSB.
SSBT
RSB
OFC..
ZONE ORD -4:
-LOT SZ
END
SIDE,
Print Applicant/Agent Name
APPUPFIMT.
This p
peimit
Misc.
Permit
1
n! '7DA
, TE
-15-81
"
unit to replace expired
# 0414. See original.
6.00
64.25
TOTAL
FEE 1 .ham
VALUATION
'BLDG. DEPT.
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.
❑
NO
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A 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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B. Bonding
30 Fixtures
31 Service
32 Final