001282IIIIIIIIIIIIIIIIIIIIIIIII 67
IE
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
i(05-tic2Aa
• •This permit becomes void i1 work not commenced within 180 days Irom date of issuance, OR, if work has been suspended or abandoned for a period'of 180 days.
. . 1
LICENSED CONTRACTORS 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 lull force
and effect.
License Class Lic Number
Date • Contractor
•
OWNER -BUILDER 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 county 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 file a signed statement that he is.ficensed 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)orthat he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byany applicant for a permit
subjects the applicant to a civil penalty o1 not more than five hundred dollars ($500.):
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 far sale (Sec..7044. Business and Processions 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 improvemnt 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. •
Date •
/1 "8 8 P C (Attach ed•Certificate).
Owner ti ":>7--/-.4-e;----Ke / oz -t..4.4_,)••
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.). .
Policy No. Company.
, 0 Certified copy is hereby furnished. •,
' 0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L, F. MI) atlantic) MrL^S
ADDRESS 54-2�65AvenidaAlvarado
CITY/COMMUNITY/STATE/ZIP
La Qpinta, CA 92253
JOB SITE ADDRESS/SPACE .
&We
CITY/COMMUNITY/STATE/ZIP •
same .
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Pz35
P U25
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TRACT
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Permit Fee
MOD
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!4I Fee -
TRACT NAME •
OWNER NAME (L. F, Mpis n ApPl
CONTRACTOR-FIRM NAME iC�anLL.
�1t
ADDRESS b
above
CITY/COMMUNITY/STATE/ZIP
6.1►.JL7YG
PHONE Ir -
•
LICNC II
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 0
USE OF PERMIT B]. ck iajj. ,
81
ZON
FSB.
SSB
SSB
RSB
' ZONE ORD N '
,
•' LOT SZ
TOTAL
FEE
•END
SIDE
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
• the permit is for one hundred (5100) o,' less:) 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 Applicant
NOTICE TO'APPLICANI:-)f, after making this Certificatelof 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:
O I 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, fa)sework, or
demolition or dismantlidg thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2. Sec341. Title 8:
C.A.C.) rt t t •
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 Safety Permit No
Date • ' Applicant
'CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.). k
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. I agree to comply,with all state laws and county ordinances relating to buidling
construction; and•authorize a' representative.ot fhe City of La Ouinta Department of Building and Safety to enter
upon the,property for=which I have applied for this pe ml forthe purpose of making inspections.
1/
/<- do �>�. (s 2 -
ter. Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPVPRMT owl 2R2
1"E11-85
Elm.
•
Permit to construct 322 ft of 6high
block wall as per, approved plans.
Plan Check Fee -
48.42
Permit Fee
74.50
!4I Fee -
' .60
TOTAL
FEE
•
•
123.52
A0266
BLDG. DEPT.
11
1
VALUATION
3.; 5.2 CK , V
, `i J -).
•
NO.
OPERATION
1 DATE
I INSPECTOR
NO.
OPERATION '
I DATE' IINSPECTOR
BUILDING APPROVALS
'MECHANICAL APPROVALS:
1
: Set Back
-33
•• Veritilation System - •
2
Ftgs& Frms
/�� �S
- /1
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. MI
43
Final
10A
Fireplace T.O. MINPON
ADDITIONAL INFORMATION
.
•
,
SEWAGE SYSTEM. SIZE.& LOCATION
11
Exterior Lath
12
.Internal Lath
12A
Drywall
13
Finish Grade
. INSULATION
Thick
V R
Value:
7A
Walls (Batts)
12B
Ceiling (Batts)
12C
Ceiling (Blown)
14
Final
/
-`�!/U�i
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•
. REAR OF PROPERTY LINE
ELECTRIC -APPROVALS
;26
Power Pole
P/L
P/L
- .
•
.
`27
Conduit
28
Service Entrance
29
+
, . Wiring
29A
Grounding Wire
296
Bonding
30
Fixtures
31
Service •
32.
Final
STREET NAME
100'
r- 7 '
5'f2SAv A/izdo
Ofl,4,t'Do Ce/?Tej S(q•//ft p.3
ti7:/.7.
Hovst
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