SFD (0150)77703 Avenida Madrugada
0150
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
-1 - '? 1D,3
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 180 days.
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 full 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 asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9(commencing with section 7000)of Division 3 o 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 ($500.):
0 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 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 improverrint 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 1, 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 - Owner
B. & P.C. (Attached Certificate).
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.
li:Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Departmentor
'or , City,L` r -Department.
Date Applicant
APPLICANT NAME (L. F. MI)
DATE
ADDRESS
CITY/COMMUNITY/STATE/ZIP
2 1-3
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
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TRACT.IT,E,
OWNER NAME (L. F, MI)
CONTRACTOR -FIRM -C _ NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
(n
PHONE,
LICNIC
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
LICNQ N
USE,OF PERMIT'
BL
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FSB
SSB
SSB
RSB
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ZONE ORD .
R E C E V 111 11-3
J U N 2 0 1983--
I LOT SZ
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City Of La Quinta
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' OMPENSATION INSURANCE: This section need not be completed it
the permit is for one hundred ($100) o. 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.
DateApplicant
NOTICE TO APPLICANT: If, after making this Gertificatdof 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:
0 1 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, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B.
C.A.C.)
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.).
Lender's
Lender's
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=mentionecl 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`represenlative of the City of La Ouinta Department of Building and Safety to enter
upon the properly for whic i f have ipPI ' ied for this permit for the purpose of making inspections.
Signature of Applicanl'or Agent
Print Applicant/Agent Name
Date
APPLIPRMT
DATE
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3
A o Clcowo
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J f,
R E C E V 111 11-3
J U N 2 0 1983--
Ll
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City Of La Quinta
TOTAL
FEE
VALUATION
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
NO. OPERATION I DATE
BUILDING.APPROVALS
1
Set Back
2
Ftgs & Frms
2A
Slab Grade
3
Steel
4
Grout Blocks
5
Bond Beams
6
Roof Deck
7
Framing
8
Vents
9
Garage Fire Wall
10
Fireplace P. L. ❑
10A
fireplace T.O. ❑
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 I /Q/'/ f-3
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
INSPECTOR NO. OPERATION I DATE INSPECTOR
MECHANICAL APPROVALS
33 Ventilation System
34 Plenums & Ducts
T/y 35 Furnace Compart.
36 Inlets & Outlets
37 Combustion Air
38 Compressor
39 Appl: Clearance
40 Fire Damper
41 Smoke Detection Device
42 Commercial Hood
43 Final
OPEN ADDITIqjNAL INFORMATION
/jj X. I 2Z 4, 7
V'
, -
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/4
ELECTRIC APPROVALS I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire ; v.
°5
29B Bonding
30 Fixtures:':. .. y
31 Service
32 Final
SEWAGE SYSTEM SIZE & LOCATION
Tank Pit L. Line
REAR OF PROPERTY LINE
STREET NAME