0720 (BLCK)` PERMIT APPLICATION
ti,a., rte; City of La
Duinta
Department of Building and Safety y"
CITY/COMMUNITY/STATE/ZIP- -
La Quinta, k 92253
BOK
j; 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.-
PRC
CERTIFICATE OFEXEMPTION FROM .WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
LICENSED .CONTRACTORS, DEC ARATION.' I hereby. •affirm'that I am licensed under, provisions of. Chapter; 9
- Ihepermit is for one hundred: ($100) o: less..l certify that in the performance of the work for which this'permit is. ' -
(commencing.withSection 7000) of.Division 3 of the2Business-and Professions Code,and my license is in full force
issued,Ishallnotemployany.personinanymannersoastobecomesubjectto,theWorkers'CompensationLawsof..
and effect.
California.
License Class Lic. Number
Date Applicant -
•: Date Contractor - _ .,
. NOTICE TO APPLICANT:.If, after making this Certificate of Exemption; you should become subject to the Workers' -• .
OWNER`BUILDER DECLARATION:.I hereby affirm that I ain exempt Irom the Contractor's License Lawafor the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
'
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires. a permit to '
be deemedlrevoked;
construct, alter: improve. demolish, or repair any structure, prior to its issuance,.also requires the.applicant for .
DIVISION OFANDUSTRIAL SAFETY PERMIT CERTIFICATION:
• such permit to file a signed statement that he.is licens,ed.pursuapt to the provisions o!.the Contractor's License Law.
; : O 1 hereby certify that ndex6vation five'(5) or more f6et in depth into which a'pirson is'requir6d to descend, will be. -
(Chapter 9(commencing.with section 7000) of Division 3ofthe Business and Professions Code) or that.heisexempt
-made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or ^
• therefrom and the basisfortthe alleged exemption. Any violation of'Section 7.031.5 by.any applicant -for a•permit
demolition,or dismantling thereof, will be more thamthirty-six(36) feet high. (Chap 3.2; Grp? Art2, Sec341; Title8:-
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): 4..•�;*_:.
CITY/COMMUNITY/STATE/ZIP
0;,1: as owner of the property, or my employees with wages. as their sole compensation, will do the work, and the _
p As owner -builder, bwill riot employ -anyone to do work which would requiie a permit from the Division of .
structure isnot intended or offered for sale (Sec. 7044, 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 tri owner of property who builds, or improves thereon„arid who does such work himself or
e'
through his'own employees. provided that such improvements are not intended or offered for sale. It; however, the ,.,_.O
Division of Industrial Safety Permit No.
building or improvemnt.is sold within one year of completion, the owner -builder will have the burden ofprovingthat_.
Date= Applicant..
. did not build or improve for the purpose oesale ).,.•
CONSTRUCTION LENDING AGENCY: I heieby affirm that there is a construction lending agency for the performance
0 I, as owner of.the property, am exculsivefycontracting with licensed contractors to constructAhe 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 contractor(s) licensed pursuant to the ' '
r
Contractor's License Law.). s.
Lender's Address
:• ❑ 1 am exempt.under Sec. B. 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
.. '
Date' Owner '
-city and county ordinances and state laws relating to building construction, and hereby.authorize representatives
of this county to enter upon the aboJe=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.).
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 comply with all state laws and county ordinances relating to buidling;
>-O Certified.copy is filed with the City Building Inspection Department or City '• Department. a Cj
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
- ..
'Applicant
upbo the property for which I nave'applied loi this permit for the purpose of making inspections: -.
Date
—
A - A/ sem^ ., /) `— }
Signature of Applicant or Agent Date
Print Applicant/Agent Name
TAMES ( MI)
APPLICANT Lyons
.L -
�Ons
ADDRESS... ... ..... .. .._ ,... ...
ADDRESS
1409 W. Franeisquito.
CITY/COMMUNITY/STATE/ZIP- ..-
W. Covina, CA 91790
JOB SsAc
51=$30AV MCP
CITY/COMMUNITY/STATE/ZIP- -
La Quinta, k 92253
BOK
PAG
PRC
C
TNM .'
RNG
SE ..
S
TRACT' -
-' LOT
—TOTAL
L
FEE-
MOO
SB
•+ -
TRACT NAME .. •^ -
OWNER NAME (L. F. MI( .. ....
SMS
CONTFIACTOOR-FIRMNAME
TFtlAR-BAME-R '
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE .
564-1109'
LICNC.1
-ARC/ENG FIRM NAME -.
ADDRESS - A.
e
CITY/COMMUNITY/STATE/ZIP
PHONE N'.
-
LICNC. N
USE OF PERMIT
Book, Carden Wall
BL
ZON
FSB
I SSB'
SSB
RSB
OFC...
- ZONE ORD'.;,. q�
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LOT S2
..
° END
SIDE ,
'APPUPRMT �.Cl DATE r -
,, 5-15-84 ffid1�.
Peimit to build 146” of 6' and 51' of '
P] ons
'Block Garden' Wall as p,,,e�ar
/approved
,.
and Applicable codes Ordinances.
50' of rear block wall to have 6- 2° steel..
pines at 101" ` moart- to stand 5' above 6'
black wrall to. hold m trees CMX no
fenc6 ' between pipes above 6'
—TOTAL
L
FEE-
VALUATION 1,20.00. '
BLDG. DEPT.
r -ti
P`
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
Ad -
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
P/L P/I
STREET NAME
26 Power Pole
27 Conduit .
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 • Service
32 Final