MISC (1051)irte- '� � xs • -• � �
_
..^,k SFr •'' PERMIT APPLICATION
City of La Ouinta "
Department of Building and Safety
CITY/COMMUNITY/STATE/ZIP
I,a Cuinta CA 92253
BOK -
•`'� • Y. '.• �.• e'�' �',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. _
frig _ ,
C 1•a -- ir•r•, :,;k.;...:`''i
�.'.+' .Y•.�y . • ""'t.'
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if .
• LICENSED CONTRACTORS DECLARATION: I hereby, affirm -that I 'am licensed under provisions of Chapter 9 -
I the permit is for.one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
= (commencing with Section 7000) of Division 36t the Business and Professions Code, and my license is in full force '
issued. I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of
•'andeffect.s - '- -r'
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 am exempt from'the Contractor's License law dor the`
c„ 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 deemed revoked.
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 statement that he is licensed pursuant to the provisions of the Contractor's License Law
'aflher'ebycertify thatiioexcavationfjve(5)ormore feet indepth into whichapersonisrequiredtodescend, will be
(Chapter 9(commencing with.section 7000) of Division 3 of the Business and Professions Code) or that he is exempt.-
made in connection with work authorized by this permit, and that no building structure, scaffolding..falsework, of
•,. therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permik,.;r
demolition or dismantling`thereof,'will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8, -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):=ii'•c+.
C.A.C.)
. rO1 as, owner of the property, or my employees.with wages as their, sole compensation; will do the work, and the'.,...
- ❑ As -owner -builder: I will not employ anyone to-do work which would require'a permit froin 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 a permWto 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 himself or
' through his own employees, provided that such improvements are not intended or offered for sale: If, however, the
._ ❑.Division of Industrial Safety. Permit No.
building orimprovemni is sold 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.). y }�-- ,e ,'
CONSTRUCTION LENDING AGENCY: I hereby affirm thatUere is a construction lending agency for the performance
o I, as owner of the property: am exculsively contracting-withticensed 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
rLender's Name
builps or improves thereon, and who contracts for such projects with a contractor(s).licensed pursuant -to the
LOT SZ
Contractor's License Law.)..
Lender's Address
O I am' exempt under S_' • ' B:'8 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
Da��% 'vJ1 Ownerec.
' d '•Owner'
te
_ city and county ordinances and state laws relating to building construction, and hereby authorize representatives
WORKERS' COMPENSATION DECLARATION: 11 hereby affirm that I have a certificate of consent to self -insure: or a
of this county to enter upon the above-mentioned property for inspection purposes.-
. •
Certificate of.Workers' Compensation Insurance', or a•certified copy thereof (Sec. 3800. Lab. C.). --
1.+ !/ l til f (� ,�^ 4� �t
Signature of Applicant or Agent Date
• Policy jf ll Company .: i / r �' r -�
- CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplication and statethat
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.:. '
' construction, and authorize a'representative of the City of LA 0uinta Department of Building and Safety to enter
//" I s �� `
Date Applicantr.
upon the property for which'l•have applied forrthis'permit for the purpose of making inspections.
o
Signature Ot Mrpficant or.Agent Date
V �iy��
Print Applicant/Agent, ame /
APPLICANT NAME (L, F: MI)
Pce Awning
ADDRESS • ... .. .. .. .... '
83-559 Indio Blvd
(�
CITY/COMMUNITY/STATE/ZIP - 91,2V
Bx} ,.CA
JOB SITE ADDRESS/SPACE
78--990 Miles Ave. Sp. 21
CITY/COMMUNITY/STATE/ZIP
I,a Cuinta CA 92253
BOK -
PAG
PRC
C
TWN
RNG
SE
S
TRACT
LOT
MOO
I Sel
-
TRACT NAME '
Vista Dunes Trailer Park
OWNER NAME (L. F. MI)
Tata Hall
CONTRACTOR -FIRM NAME-
77��
Z'f,,..��..,,..��
f../ licant .
ADDRESS • w
above
CITY/COMMUNITY/STATE/ZIP '�•{�,�� r
�JboVe
PHONE a
:347--16311- 1
LICNC II
273891.
ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONE II ` -
,_
LICNC II
USE OF PERMIT Awning,,Toic � & Rmlosure .
2 tJliil Y< liLA.
`
BL
• ZON
- FSB
: 'SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
R
END
SIDE
APPL/PRMT �y DATE .'
�. ! 11-15-84,��.
Permit to install a 9 x` 37 Awning,
a 8 x 36 porch and a 8 x 36-x 6 enclostxe
as per approved plans.
Pentut Abe 40.00.
W TOTAL
FEE 40.00 •
VALUATION 4W."0`7'.;'
- 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.
❑
NOADDITIONAL INFORMATION
/
11// o2 7/ F
111 !!!
-
i
e 0
•
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 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
•q
ELECTRIC APPROVALS
REAR -OF PROPERTY LINE
P/L Pel
STREET NAME
26 Power Pole
27 Conduit
28 a Service Entrance
29' Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
KID
CITY 6
-ADDRESS STATE. PARI( NAME PARK�
'CUSTOMER
"N A m SPACE NO. SIZE. -
A
T
STREET
-SPA':NO. "
'WE THE UNDERSIGNED :HEREBY APPROVE THE INSTALLATION OF THE A'BOVF %TRlI(-.T(lRF(S) AND AGREE THAT THE INFORMATION IS CORRECT
j e. `AND IN.ACCORDANCE WITH APPLICABLE PROVISION OF Tr+F- HEALTH AND SAFETY CODE AND RELATED RULES OF THE STATE OF CALIFORNIA.
TENANT PARK MANAGER
7-
SIGNATURE. n GSIGNATURE
A
A -2-72
A