Loading...
0295 (RC)PERMIT APPLICATION /) 3 5Q City of La Duinta Department of Building and Safety This permit becomes void if work not commenced within 180 days from date of issuance. OR; itwork has been suspended or abandoned for a'period of 180 days. LICENSED CONTRACTORS' DECLARATION: Ihereby affirm that. I am -licensed under provisions of Chapter 9. (commencing with Seclion 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 fi• OWNER -BUILDER DECLARATION: lhereby.affirm !that I am e><empt 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 construci,'alter, improve; demolish; or repair any structure, prior to -its issuance, also requires the applicant for such permit to file a signed statement.thath he is licensed 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) 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 t, 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 i mprovemnt.is sold within one year of completion, the owner -builder will have the burden of proving that hie d/id,rloI build or improve for the purpose of sale.). O 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.). _ v� . 0 1 am exempt under Sec �' ' '/". B. 8 P.C. (Attached Certificate). Oat, X ��' �% nerX WORK Ow S' COMPENSATION DECLARATION: I hereby a�m that I have a certificate of consent to'self-insure, or a' certificate'of Workers' Compensation Insurance Ar a certified copy.thereof (Sec.'3800.'Lab.'C.). Policy No. Company O 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)- •• ' • ' H�derfson %Q ue/se�vr�e. ADDRESS / /U �"� - - ✓c���� CITU/ 0MMUNITY/STATE/ZIP - ��l�iE 914 S JD..J e SPAr:E .. . CITY/C MUNITY/STATE/ZIP - '- BOK PAG PRC C` - TWN• RNG SE, S TRACT - .LOT MOD SB ' TRACT NAME OWNE NAME (L F, MI) J - ,eL Urn/ems �.lrg x� CONTRACTOR -FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE a LICNC 0 • - ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE II [ LICNNC 8 USE /�7I�J BL _1 Sm JaY ZON City of La Quinta FSB .SSB SSB RSB - OFC ZONE ORD N LOT SZ END • ' SIDE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed If 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 i n any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this -Certificate of 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, w ill 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)4eethigh, (Chao 3.2, Grp 2, Art 2, Sec 341, Title 8. 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. r o. O 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 Name Lender's Address ... 1 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 herebyauthorize representatives of this'county to enter upon the above-mentioned property forinspection purposes. Signature of Applicant or Agent ' Date ff CERTIFICATE OF' COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read Misapplication and state that t the information given is correct. I agree to comply with all state laws and county ordinances relating.to buidling construction,.and authorize a' representative of the City of La Ouinta Department of Building and Safety to enter upon the propertyfor which I have applied for this permit for.the purpose of making inspections' . . Signature of Applicant or Agent Print Applicant/Agent Name Date APPL/PRMT I'1 DATE �4�� Or4c 4.S' S�©clJj7'CIO o 4„ _1 Sm JaY City of La Quinta TOTAL a.. FEE O 7, s` BLDG. DEPT. 'VALUATION�� ��I •• 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. ❑ NON ADDITIONAL INFORMATION /� Dom_ e .SD���-• R �i,_ n SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick 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 STREET NAME P/I 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final . M III �&'A1VVeAtit kzi V, of of '14a Quinta itt�tuu5�tP tt talc i; This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS 78-353 Hwy 111 Use Classification Office Bldg. Permit No. 295 Group B2 Type Construction VN Fre Zone Use Zone CPS Owner of Building Anderson Travel Service Address 78-353 Hwy 111 City La Quinta, CA 92253 By Dote: November 29, 1983 Building Official POST IM A OONe?ICUOUS PLACE