001395 (RC)LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Div
and effect.
License Class ic. Number %
Date ' Contractor
OWNER -BUILDER DECLARATION: I hereby affirm t at 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 licensed pursuant to the provisions of the Contractor sLicense Law
(Chapter 9 (commencing with section 7000) of Division 3 oithe 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 ($500.): ' .
01, as owner of the property, or my employees with wages as their sole compensation, will do the work: and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or,
through his own employees, provided -that such improvements are not intended or offered for sale. If, however, the
building or implovemnt, is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve, for the purpose of sale.). *-
0 1, as owner.of.the.property, am.exculsively contracting with,licensed contractors to construct,the project (Sec: -
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who. =
builds or improves thereon, and who contracts for such projects with a coniractor(s) licensed pursuant to, the
Contractor's License Law.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date ' Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate'of Workers' Compensation Insurance , or a certified copy thereof (Sec: 3800: Lab. Q.
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days. '•�
CERTIFICATE OF EXEMPTION FROM WORKE$S' COMPENF:ATION INSURANCE: This section need not be completed if
ON: I hereby affirm that I am' licensed under provisions of Chapter 9 the permit is for one hundred ($100) o• less. I certify that in the performance of the work for which this permit is
ision Sof the Business and Professions Code; and my license is in full force issued. I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws;
%' ) California. -
Policy No. Company
0 Certified copy is hereby furnished.
0 Certified copy is'filed with the City.Building Inspection Department or City Department
APPLICANT NAME (L. F. MI) D Wirakd
T �'y�
ADDRESS • 255 N . El Cillo Rd.
CITY/COMMUNITY/STATE/ZIP Pa M Spr __ s, CA 92262 .
JOB SITE ADDRESS/SPACE 78-401 Riy 111
CITY/COMMUNITY/STATE/ZIP iJQQWmta,. CA 92253
BOK.
PAG
PRC
C
-
TWN
RNG
SE
'S
TRACT.
LOTMOD
Elect. Flee
31.00
SII
I SB
..
TRACT NAME Pla ! -
j�
OWNER NAME L. F. MI) ' -
CONTRACTOR -FIRM NAME
applicant'
ADDRESS _ b6ie
CITY/COMMUNITY/STATE/ZIP a1.J1.JVG
PHONE •
LICNC .
f
ARC/ENG FIRM NAME -•
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICNC M
29$ .64
USE OF PERMIT Partitions
i
BL
ZON
FSB
SSB
SSB
RSB
'ZONE ORD a
LOT SZ,
END
SIDE
k
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
~Compensation provisions of the Labor,Codp, you must forthwith comply with such provisions or this permit shall
be deemed revoked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 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, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2, -Art 2, Sec 341, Title 8.
C.A.C.) ..ip`.. .
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 Name
Lender's Address
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 thisapplication and statethat
the information given is correct. I agree�to,complywith all state laws and county ordinances relating to buidling
construction, and authorize a'represer�lativ�ithe City of La Ouinta Department of Building and Safety to enter
upon t property"for--which I have adpliedforthis er It fo he purpose of making inspections.
f Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT n n l I �
nnn...777
_2 B
�. g�G •
vv v..7 • • .
Penult to constnict.partitions asper
approved plans and applibibble codes
and ordinances.
Mech.iFee
28.50
Plan Check Flee
97.274
Const. Fee
140.51
Elect. Flee
31.00
SII
�� 1.37
e
.1'
f
t
TOTAL
FEE
29$ .64
A 1 3 8 3 5 30 2
~r� VA PyTION 19,170.00
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
` X
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.
❑
NO.
NO.
ADDITIONAL INFORMATION
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 l
PLUMBING APPROVALS
15 Ground Plumb N
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
PSL 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
1
}
KID', q�'9bC�i�a�a1
�
opiq q y g �gp�B�p�ggo�,�pp O \ _
� :�+i � � � mca� /��� 5.7' a t�B 1. O °war�/r,+ �r o C G7 y oaQ ''�• , ,Y�/a �,t: �lDo �rG�,� �--rid/7
ViNif aU V-1 A-0
' 1
a
Io
ev ? rld
A®
H
I
�,
1
r
n
1
(IIX
t�M
ll
`l�,
—aell
4
p
9�
i
INJ
E
�i
O
`l�,
—aell
4
p
9�
(9.oa9z2`Z
00*
CiTY OF LA QUINTA
Adi
5 1 -
communilly Develop!
QA
S-L!r3jr0r.'� T 1 1
DKIrt
o �
1N
_4K
//-xiz vv,�4 /v
1 jo
VpppAOVED p"-aN
v
a
rs
i
(f )-C11 rT ti
Tit� of (Quinta
lN it t*tb in g anb �'afet� 43ibir�ion
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 78-401 Hwy 111 '
Use Clossificotion Office Bldg. Permit No. 1395
Group B2 Type Construction VN Fire Zone Use Zone CPS
Owner of Building Don Howard Address 255 N. El Cielo Road
City Palm S rin s, Ck,92262 By'.Tom Graham
v �n Dote: June 21, 19 8 6
Building Official
POST IN A CONIMICUOUS PLACE