000913 (BLCK)PERMIT APPLICATION
City of La Ouinta
�r Department of Building and Safety
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
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS, DECLARATION: .1 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
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued. I shall not employ any person inanymannerso asto become subject to the Workers'.Compensation Laws of
and effect.
1 `rz
California.
License ClassLic. Numbers ?
Date r cI ''7_ '77-1E 4- Contractor' t �L_- t -d' ? L r I! l ,r ..-
Date Applicant
NOTICE -TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
- r �(('--,.Compensation
provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires.a permit to
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construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
suchpermittofile a signed statement that he is licensed pursuant to the provisionsoftheContractor'sLicenseLaw
01 hereby certify that no exc - avation five (5) or more feet in depth into which a peison is reqdir6d to descend, w ill 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, or -
,therefrom and the basis for'the alleged• exempt ion. Any violation of Section 7031.5 by any applicant.for a permit, h,
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z. Art, 2, Sec 341, Title 8, '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O 1. 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 hot employ anyone to'do work which would -require a permit from 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 permit to'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
ADDRESS
througlrhis own employees, provided that such improvements are not intended or offered for sale. If, however, the
❑ Division of Industrial Safety Permit No.
•, building or improverrint issoldwithin oneyearof completion, the owner -builder will have the burdenof proving that
Date Applicant '
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is 5 construction lending agency for the performance
0 I, as owner o1 the property, am exculsively. contracting with licensed contractors to construct the project (Sec.
of the work for which this permit is issued (Sec. 3097, Civ. C.).: I.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
'thereon.
Lender's Name
builds or improves and who contracts for such projects with a contractor(s) licensed pursuant to the
SSB
Contractor's License Law.).
Lender's Address
- .❑ I am exempt under Sec., 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 above -mentioned -property. for inspection purposes. °
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure; or a
f- .
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certificate ofbrkers' 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
❑ Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
❑ Certified copy is filed with the City Building Inspection Department or City Department.
construction, andauthorize a representative of the City of La Ouinta Department of Building and Safety to enter
DatApplicant
e
upon the property for which I have applied for this permit for the purpose of making inspections.
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APPLICANT NAME (L. F. MI) Kretz Co� ' - -
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ADDRESS .. .. ., •
40-950 Starlight lane
CITY/COMMUNITY/STATE/ZIP
Be= ida Dunes, CA 92201
JOB SITE AODRESS/SPACE
78-401 B.
CITY/COMMUNITY/STATE/ZIP • . 1 '
Ls Quinta, CA 92253
BOK
PAG
PRC
C
PLMS •
TWN
RNG
SE.
S•
TRACT
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MOD
SB
TRACT NAME
OWNER NAME (L. F. MI)
.CONTRACTOR -FIRM NAME - vv.�� ••�}�� + ��,�
Yzet�i Co s�.,Zuc im
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
Plan Ck Fee
LICNC II
'
ARC/ENG FIRM NAME• it
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE ,
-
LICNC ,
..
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
RSB
OFC
p ZONE ORD N..
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TOTAL
FEE
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END •'
•SIDE '
-0
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT
fl O N" A l 3
ATE
O9-5-84 ..
;j ExteriorrWall,
t
^9' p
j
and -Dai ��
,J.
Ceiling
,,,Lights
per asapproved
PLMS •
C%
.50
Plan Ck Fee
29.82.
Eleftrinialn
Permit rpe
50.50
'V
-
TOTAL
FEE
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BLDG. DEPT.
VALUATION 4,000.00
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
42Commercial Hood
10
Fireplace. P.L.
❑
43 Final -
10A
Fireplace T.O.
❑
NON ADDITIONAL INFORMATION
,- `' �% ), (�
7� /��
'
_ ...
'
SEWAGE SYSTEM.SIZE & LOCATION ".
11 Exterior Lath
12 Internal Lath`s%/��4/�
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