001156 (RC)PERMIT APPLICATION ^ St y
City of La Ouinta ! U
Department of Building and Safety
,,This permit becomes void if work not commenced, within 180 days from date.of issuance. OR, it work has been.suspended or abandoned for a period of 180 days.
1 • . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that .1 am licensed under provisions of Chapter 9 the permihis for one hundred ($100).0. 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 in any manner so as to become subject to the Workers'CompensationLaws of
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`Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
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 courtly which requires a permit to
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 do file a signed statement that he is licensed pursuanttothe provisions ofthe Contractor's License Law 01 hereby certify that no excavation five (5) or more feet in depth into whicha person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat 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 exemption. Any violation of.Section 7031.5 by any.applicant for a permit 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 penally of not more than five hundred dollars ($500.): 1 . C.A.C.)
❑ 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 not employ anyone to do work which would require'a permit from the Division oV
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, add 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 or improvemnt 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.). CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0- 1. as owner of 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 Lender's Name
builds or improves thereon; and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). Lender's Address
❑ 1 am exempt under Sec. ✓ 7 . B_8 PP.CCo Attached Cerlific te). I certify that I have read this application and state.that the above information is correct. I agree to comply with all
Date Ownecv/ � +� :r��" '�`'� '" 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
certificate ohWorkers' 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 1 have read this application and state that
• Certified copy is hereby,furnished. the information given is correctrl 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: arid aut�grize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the pro perty fo .Which hav applied for this perniit•for the purpose of making inspections.
Date Applicant c
Signature of Applicant or Agent Date
APPLICANT NAME (L, F. MI) Hsaltbm Dental
ADDRESS
1940 IS. Helm
CITY/COMMUNITY/STATE/ZIP '_ , CA 93727
JOB SITE ADDRESS/SPACE 78-40 7.
1 111
CITY/COMMUNITY/STATE/ZIP,(,•J
Ia Quinta, CA 92253
BOK
PAG
PRC-
_C
•TWN
Plumbing Fee 48.00
RNG
SE
S
TRACT
LOT
PA I ^ DEC 2 W.
MOD
..SB
'/�•/�•
TRACT NAME U
Plaza is Quinta Bldg.
OWNER NAME (L. F. MI) George ' Fisher ,
CONTRACTOR -FIRM NAME Omer'
ADDRESS ,.,oveM
ab
CITY/COMMUNITY/STATE/ZIP ,
above _
PHONE .
LICNC 1
ARC/ENG FIRM NAME
RR.H.a VlatterS
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC •
USE OF PERMIT
Dental office and lab
BL
ZON
FSB
SSB
SSB I
RSB
OFC,
ZONE ORD V
LOT SZ
END
SIDE,
Print Applicant/Agent Name
APPUPRMT■ ✓♦.115 fi 12 -a -S4 gIDG.
Permit to do interior alterations to
be a ental office and lab as per
approved plans.
Mech. Fee 8.00
Plan Check 135.26
Oonst. Fee 146.50
Flect. Fee 28.00
SMI Fee 1.47
Plumbing Fee 48.00
Building not to be open for business until
Occupancy Certificate is issued by the
Building Department.
PA I ^ DEC 2 W.
TOTAL
367.23
BLDG. DEPT.
VALUATION 20,000.00
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
42 Commercial Hood
10
Fireplace P. L.
❑
43 Final
10A
fireplace T.O.
❑
NON 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
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
�J
II II
I
Tit� of '14tt ouinta
llltitbing rznb �Safet�r 13ibryaiun
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 buildings construction or use. For the following:
BUILDING ADDRESS 78-401 D Hwy 111
Use Classification Office Bldg. Permit No. 1156
VN
Group B2 Type Construction Fire Zone Use Zone CPS
Owner of Buildinq George Fisher Address 1940 N. Helm
City Fresno, CA
By; Tom Hartung
Date: April 19 1985
Building Official
POST IN A OON8"C000S PIAC[