0699 (BLCK)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.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class
Contractor
Lic. Number
OWNER -BUILDER DECLARATION: I hereby affirm that 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'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 fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
.O I. as owner of the properly, 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, thea
building or i mprovemnt 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.).
❑ I, as owner of the property, am ezculsively 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.).
0 1 aln exempt under Sec. - B. &P:C. (Attached Certificate).
i
Date .1 � � � Owner _�N-.>,. �i t. !, .-e� C ♦i'�^r'.
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. C.).
Policy No. Company
O Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building'Inspection Department or City Department.
Date Applicant
APPLICANT N ME (L, F. MI)
ADDRESSy Y/ —5 /A-, �I /
CITY/COMMUNITY/sTATE/ZI P
L A G?
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
BOK
PAG
PRC
C
TWN
RNG
SE
S
TRACT
LOT
P'
119 ��SO
MOD
SB
.t
i
TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHO/N_-e► EV, .1� /
s fo 7 s� •%
LICNC M
TOTAL
FEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD a
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 in 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:
❑ 1herebycertifythatnoexcavationfive(5j"ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
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.)
O 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 Addre
I 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 this application and state that
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 property for 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
fl S F DATE
� CJX
41A_1r/1--
-0/4x r/,g
,��,c
1T .Wcoa,Q 04 !4 AJ -
C'.✓DEJ
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119 ��SO
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i
9
Al ja
-. -
TOTAL
FEE
VALUATION -)-.5 r`,- 0(!�)
BLDG. DEPT.
26 Power Pole
27 Conduit
' 28 Service Entrance +
NO.
OPERATION DATE , INSPECTOR
NO.
I _,.-..,.,,OPERATION DATE INSPECTOR
29B Bonding
BUILDING APPROVALS
30 Fixtures
MECHANICAL APPROVALS
1
Set Back
•32• Final
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
Al
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
• 10
Fireplace P. L.
❑
43
Final
10A
-"Fireplace T.O.
❑
OP'N
NO.
ADDITIONAL INFORMATION
1
SEWAGE SYSTEM SIZE & LOCATION .
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
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
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
26 Power Pole
27 Conduit
' 28 Service Entrance +
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
•32• Final
STREET NAME
1717
-of
Tit� of Ka Quinta
jluitbin�- anb �sUfet� �ibi�sinn
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 78-445 HIGHWAY 111, LA QUINTA, CA
Use Classification POOL RETAIL Bldg. Permit No.
Group B2 Type Construction VN Fire Zone Use Zone CPS
OwnerofTuild��D. Gillingham/E. Schreck Address 78-445 Hwy. 111, La Quinta, CA
us e
_"17r!�5a Qu' a, C _
By.
Date; February 27, 1991
Building Official
POST IN A CONaTICuaU! PLACE