0645 (RC)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
�77
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;complelRd if '
' LICENSED CONTRACTORS' DECLARATION: I hereby affirm that I am licensed under provisions. of Chapter 9
:•the permit is for one hundred ($110) o. less. I certify that in -the performance of the work for which this perti is
(commencing -with, Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force s
issued, l shall not employ -any person in any mannersoasto become subject tothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date. - .Contractor -„ 4 ...,.••_ —NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
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OWNER=BUILDER DECLARATION: 'I hereby alfirrn that I am exempt from the Contractor's License Law for the "
, Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall '
following'reason (Sec. 7031.5. Business and Professions Code:.Any city'or•county which requires a. permit to
be deemed revoked.
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 to file a signed statement that he.is licensed pursuant to the proyis ions of the Contractor's License Law
O'Iherebycertify that noexcavation five (5)ormore feet indepth into which aperson isrequired todescend, will be
(Chapter 9 (commencing with section 7010) of Division 3 of the Business and Professions Code) orlhat 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 fora permit.;;,
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, -
subjects the applicant to a civil penalty of not more thandive hundred dollars ($500.):
C.A.C.) '
0 1. as owner of the property, or my employees with wages as their sole compensation, will do the work; and the
0 As owner -builder, I will not 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
ARC/ENG FIRM NAME
• through his own employees, provided that such improvements are not intended or'otfered for sale. If, however, the '
[I Division of Industrial Safety Permit No.
building or i mprovemni is sold within one year of completion. the owner-builderwil I have the burden.of proving that
Date Applicant
he did not.build or improve for the purpose of sale.). ''tic
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0 I, 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.). - '
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
O I•am exempt - under Sec. B. 8 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 If Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
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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, ora
-
certificate of Workers' Compensation Insurance -, or a certified copy thereof (Sec. 3800. Lab. C.).:
Signature of Applicant or Agent Date
Policy No. Company
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 have read this application and state that
❑ Certified copy is hereby furnished. '.
the informatiorogrven is correct., I agree to comply with all state laws and county ordinances relating to buidling
• ❑ Certified copy is filed,with the Cit Building Inspection De artment or City'De Department. _
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constructio , and authorize-a'repiesentative of thVity of La Ouinta Department of Building and Safety t enter
Applicant
ry.
upon t e p�erty for whi haves apJp iedsfgr-this per" irtt�for the purpose of making inspections.
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Date
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Signature of Appticant or•Agent Date
Print Applicant/Agent Name
APPVPRMTDATE
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ADDRESS
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CITY/COMMUNITY/STATE/ZIP '
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TRACT NAME '
OWNER NAME (L, F. MI)
CONTRACTOR -FIRM NAME -
ADDRESS -
CITY/COMMUNITY/STATE/ZIP -
PHONE _IIJ • / ®
LICNC 0
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP • • '
PHONE • -
LICNC U
USE OF PERMIT -
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SSB
SSB
RSB
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END
SIDE -
APPVPRMTDATE
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RPC
S'14 A , Sp
MAR, 14 1984
Ci of La Quint
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TOTAL ; .�
FEE •
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. •• � VALUATION
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPECT'09
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
FireplaceT.O.
❑
OWN
NO. ,ADDITIONAL INFORMATION
N O.
3'
,, 4& 7
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"
SEWAGE SYSTEM SIZE,& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
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
i
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
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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
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This Certificate issued pursuant to the requirements of Section 306 of the- Uhiform, Building'
Code certifying that at the time of issuance this structure was . in compliance with the various
ordinances of the City regulatinIg buildingtconstruct ion or use, For th.e.folidwing:
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BUILDING ADDRESS - .7 457• H 1:11"
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Use Classification'645
Of f ice Bldg. Permit No.
Group B2 Type Construction VN Fir* Zone yes I -zone CPS
Owner of Building Dennis Becker Address 78-457 Hwy 111.
City La Quinta, CA 92253
Tom Hartung
By;
Date:— March 13, 1984
Building Official.,
PM-IN'A 009"CUOUS' PLACU.,
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