001295 (BLCK)J - PERMIT APPLICATION +
City
of La Quinta
Department of Building and Safety - !;
CITY/COMMUNITY/STATE/ZIP _ - -
la Quinta, CA 92253
BOK
' s This permit becomes void if work not commenced'within 980 days from'date of issuance, OR, if work has been suspended or abandoned for a -period of 180 days.*'- 'r
• .,
.r CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENS.TION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby. affirm that I am licensed under provisions of Chapter .9
-`the permit is for one hundred ($300) It, less. I certify tha- in the performance of the work for which this permit is
' (commencing with Section 7000) of Division 3 o the Business and Professions Code, and my license is in full force • ' ',.
.issued, I shall not employ anyperson in any mannerso asto become subject to the Workers' Compensation Laws of . .
and effect.
California.
.License Class Lic. Number. f�`� .`r
Date ' Applicant
• Date - Contractor ' �`�J '- ' �•7:'
NOTICE TO APPLICANT: If; after making this -Certificate d.Exemption, you should become subject to the Workers;
OWNER -BUILDER DECLARATION: I herebyafjirm that I am exempt from the Contractor's license Law for the •^,
Compensation provisions of the Labor Code, you must fathwith,comply with such provisions or this permit shall
t.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit
- be deemed revoked. t
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for ...
DIVISION OF INDUSTRIA[ SAFETY PERMIT CERTIF.ICATICV:,
such permitto file asigged statement thatheis licensed pursuant to. the provisi.onspf the Contractor's License Law
'❑ 1 hereby cirtify that no excavation five (5) or more feet i -i depth i6to which a person is required to descend, will be" ,
'(Chapter 9 (commencing with section 700) 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 ..exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more,thanthirtysix (36) feet high. (Chap 3.2. Grp 2: Art 2, Sec 341, Title B• -
subjects -the applicant to a civil penalty of not more than five hundred dollars (S500.):.
C.A.G.)
0 I. as owner ol.the property -or my employees -with wages as their sole compensation, will do the work; and the
O As owner -builder; I will not employ anyone to do work which would require a permit from the Division ot.°'
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 his 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
,' . +.
' through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
O Division of Industrial Safety. Permit No.
' building or improvemni 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 age ncyfor the performance''
❑ 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, Gv: 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.). • ' z `
Lender's Address
' ❑ lam exempt under Sec. B. 8 P.C. (Attached Certificate)., ,,••
• • .. • I.cerlifythat I have read this application and state that the above information is correct. I agree to comply withLall `
Date L Owner ""
city and county ordinances and state laws relating to buitlfng construction; and hereby authorize representatives
of this county to enter upon the'above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm thaPl have a'certificate of consent to self -insure. or a
certificate of Workers' 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 EITRY: I c6tifyI have read this application andstate that
•+= O 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; and authorize a representative.of the City -3f La Ouinta-Department of Building and Safety to enter ,•
Date -; Applicant '
upon the propertylorwhich I have /ap�plied lor'this pernit for the purpose of making inspections.
�/i .,�'.i /- fes%/ ! .- /- y' �`"'1
Signature of Applicant or Agent Date
y
APPLICANT NAME (L'. F. MI)
ADDRESS
P.O. B= 1040
CITY/COMMUNITY/STATE/ZIP '
Ia Quinta, CA 92253.
JOB SITE ADDRESS/SPACE
53-300,Avenida �1LiRal/�� in' tea
CITY/COMMUNITY/STATE/ZIP _ - -
la Quinta, CA 92253
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TRACT NAME I - •' ..
OWNER NAME (L, F. MI)- -`
Applicant
CONTRACTOR -FIRM NAMEappyLzant
ADDRESS .• .
abme
CITY/COMMUNITY/STATE/ZIP ''_i.•,, .�� ; - •• ..
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PHONE 0
L.ICNC
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a - -
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LICNC N
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USE OF PERMIT -
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- LOT SZ�?•'
END. -
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" 'A03`82
BLDG. DEPT.
Print Applicant/Agent Name i
4'
APPL/PRMT i .■' •/
DATE3-19-85 ELDG. -
f
Permit to oonstxuctt.180 ft. of 30 high,
block wall as Per approved pland.
wall is also behind
M-320 Av6i. Ramirez.
Plan Cock
= 25.02 ^ '
Penuit Fee
38.50
Mr Fee '
.50
w
x
y-
TOTAL'` "
64 Oi
;FEE
• VALUATION 21700:00" `
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
S
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
S
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
t3 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