001063 (BLCK)-C7
PERMIT APPLICATION
City of La Ouinta
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.
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
Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Caw for the
following reason (Sec. 7031.5. Business and ProfessionsCode: 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 for a permit .
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.);,
❑ I. as owner of the property, 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, the
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.).
0 I, as -owner of the property, am exculsively 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 am exempt -under Sec. .,B. & P.C. (Attached Certificate).
Date owner//
WORKERS' COMPENSATION DECLARATION: I hdreby 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
0 Certified copy is hereby furnished.. -
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)
Mary Wood Day School
ADDRESS
77224 Calle Potero
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE ..
Above
CITY/COMMUNITY/STATE/ZIP
above
BOK 1
774
PAG
262
PRC
012
C
TNM
PING
SE
S
TRACT
LOT 13
23.50
SMI Fee
MOD
s8
TRACT NAME
OWNER NAME (L. F. MI)
Frances HACK
-CONTRACTOR-FIRM NAMEQ�yy�yy'
J�Ot�A�li�X �6.���A1?1dlm.�Lil1�X
ADDRESS '
CITY/COMMUNITY/STATE/ZIP '
PHONE a
O
LICNC
I? lox
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE 11
LICNC 0
TOTAL
FEE
USE OF PERMIT
Fence
BL
ZON
FS8
SSB
SSB,
RSB
OFC .
- ZONE ORD M
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:
0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
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.)
0 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 Address
._a . I certify that Lhave.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/PRMTN1 n83 11DATE
—29"84 ia• .
Ilermit to install
300' of
6 foot high fence
as per
'approved plans.
Plan Cghck Fee
15.27
Const. Fee
23.50
SMI Fee
.50
RIS
-q/
O
.
I? lox
TOTAL
FEE
39.27
BLDG. DEPT. VALUATION 1, 50.00 '
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 B ocks
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 F ire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplac3 T.O.
❑
UPN
NO.
ADDITIONAL INFORMATION
/
/o/3`/,�i% �d-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath(�
12 Internaltath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (63tts)
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 Haater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
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