0063 (RPL)PERMIT APPLICATION
r1� " 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 p3riod of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of 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 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 3of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any -applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (5500.):
o 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, 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
building or improvemni is sold within oneyear of completion, the owner -builder will havethe burden of provingthat
he did not build or improve for the purpose of sale.).
O 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
•builgs or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec.
Date Owner
B. 8 P.C. (Attached Certificate)
WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 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
Company
o Certified copy is hereby furnished.
O Certified copy is filed wiitrh,the City Building Inspection Department orrcity Department.
Date 'ti F J Applicant /cam, +dirt. a/�r fr7f
APPLICANT lvar M L, F, 15rat j -
ADDR
P:SSV. B= 780
CITY/COMMUNITY/STATE/ZIP
��+T�C 92253
JOiiESS/SP
,/5IQ4eiosQiZvA
CITY/COMMUNITY/STATE/ZIP
LiaQk, CA 92W
BOK
PAG
PRC
Com!
TWN
PING
SE
S
TRACT, J
LOT
MOD
SB
TRACT �NAME
t��.y
Santa l� osa. COM
OWNER NAME (L. F. MI)
CONTRACTOR-FIRM
UNpy s
^/4-222 Hight Ul
CIT,. 1r/COMt BRUVI, CA92260
d!
PHONE.•
346-4804
LICNC M
X226445
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
'
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
RSBOFC
ZONE ORD M
LOT SZ
TOTAL
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSAT,ON INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify that i r the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as tc 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 for ihwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet ir0epth into which a person is required to descend. will be
made in connection with work authorized by this permit, a id that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-.3ix (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8.
C.A.C.)
❑ 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.
❑ Division of Industrial Safety Permit No
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that th:re is a construction lending agencyfor the performance
of the work for which this permit is issued (Sec. 3097• Cv. C,).
Lender's Name
Lender's Address _
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 Willing construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propeiy for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF BTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with fll state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City D1 La Ouinta Department of Building and Safety to enter
upon the property for which l have applied for this pernit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT� 3
�J 6 3
DATE
2 22-83
Pemitfor t Per Plaut
ley
�SpaT�and�
e,
Contrtor
�iy
Plait Check
$22.45
Spa Permit
45.00
TOTAL
£7.25
VALUATION $3"100.00
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
r
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
f=ireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
i
t
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 Ceilin low.)
14 F I o
PLI[4-JK0PRbVALS
15 Groun
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