001065 (RR)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. '71
/
License Class , Gr Lic. Number �� 7f
Dare r //' ., > G •. (_.-
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from theContractor'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 for a permit
'subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
0 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, the
building or improvemnt 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 (Seca'
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 ^/�.'o a Z C- Ownerz,- w
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. 380O. -Lab. C.).• q.," • .
Policy. No. Company
O• Certified copy is hereby furnished. - - -
O.Certified copy is filed with the City Building Inspection Department or City Department:
Date Applicant
APPLICANT NAME -(L, F. MI) '
Custom Roofin
ADDRESS - -
78-550 Darby Rd
CITY/COMMUNITY/STATE/ZIP
?ndio, CA 92201
JOB SITE ADDRESS/SPACE '
53-235 Navarro
CITY/COMMUNITY/STATE/ZIP
La.Quinta, CA 92253
B
fP 1 PRC.,W
��
C
30 lbs
TWN
RNG ,
SE
S
TRACT
LOT`
MOD
SB
-
TRACT NAME
OWNER NAME (L. F. MI)
La Quinta Realtv
CONTRACTOR -FIRM NAME : '
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP "
above
PHONE. '
345-3751
.k
LICNC.
274 921
013
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP - -
PHONE N
LICNC •
'
USE OF PERMIT
Re -roof
BL
ZON
FSB
SSB
SSB
'RSB
OFC
ZONE ORD t •
LOT SZ
END
SIDE.'
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN; ATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify the -t 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: It, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must-orthwithlcomply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATI]N:.
O 1hereby certify that noexcavation five (5)ormorefee 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 tfiil-y-six (36) feet high. (Chap 3.2. Grp 2, Art 2; Sec341, Title B,
C.A.C.)
0 As owner -builder, I will not employ anyone to do •+ork which would require a permit from the Division of
Industrial Safety, as noted above; unless such person ias a permit to do such work from that division.
O 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. Q.
Lender's Name
Lender's Address
I certify that I have read this application and state that he above information is correct. I agree to comply with all
city and county ordinances and state laws relating to bLilding construction, and hereby authorize representatives
of this county to enter upon the above-mentioned proprty 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. 1 agree to comply witAall state laws and county ordinances relating to buidling
construction, and authorize a representative of the Cit - of La Ouinta Department of Building and Safety to enter
upon the property for which1have applied for this permit for the purpose of making inspections:
Ii Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT
00 OH� DATE
3.1-30-84 BLDG.
Permit
to re -roof complete house
using
new metal on edges 1 laver
30 lbs
felt with 2 lavers 151b felt,
small
crushed rock and coated white.
Larne
dress rock on Ditched roof.
Permit
38.50
SMI Fee ,50
r,
.k
013
TOTAL
FEE
39.00
BLDG. DEPT. VALUATION 2,000-QQ
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 Com part.
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
Fireplace T.O.
❑
NON ADDITIONAL INFORMATION
y 1-21 � �V
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 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
PSL PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final