001158 (RER)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
APPLICANT NAME (L. F. MI) T nssee Bu dens '
ADDRESS 81447 Fiaschia Street
• 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.
CITY/COMMUNITY/STATE/ZIP La L'A+inii, CA '92253
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I. hereby affirm- that I amaicensed under provisions of Chapter 9
the, permit is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is "
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued,.l shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of
and effect. ( !
�//
California.
License Class Lac. Number / r 1 -
Date. Applicant
Date -- - - > +Contractor rt Ji ` •s '— c`
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
OWNER -BUILDER DECLARATION:`+'I heieby7aftirm that I am exempt from the Contractors License Law for the
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 pursuqnt to the provisions.of the Contractor's License Law
0 1 hereby.certily that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt
made in connection with work authorized by this permit, and that no buildingstructure. scaffolding, falsework, or,
therefrom, and the basisfor the alleged exempt ion., Any violation of Section 7031.5,by any applicant for apermit
demolition or dismantling thereof, will be more than thirty-six(36) feet high. (Chap 3.2, Grp 2. Art 2, Sec341: Title8,.
.subjects the applicant to,a civil -penalty of not more than five hundred dollars ($500.):
C.A.C.)
❑,I. as owner of 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 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
LICNC N
through his own employees; provided that such improvements are not intended or offered for safe. If, however, the
O Division of Industrial Safety Permit No.
building orimproyemntissold within one year ofcompletion. 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 agency for the performance
O 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 .
OFC",
Contractor's License Law.). _
Lender's Address
O l am -exempt under Sec. . B. 8 P.C. (Attached Certificate).
• • 1 certify that I have read this application and state that the above information is correct. I agree to comply with all -
Date Owner
city.and county- ordinances and state laws relating to building construction, and hereby authorize representatives
END
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, or a
certificate of Workers' Compensation Insurance', or a certified copy thereof (Sec. 3800. Lab. C.).
Signatu'r'e of Applicant or Agent' Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state 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
O.Certified copy is filed with the City Building Inspection Department or City. Department.
construction, and authorize a'repres"entative Jfhe City of La Ouinta Department of Building and Safety to enter
Pon the,ptibperty for which I haviitapplied,foeThis permit for the purpose of making inspections.
Date Applicant.
iY G C C �t Ll.c t / c L --
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI) T nssee Bu dens '
ADDRESS 81447 Fiaschia Street
CITY/COMMUNITY/STATE/ZIP
Indio, CA 92201
JOB SITE ADDRESS/SPACE 77-255 ' Calle Nogales
CITY/COMMUNITY/STATE/ZIP La L'A+inii, CA '92253
BOK/
PA +,
PRC�l
C
TWN.
RNG
SE
S;
TRACT
LOT26
MOD
SB
'. ”
TRACT NAME None'*
OWNER NAME (L. F. MI) • • -
CONTRACTOR -FIRM NAME - -
Applicant
ADDRESS above
CITY/COMMUNITY/STATE/ZIP above ,
PHONE a '
LICNC 0
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
RSB
OFC",
ZONE ORD N
LOT SZ
END
".SIDE
Print Applicant/Agent Name
APPL/PRMT nDATE
31'84 COMB.
rt R l �. 12-31-84
Permit to bring house up to code as
per special inspect.Lon list in file.
-
V
,. TOTAL'
FEE
15.00
BLDG.DEPT.?
VALUATION 5,000.00
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 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
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
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
Tit,
ry W Z14
78-105 CALLE ES. _.LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
December 14, 1984
To Whom- It+ May Concern:
RE: Special Inspection at 77-255 Calle Nogales
Pursuant to the inspection conducted'at'the above mentioned
address, the following-gorrections must be made prior to
the release of electric service:
1) :-Replace missing circuit.breakers.
2). Verify grounding-of'service and bonding of water piping.
3)'. Replace br-remove wires terminating at firewall.
4)' Repair.drywall at firewall.
5) Replace missing doors and windows. -Door from garage
to kitchen must be self-closing.
6) Washing machine stub -out at garage wall'to-be
cast-iron.
7) Address numbersto be visible.from street.
8) All electrical fixtures.to be installed or
outlets to be -covered.
9) . Replace A.C. Compressor.
10) Replace plumbing in kitchen and bathroom sinks.
ll),Extend pressure relief on -water heater to
within 67-of•slab"and elbow down.
12) Replace garage -door spring.
13) Finish grade to be,inspected and approved by -City
Engineer. -
If you have,any questions, please contact the -Community
^ Development_Department.
Sincerely,
COMMUNITY DEVELOPMENT DEPARTMENT
Tom Hartung
Building Inspector y
Building Division
TH/psn
MAILING ADDRESS - P.O. BOX -1504 - LA QUINTA, CALIFORNIA 92253