001049 (GRES)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. -•
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.).
Policy
Company
• 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,�1.1)_��'y=k Land ,►
jjPP.. [[O•OBJ110000
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION 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 ($100) o, less. I.certifythat in the performance of the work for which this permit is
(commencing with Section 7000) of Division Sof the Business and Professions Code,:and my license is in full force
issued. I shall not employ any person inany mannerso as to become subject to the Workers' Compensation Laws of
and effect.
California.
'cense Class / Lic. Number _ a
Date Applicant
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Date '^ - Contractor �-y
OWNER -BUILDER DECLrARATION: Thereby affirm that a�n exempt from the Contractor's License Law for the'
NOTICE TO APPLICANT: II, -atter 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
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 pursuanttothe provisions ofthe Contractor's License Law r
0 hereby certify that no excavationfive(5)ormoreteetindepthintowhichapersonisrequiredtodescend.v411be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat heisexempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or.
. therefrom andAhe basis for,the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
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.)
O 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
'
through his own employees; provided that such improvements are not intended or offered for sale. If, however, the
0 Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion, the owner -builder will havetheburden ofproving 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
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project 1Sec.
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
. . .
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Sec: B. 8 P.C. (Attached Certificate).
I 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
•
of this'county to enter upon the above-mentioned Dfooerty for inspection Durposes.
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.).
Policy
Company
• 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,�1.1)_��'y=k Land ,►
jjPP.. [[O•OBJ110000
ADDRESS ' .
CITY/COMMUNITY/STATE/ZIP Qu nta, CA •92253
JOB SITE ADDRESS/SPACE -.
ibm 78-178 Calle Norte
CITY/COMMUNITY/STATE/ZIP
Ta Oni 5;
BOK
PAG
PRC C
plan cbeak
TWN
RNG
SE
•.S
TRACT
LOT
11.50 '
MOD
Set
SMI
TRACT NAME Dtm La
Q_=_l- II
OWNER NAME (L, F. MlfZ,-�li� .
CONTRACTOR -FIRM N�2;IjEplicant ..
ADDRESS abcw e
CITY/COMMUNITY/STATE/ZIP
abow.
PHONE . '
LICNC •
'
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
t
LICNC •
117.22
USE OF PERMIT
Garage QxVersim
BL
ZON
FSB
I SSB
SSI1
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
'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'represept5five/of the City'of L.aDuinta Department of Building and Safety to enter '
upon the property for which I have/a plied for this permit; o'r the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMTn o l n49
DATE '
11-9-84 Bldg.
Permit for a aaracre omver slon as
ner armirrAred plans.
plan cbeak
20 36.7/2
56.50
Elec.
4.00
Pluabim
11.50 '
Mech.
8.00
SMI
.50
P
t
TFEE
117.22
VALUATION 5 /j / , 30
BLDG. DEPT. '
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.
❑
OP'NO.
ADDITIONAL INFORMATION
r.
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 faI 3%
16 i 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