000937 (SFD)' PERMIT APPLICATION '
City of La Ouinta �� C
Department of
Building and Safety • . �, (J
This permit becomes void it work not commenced within 180 days from date of issuance. OR, it work has been suspended or.abandoned for a period of 180.days. .. `
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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. l certify that inihe 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 forceissued,
and effect.
I shall not employ any person in:any manner so as to become subject'tothe Workers'CompensationLaws of
California / /r te / or' )I / %( � %,
J /�/` /�•�
• License Class Lic.-Number
✓Date r / Applicant �` , �`��+•
_ _�
• Date Contractor NOTICE TO APPLICANT: If, after making this. Certificate of Exemption, you should become subject to thvWorkers' -
"m: •;n -
• ' OWNER -BUILDER DECLARATION: ' I hereby all that I am exempt Irom.the Contractor's License Law for the
Compensation provisions of theLaborCode, you mustforthwith comply with such provisions or this peymit shall
be deemed revoked. '
'following reason.(Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
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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:iiie.a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 i hereby*certi!y that no excavatiori'five (5) or more feet in depth int o which a person is requiFed to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, lalsework, or •
therefrom and the basis for the alleged exemption. Any violation;ot Section 7031.5 by any applicant for a permite
demolition of dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B. "
subjects the applicant to a civil penalty of not more than livChundred dollars ($500.):
is
C.A.C.)
o.1. as owner of the property, or. my employees with wages as their sole compensation, will do the work, and the
' Nd'As owner -builder, I will not employ anyone to dowork 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:
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
Industrial Safety, as-noteo above, unless such person has,a-permit to do such wak from that division.
. It +
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' through his own employees, provided that such improvements are not intended or offered for sale: If; however, the.. .'
building one ofcompletion. the owner -builder will have the burden of.provingthat
,t7 . O Division of Industrial Safety Permit No. Y/r I s�
• ' " -" Applicant ��/IC'7! -/'zC X11
orimprovemntissold within year
he did not build improve for the purpose of sale.).
..-
Date - -
CONSTRUCTION LENDING AGENCY: I hereby affirm thalihere is a construction lending agency for the.p rformance
❑ 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.,.. '
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builds or improves thereon, and who -contracts for sus .projects with a conVaitor(s) licensed• pursuant to the
Contractor's License.Law:). / ` r ti...
Lender's Name
f/ Lender's Address
O 1 am exempt under Sec. B.S&P.C. (Attached Certificate)..:.
I certify that I have read this application and state that the above information is correct. l agree to comply with all
a' :. �•
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
564-AAAR
' 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 sell -insure: or a
-certificate of Workers' Compensation insurance , or a certified copy thereof (Sec: 3800. Lab. C.).
Signature of'Applicant or Agent Date
Policy No. Company
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' CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:.I certify l have read this application and state that
O Certified copy is herebylurnished.
✓ the,information given is correct. I agree to comply with allrstate laws and county. ordinances relating to buidling
❑ Certified co Is filed with the Cit Buildin Inspection De artment or City- Department.
copy Y p y p
construction, and juthorize Vgrresentative.of the,City`ot/La Ouinta Department of Building and Safety.to enter
the 7property whichll have app�ed lar his,pe�rm�it for the purpose.of making°inspections: '
Date Applgcantp
t`ponfFir
USE OF PERMIT
Signature lit Applicant or Agent Date
-
Print Applicant/Agent Name
APPLICANT NAME (L• F. MI) Clark DrielopClE3' It ^_m'
ADDRESS - • '
501A2 Aanenild a Vista RmA
CITY/COMMUNITY/STATE/ZIP
La QuAlata. Q# 92253
JOB SITE ADDRES&SPACE
8-099 Cala Norbe
CITY/COMMUNITY/STATE/ZIP-
Ta lfliixata CA 92253 •
BOK
PAG
PRC CRNG
Plan check Fee
258.05
est_ Pea
397.00
F.1act- Fne
TRACT_
qMT
LOT
P1iambiLT'flcr Fee-
MOD-,
SB
..
2�15f3
1.27.4 . �7 •
54
_258.05. 7-20-84
956.62
3
(' ®
TRACT NAME ` ..
tlTl'11fM� .
OWNER NAME (L, F. MI) •, ,
C11 alTrk Ti calcowrm.
CONTRACTOR -FIRM NAME,
Mortar
ADDRESS .. ..
s'>t•'�a1'7t1p
CITY/COMMUNITY/STATE/ZIP
' .a%?I'11R71P
PHONE . I
LICNC .
564-AAAR
ARC/ENG FIRM NAME -
ADDRESS -
7A -71 Foot? 111
CITY/COMMUNIT,Y/STATE/ZIP. - ..
ID=Irn llsacgrF rA C ii
PHONE . LICNC � �
-•
346-0546 •
USE OF PERMIT
.A]L7t
BL
ZON
•FSB
SSB
'SSB
RSB
OFC'
...ZONE ORD*
LOT S2 -
END , -
s
. SIDE'
APPLIPRMT
DATE^
9-20-84 S.F.D.
Pemit to cionstrtaat 1537 ft. of
mmia n1us 150 saw
CI7rsct.
ft. S. Dorch `
and 438 sa. ft. of c araae as new
arnrcftred vlans..
Mech_ Fe
24»00
Plan check Fee
258.05
est_ Pea
397.00
F.1act- Fne
32.49
qMT
6.73
P1iambiLT'flcr Fee-
97„00'
_ ria -UP -1- pF?e
45n.00
'
1.27.4 . �7 •
i ..� ®�^•
_258.05. 7-20-84
956.62
(' ®
TOTAL-
FEE .214 6
BLDG. DEPT.
.'.VALUATION 87,265.00
NO.
OPERATION
INSPECTOR, °4
NO. ;,-,,I-OPEWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
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'N
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R"
IValuel
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
I
P/L Pi
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final