000936 (SFD)PERMIT APPLICATION1-
City of
`'.•- Department of
La Ouinta {l .
Building and Safety ' •,'
This permitbecomes void if work not commenced within 180 daysfrom date of issuance, OR, if work has been suspended or abandoned for a perioQ•of 180 days....- .
CITY/COMMUNITY/STATE/LIP.
La Quainter. CA 92253
CERTIFICATE OF EXEMPTION FROM WORKERS',COMPENSATION INSURANCE: This section need not be completed if -
410ENSED CONTRACTORS DECLARATION: Thereby affirm thata.l am licensed under provisions of.Chapter. 9 '
the permit is for one hundred ($100) It, less. I certify that in the performance,af the wo�afor which this permit is'
(commencing with Section 70DOj of Division Sof the Business and' Professions Code, and my license is in full force .
and effect.
issued,I shall not -employ any person I "any manner so as to become subject to the Workers' Cofnpensation,Laws of .
California%� %
�-
SE n'.,
y/p�
�` r r < Applicant
License Class Lic. Number
Date _
of
Date - Contractor -
NOTICE TO APPLICANT: If, after making this Certificate Exemption, you should become subject to the,Workers"•
' OWNER`-BUILDER'DECLAAATION I hereby affirm that I am'exempi from the Contractor's License Law.for the
Compensation provisions of the Labor.Code, you must forthwith comply with such provisionsor thisspvermit shall
be deemedTevoked,
following- reason (Sec. 7031.5, Business and Professions Code: Any city.or county which requires a permit to
TRACT NAME
None*�,�.,.� '
N
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 filea.signed statement that he is licensed pursuantto the provisions of the Contractor's License Law
..❑ 1 hereby certify that no excavation live (5) or m6re 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) or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
;,.demolition ordismantling-thereof, will be more than thirty-six (36)'teet 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 1. as owner of the properly, or my employees with•wages as their sole compensation, will do the work, and the _
� As owner -builder, I will hot employ anyone to do work which would requireea%permit from the -Division of
' structure is not intended or offered for sale (Sec. 7044. Business and Professions. Code: The.Contractor's License ..
it t
Industrial Safety, as noted'above, unless such person has°ya permit tondo sucfh work from that division`.
Law does not apply to an owner of property who builds, orimproves thereon, and who does such work himself or
: . ! d /���� di 1
through his own employees. provided that such improvements are not intended oroffered for sale. It, howeveruthe
_ _O Division of.lndustrial Safety Permit N. ` ♦ 1 /�'
e e 14 �.
building orimprovemntissold within one year ofcompletion, the owner•builderwill havet heburden.ofproving that ;
he did not build or improve,for the purpose of sale.).
1.CONSTRUCTION
Date "' �- Applicant /�/ e/ .f' ,%t",-
(/ f
LENDING AGENCY: I heretiy affirm that there is a construction lending agency for the performance
0-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 Licen`se.Law does not applygo an owner of property who.
of the work for which this permit is issued (Sec. 3097, Civ. C.).
/ R
builds or improves: thereon,'and. who contra fs for such projects with as contiactor(s) licensed pursuant to the
Contractor's License Law.). f� - // �,l.( T
`�( /(�B'8
Lender's Name
ddress • _
✓ Lender's Address—
.P.C. (Attached Certificate).
❑'I am exempt under. Sec.�-•,/ _ _
I certify that.l have read this application and state that the above information is correct. I agree to comply with all ••
;Date' 7/ Owner i!-
city and,county,ordinances and state laws relating to building construction, and hereby authorize representatives
'
of this County to enter upon the above-mentioned *property for inspection purposes.
WORKERS' COMPENSATION DECLARATION I hereby affirm that have•a certificate of consent to self -insure, or a
. certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q. T
'Sfgnature 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 4!.1
O Certified copy is hereby furnished..,,
the information given is correct: I agre!,to comply with all state -laws and county ordinances relating to buidling •:: -
O Certified copy is'1ilid.with the City Building inspection Department or City � Department.
.. consfruction�and authorize a'repr`sentative of the City of Va Ouinta Department of Building and Safety to enter -
upon the have appllied/'for thisf ermit for the purpose of making inspections.
Date Applicant
pr�operyty,foor.wh%h,l
77
(/ Signature of Applicant or Agent 1✓ Date
APPLICANT NAME (L• F. MI) ..
Clark7 l-cwxro P-nt rvivn
ADDRESS-
rn_-11_n2 174_ T_�.44.!�,
CITY/COMMUNITY/STATE/ZIP •- _ '-
Ta (1��$tnll-a f'a! QT> 'A
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/LIP.
La Quainter. CA 92253
BOK
PAG
PRC .
C TWN
FIND
SE n'.,
S
TRACT
20158
LOT
53
397.00,
MOD
3
SB
SM'Fee
TRACT NAME
None*�,�.,.� '
N
OWNER NAME (L. F. MI) -
Clark Dawelo�n '
CONTRACTOR -FIRM NAME
Owner .,
ADDRESS
abom w
CITY/COMMUNITY/STATE/ZIP - -
PHONE 11 +
564-6448
1.214.67'
LICNC •
-
ARC/ENG FIRM NAME ..
Pat ick Sheehy
ADDRESS
74-215 Wy 111 ' ri
CITY/COMMUNITY/STATE/ZIP •' -
Pa3n Desert. CA 92260 .,-
PHONE 346-059' IICNC..
...:
USE OF PERMIIT`,,,� A- -
Aix—snm Cbnd )
BL
,
-ZON
,FSB SSB-
SSB ,
RSB
OFC, .
- ZONE ORD 117
LOT SZ
END
SIDE.:.
..G
-'TBLDG. DEPT.
Print Applicant/Agent Name
APPUPRMTDATE
OHRr�
9-20-84 S.F.D.
Pemit to construct 1537 sq. ft. of
condo plus 150 sq.
ft. of porch and
438 sq. ft. of garage as per apprw ed
Neth. Fee
24.00
Piaci Check Fee
258.05
Cont. Fee
397.00,
Elect. Fee
32.49
SM'Fee
6.13
P%robi{r��ee
�A
Prm. DeF'ee
44''7.0/0
450.00
1.214.67'
c ®�
PD -258.05 7-20-84
�'\a�4
956.62 ~'r
1
TOTAL'
FEE
,
VALUATION 87,265.00 -•=
r -I
Ah
NO.
OPERATION I IMTE
INSPECTOR
NO.
OP ATION 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.
❑
NO
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wi-e
29B Bonding
30 Fixtures
31 Service
32 Final