000934 (SFD)• ^ PERMIT APPLICATION O e +
City of La Ouinta
Department of Building and Safety •. G
50-102 Avefd a Vista Bonita
CITY/COMMUNITY/STATE/ZIP '
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.
'
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 forone hundred ($100) o,'less:l certify that in the performance of the work for which this permit is
• (commencing with Section 7000) of Division 3o1 the Business and Professions Code, and my license is in lull force'. • .
and effect.
issued; I shall of employ any person in any manner so asto fiecome subject to the workers- Co:pesationLaw,of
California.
PRC
��` 10#41'1 ' ^•' •
License Class Lic. Number
'
Date ` Applicant _� }..
e•of tthe
Date Contractor
.NOJICE JO APPLICANT: If, after making this Certifica Exemption, you should become subject t Workers'
OWNER -BUILDER DECLARATION .Thereby aflirm.that I am exempt.from.the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemedNreJoked. ;
following reason (Sec. 7031.5. Business and Professions' Code: Any city or county which requires a. permit to ..
6.83
construct: alter, improve, demolish, or repair any structuie, prior to•its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
suchpermittofileasignedstatement.thatIteislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw,, -
0 hereby ceitifj that no excavation five (5) or more feet in depth into which a person is required to dekend, will be
' (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions. Code) or that he is exempt .'•
made in conhection 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 fora permit- :. -.
, 4t . demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, AA 2, Sec 341, Title 8, .
subjects the applicant to a civil penalty of not more than five hundred.dolfars ($500.): v+ •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
❑ As owner -builder, I wilt not employ anyone to do work which would require a permit from the Division of • ' -
structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code:,The Contractor's License . ' • •
•.. Industrial Safety, as -noted above, unless -such person hasa permit tordo 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,
❑ Division of Industrial Safety.P.ermit No.
��� - Athrough
his•owoemployees, provided that such improvements are not intended or offered for sale. If; however, the
�f ��••
vv�G /� 141,
//9 7
building orimprovemntissold within one year ofcompletion, theowner-builder will have the burden of proving that
he did.not build or improve for the purpose of sale.). • -.. aj
i:`. •..
Date Applicant / -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there'is a construction lending agency for the rformance-
❑ I, as owner of the property, am excutsively 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 loan owner of property who
' builds or improves thereon, and who contracts for suchlp—rojects with a contractors) licensed pursuant to the
Lender's Name.
Contractor's License Law )' �� v/' /���
Lender's Address —t
LICNC I
O d^am exempPunder Sec` ,�+ ' - `)B? 8 P.C. (Attached Certificate)., '
.. :' .I certify that-[ have read this application and state that the ,abo a information is correct I agree to comply with all,
L . y
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives a .'
USE OF PERMIT -
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 ol,Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. tab: C.). '
Signature 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 ..
" ❑ 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 Certilied co Is filed with the Cit 'Buildih Inspection Department or Cit ' Department.
DY Y 0 P D , Y
.Date.
construction, snd•authorize a Yepiesentative of thezlCity,ofta Ouinta Department of Building and Safety to enter
theA,pvropertyf'for``uu ich ldave appl'etd/`forfthre/perm- 7fi the of making inspections.
-
Applicant
upon purpose
}/ t`Ce •G
1. -
Signature of1pplicant or Agent V" Date s
APPLICANT NAME (L. F. MI)
Clark.DeM- ' l' omwrt .yVD w' -
ADDRESS
50-102 Avefd a Vista Bonita
CITY/COMMUNITY/STATE/ZIP '
•Ia Quinta, CA 92253
438 sDr_ _ of rsraramp ac npTr arir�=A
JOB SITE AODRESS/SPACE -
78-095 rz'Ca11e NC?JL
_
CITY/COMMUNITY/STATE/ZIP •.
La Quinta, CA 92253
BOK
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TRACT
20158.
LOT-.
52y
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Plumbing Fb6 r
'MOD
4
Se
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TRACT NAME *�y�,,�,.. ,
l ixie.
OWNER NAME (L.,F, M0 • - _ ... .
Clank Deft
CONTRACTOR -FIRM NAME �..,•
• Ow a s.
ADDRESS - -
above
CITY/COMMUNITY/STATE/ZIP .. ,
abme
PHONE 0
UCNC 11
rc
564-6448
ARC/ENG FIRM NAME -
PatrickS e•pl�N
ADDRESS f -
74-215.Mv 11
CITY/COMMUNITY/STATE/ZIP '- 1
,.
Palm tart a M 9 RAQ
PHONE N
LICNC I
34&-05rg6 -
\
USE OF PERMIT -
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-
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r••.SIDE.
Print Applicant/Agent Name
APPVPRMT -q
DATE
9�-��-84 S.F.D;`
Fleapit to fr1_sqtT'1174t 1736 _an_ t_nf
afartdo n1iis 15n crtr.,
ft- of 1rxn" Ar;A '
438 sDr_ _ of rsraramp ac npTr arir�=A
Talons:.
mknnh_rcNa
inn
P1,aln k VIPP
_ 7 Sr.
tf"nnett- rAP
A77 nn
F.1 icon# r9:1,15
IA -00
SMI Fee
6.83
Plumbing Fb6 r
49-50
Prop. Devel. <Pee
45F1w1Al1
-
`\ B4
-
PO /-:7-tA-Q4
542 .3 ,1 ,
'TOTAL,•
FEE. I;cEy' Y.eV}
J }° f� VALUATION 97,732,40
BLDG. DEPT.
A&
r1
NO.
OPERATION IWTE
INSPECTOR
NO.
OP TION 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)
128 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