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000923 (SFD)PERMIT APPLICATION _'v (� City ! of La Ouinta lJ ! I • Department of Building and Safety • CITY/COMMUNITY/STATE/ZIP' la ' CA 92253 BOK ' ' ^ This:perrnit becomes void -it work not commenced within 180 days from date of issuance. OR: if work has.been suspended or abandoned for a period'of 180 days. s ' 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 (commencing with Sectiom7000) of Division 3'of the Business and Professions Code; and my license is in full force- the permit is for one hundred ($100) o. less. ) certify that in the performance of the work for which this permit is issued, I shall not employ any person•inany mannersoa`sdo become subject,tothe W'orkers'Compensatiori Laws of and effect. California `� s� )/r Applicant. ) (l .Gi // License Class Lic. Number Date '.r Date • •- Contractor 1 1.7. ti • ` �•' - •' '' - 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 hereby affirm that I am exempt from the Contractor's License Law for the ' -� be.deemed.revoked. following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to -construct, alter, improve, demolish, or repair any struclure, prior,to its issuance, also requires the applicant for DIVISION OF INDUSTRIAL. SAFETY PERMIT CERTIFICATION: such permit to fi le a sig ned statement that h e is licensed pursuant to the prov is ions of the Contractor -'s License Law - . - ❑ Ihereby certify that noexcavationfive (5)ormore feet indepthinto which apersonisrequired todescend,will be (Chapter 9(commencing -with section'7000) of Division 3 of the Business and Professions Code)or ihathe is.exempt • , made in connection witti'work authorized by this permit, and that nobuilding structure, scaffolding, falsework, or 'q therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit 'demolition or dismaniling'thereof, will be more than thirty-six (36) feet high, (Chap 3.2. Grp 2, Art 2; Sec341, Title B, 0. subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): C/A C) • � .nxn�•-i, as owner of -the property, or my employees with wages as their sole compensation, will do the work; and.the'r \ . 6 As owner -builder, I will not employ anyone to do work which would requirepa permit from the Division of 3Industrial • .structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License ' Safety,•as noted above,°unless such person has permit tofido such work that division! Law does not apply to an owner of property who builds. or improves thereon, and who does such work himself or `a rfrom ',. O,Division of Industrial Safety Permit. No. ` 1 - A! through his own employees, provided that such improvements are not intended or offered for -sale. If, however the. USE OF PERMITT'.,.� Aix—Qrk�ftW.AJ4,1.., # , _•building orimprovemntissoldwithinone year ofcompletion, theowner-builder' will have the burden of proving that he did not build, or improve for the purpose of sate.). y, - Date Applicant f 11, CONSTRUCTION LENDING AGENCY: I hereby 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. 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 applyto an owner of property who r builds or improves' thereon, and who contracts for sucFprojects with a coniractor(s).licensed pursuant to the Lender's Name Contractor's License Law.). yrs{/% ///� J/, .• Lender's Address 0 1 am. exempt'imder Seco r'<- �L c �'`� i! 8. 8 P.C: (Attached Certificate). •. I'certify that I have read.thisapplication and state thaLthe above information is correct. I agree to comply with all _ Date Ownery' til cityand 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 I have a certificate of consent to self insure. or'a . certificate of Workers'Compensation Insurance.,or a certified'copythereof-(Sec: 3800. Lab. C.).,- .'"' Signature of Applicant or Agent Date Policy'No. 'Comp . any CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that . 1 0 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 copy�is filed with the City Building Inspection Department or City " - Department: Date Applicantry construction; and authorize a'represetative of the.City o1:La Ouinta Department of Building and Safety to enter upon the property for wwhich shave appli`ed/ffoof'.th,iis.permitffor the purpose of making inspections. r ����71 &I / v. (% Signature of Applicant or Agent (/ Date Print Applicant/Agent Name , APPLICANT NAME (L, F, MI) ^n -__k ^w_' `_`t. ADDRESS 50-102 Ave. Vista Bonita CITY/COMMUNITY/STATE/ZIP • • La QW_*++ a, CA 92253 JOB SITE ADDRESS/SPACE ^_" CITY/COMMUNITY/STATE/ZIP' la ' CA 92253 BOK PAG PRC 'C - TWN PING. -. SE "'. S T20158 LOTS Fee 33.13 " MOO A SB - TRACT NAME Nom ` No LC , OWNER NAME L. F. MI):Ark iJGYClt' , CONTRACTOR -FIRM NAME • ' •• - ADDRESS CITY/COMMUNITY/STATE/ZIP , Abolve PHONE I �y--� PD - 263.90 7=20-84 UCNC II 96647 -ARC/ENG FIRM NAME ' Pateck Sheehy .ADDRESS •' '" - 74-215 ibm 111 CITY/COMMUNITY/STATE/ZIP- Palmi Dirt. CA, 92260_ PHONE II 34.6-0596 - UCNC ' USE OF PERMITT'.,.� Aix—Qrk�ftW.AJ4,1.., # , BL- ZON FSB SSB SSB ' RSB••" OFC ". .' . ZONE ORD 0 - 'LOT SZ : END - SIDE APPL/PRMT H P flg 7. 3 ^� DATE 9-20-84 5• �Q Pendt to construct 1588 sQ• ft• of condo plus 258 sci. ft. of porch and 493�8,�sci. ft. of aaraoe as Tex ao�ved plans.' Mec. Fee 24_00+ Plan C3ck Fee 20.90 . Qcnst,. Films 406.00 - Fee 33.13 " -Elect. CM kip' -6.341 1 P1taba w A7,.00 ' Pte. nmtu. Fee 450.,00 •a 230.37 'aa4 PD - 263.90 7=20-84 96647 R r_,� A 7 y - } . .TOTAL. ' FEE • 1.230.37 ' BLDG. -DEPT: r VALUATION 90 595.60' r1 >. NO. OPERATION ATE INSPECTOR NO. OP ATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms d 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 ©p� 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. ❑ NPON ADDITIONAL INFORMATION N SEWAGE. SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall. 020 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 d 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 STREET NAME P/I 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring. 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final /