000929 (SFD)APPLICANT NAME (L. F, MI)
Clart vel1or meat rnm
' PERMIT APPLICATION /` 3
City
of La Ouinta V
-• Oepartment
of Building and Safety • .
c This permit becomes void if work not commenced -within 180 days from date
of issuance, OR, it work has been suspended or abandoned for a period of 180 days.
:, • -
•LICENSED
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed W
CONTRACTORS DECLARATION: I hereby affirm that I'am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force •
the'permit is for -one hundred (8100) o, less. I certify.lhat in the performance of -the work for which this permit is:
issued, I shall not employ any person inany manner so asto fiecome subject to themioikers'Compensation laws of J
and effect.
California ♦ y/ ///.,tJ// /J//�
��'�•�•d�✓
License Class Lic. Number
Date ', L / '�R Applicant �� -/1 �� -
Date `" Contractor - ' .-• •" `
NOTICE TO.APPLICANT: If, after making this Certificate of Exemption: you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I 'amiexempt from the Contractor"§,License Law for the, '
. ' 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 whichrequires.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 asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
'111 1 hereby certify that no exdavation five (5) or mlor:6 feet in depth into which a person is required to descend, will be
1Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions. Code) or that he is exempt
. - made in'connectibnwith work authorized by this permit, and that no building structure, scaffold ing,talsework, or '
'therefrom and the basis'for the alleged exemption. Any violation of Section 7031 S;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�jS500.):
: '
CAL.)'
�O I. as owner of the property, or my,employees with wages as their sole compensation, will do the work, and the '
�'' 0'As owner -builder, I will not employ anyone to do'work whi6 would require a permit from the'Division of -
' structureis 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
s- - Industrial Safety, as noted above, unless such person has,a permit to o such'woik from that division.
.. "�
' improvements for If, however, ''
O Division of Industrial Safety. Permit No. 1 4
• through his own employees, provided that such are notintended or offered sale. the
i / t
buildingorimprovemniissoldwithinoneyearotcompletion.theowner-builder will have the burden of proving that =-.
he did not build or improve 1or-.the purpose of sale.).
Date Aoolicant
C/ ' • r %/ ^
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 Contgactor's License Law does not apply to an owner of property who
Lend'er's Name
builds or improves thereonfand{who contracts for such -projects with'a contractor(s) licensed. pursuant to the
• Contractor's License Law.).. �(�// /(�/� Lr
Lender's Address
'• 0 1 am -exempt under.Sec: �_ -' 'i -�, r �'�� `"�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 C.
city and county ordinances and state laws relating to building construction; and hereby authorize representatives
81.
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
• certifitate of Workers' Compensation Insurance': or'a certified copy thereof (Sec:•3800. Lab. C.)..--•- :Signature
of Applicant or Agent � k Date
Policy No. Company, -
" CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
- • O Certified copy is hereby furnished.
the information given is correct. I agee to comply with all state laws and county ordinances relating to buidling
' ❑Certified co Is filed with the Cit Building Ins ection'De Department or Cit Department.
• •... Dy Y 9 P D y D
construction, and authorize a'representative of tlpe City ofA Ouinta Department of Building and Safety to enter
s a. r
• upon the prop�esrty for wjhich/1 harverao ceded for this,perrA for the purpose of making inspections. -'
Date Applicant
�sf.�L/��1 �Gs{Z� .
Signature of Applicant or Agent V Date
APPLICANT NAME (L. F, MI)
Clart vel1or meat rnm
ADDRESS
50-1-02 .APxi JA A? • _-,+ n itf-a »
CITY/COMMUNITY/STATE/ZIP -
La. Ou3i_a. CA 92253
JOB SITE ADDRESS/SPACE
,
CITY/COMMUNITY/STATE/ZIP
7a C�(Tinta.. C% 2251
80K
PAG -
PRC
C
..
TWN
RNG
TE
S
TRACT
40158
LOT
.S�/
49.50
Prop. Devel. ,Fee
MOO
4
I SB
'
TRACT NAME
j11fi►1P .
OWNER NAME (L. F. MI)
C11 ark pup -1 xr>t1romn*-.
CONTRACTOR -FIRM NAME
owner
ADDRESS - .. .
• • al'x�n�a _
CITY/COMMUNITY/STATE/ZIP • - -.
- 1� x -
PHONE •
-
LICNC 1
•^• -
564-644A
ARC/ENG FIRM NAME - •+ - •'
ADDRESS
74-215 Hwv 111
CITY/COMMUNITY/STATE/ZIP
PHONE » -' -
GCNC • r. '-
346-0596.
USE OF PERMITAM spam Condo .
81.
ZON
FSB
': SSB
-
-` SSB'
RSB
P
OFC .•
. ZONE ORD 1 -. ;
LOT SZ 1 -
'END
SIDE
• k
Print Applicant/Agent Name
APPL/PRMT ! # 1.7
J-84 - - S.F.D.•
Pmt to construct 17-16 sm ft- of
coridn n lm .150 q"' _
ft_ of rrwy- as nc1
41R sn_ ftof mracre as Txpx arxwrArPd
Tal aR14 _
,
Mach. ,fes
7A nn .
P - k rX.I.
277 551
Mist. Fee
427'40
Elect. Fee
34:98
SMI" r4kch
PludA a Feer
49.50
Prop. Devel. ,Fee
450 _ rein
1.269.86
®
PD -277.55 7-20-84
992.31
a" F
TOTAL .
FEE
BLDG. DEPT.
r �s M VALUATION 97,732.46 '
I -
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPEMATION 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.
❑
NON
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final