000938 (SFD)PERMIT APPLICATION GZ
City of La Ouinta
• Department of Building and Safely • ... l-/
This.permit becomes void if work not commenced within 180 days fromAate of issuance, OR, if work has been suspended or abandoned for a period o1 180 days. =
K�l n9 avoto IN rfi'a i+a ►
• 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 in/the performance of,the work for which this permit is
..(commencing with Section .7000) of.Divis ion 3 of the Business and Professions Code: and, my license is in full force - -
and effect.
issued, l shall not employ any person nanymannersoasto'become subjecttothe„lNorkers'Compensatiokaws of
California! sssq
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License Class. Lic. Number.
Date -' �/ ! �`% y ”' ' -
PAG
_Applicant _�✓ , -
a ouldbecome
Date. Contractor _=XrYy k ,,:,.,.NOTICE TO APPLICANT; If: after making this Certifica of Exemption, youhs subject to the Workers' ,
OWNER-BUILDER•DECLARATION: I hereby affirm that I.am exempt.from the Contractor's. License Law for the
y •- Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
•A be deemed revoked. -
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which. requires a permit to
Z -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for ' -
DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permitlotile a.sigRed statement that he is licensed pursuant to the provisions of the Contra.ctor'sLicense.Law',-.'0
lherebycerti fy that no.excavation five (5) or more feet in depth into which a persor is required to descend; will be
• .(Chapter 9 (commencing with section.7000) of Division 3 o1 the Business and Professions Code) or that he is exempt . ,
made in connection with work authorized by this.permit, and that ho building structure, scaffolding, falsework, or-.
. therefrom and the basis for the,alleged exemption. Any violation o1 Section 7031.5 by any applicant fora permit,*,,,. ,'
. • demolition or dismantling thereof. will be more than thirty-six (36) feet high: (Chap 3.Z,,Grp 2 Art Z Sec341, TitleBr
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): raSteF>_
C.A.C.) "
❑.l, as owner o1 the property. or my employees with wages as their sole compensation, will do the work, and the >
❑ As owner -builder, I will not employ anyone to do work, which would require a permit from the Division o1
- structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License
Industrial Safety; as noted above, unless such person hes`apermit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or�')
'No., �/, !•
through his own employees, provided that such improvements are not intended or offered for. sale. If, however, the .. - .
O Division of Industrial Safety Permit
y. f
building orimprovemntissoldwithin one year ofcompletion. the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.). : •, _
-
Date'- - - - Applicant
CONSTRUCTION LENDING AGENCY: I hereby. affirm that is.a construction lending agency for the pe f#ormance,
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:
of the work -for which this permit is issued.(Sec. 3097; Civ..Cq.
7044. Business and Professions<Code:'The Contractor's:L$ense Law does not apply to an, owner of property who .
builds or improves thereoneand who contracts for such projects with a contractors) licensed. pursuant to the
Lender's Name
Contractor's License Law��.,.0/,/� // l
/
Lender's Address
.,❑ 1 am exempt under Sec? . /_ �•'y 9. 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
`�f
.
"Date- U Owner ` i + '
city and county ordinances and state laws relating to building construction, and herebyauthorize 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. 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 informationgiven is correct. I agree to comply with allistate laws and county ordinances relating to buidling
❑ Certified copy is filed with'the City Building Inspection' Department or City `Department.
-
Date. Applicant
construction and authorize a' representative of the City of La Ouinta Department of Building and Safety to enter
.•upon the 'prloppeerty/forrwhlich I have a&ieed for f-his-perAt_for the purpose of making inspections.
1 /A '
_
Signature of Applicant or Agent Date
.
Print Applicant/Agent Name T
APPLICANT, NAME (L: F. Ml) -
ark Ttrxzol nirxne� tt'`�nrn _
ADDRESS
K�l n9 avoto IN rfi'a i+a ►
CITY/COMMUNITY/STATE/ZIP
T.m (A>ti of a . na Q _ K1
JOB SITE ADDRESS/SPACE ,
' "7R-_ 1191 (fall 1 n
CITY/COMUNITY/STATE/ZIP , . .
M
Ta e'1tTirli aM Q?79;*l w
BOK
PAG
PRC
C_
-
TWN
RNG :
SE
S
TRACT
LOT '�,
47.00
;
. MOD
SB
/^ 4
20158
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city
1 A
TRACT NAME
None
OWNER NAME (L. F. MI)
�1 ox -Tr n_ 0R_r^1 r_arxr_,61I*
CONTRACTOR -FIRM NAME
ADDRESS
' �i'trMRTG\ 4•
CITY/COMMUNITY/STATE/ZIP . • - •. ,
PHONE II ,
...LICNC
e
,
' 5r34-6448 .
ARC/ENG FIRM NAME -
Aaf•',r•i r4r V,
.zhcn!
ADDRESS .
74v-215 Hwv 111 ,
CITY/COMMUNITY/STATE/ZIP "
paha Desert, CA • 92260
PHONE N
LICNC: •
,
346-0596
USE OF PERMIT
A* 7��,,,�— /W,,�oWce di .
BL
ZON
FSB
S S 8
SSB .
RSB
OFC,
ZONE ORD .•.•
LOTSZ•,,:
,EN? I
SIDE
..APPL/PRMT ■ )1 ■ ■ n ■ ).'
8 94U-84S.F.D..
lo"ni f- fn eV nC*1M W -t. IRA tach f+.-- of
n1/nc . 9 Q
ff• of rT4'w•nr'h A"A
AIR ! rq f+ _ of emy- e a as rww arff"v"7PA
pLans.
Mecf"h Fee
24 ..faili
731 =T% MWme4lir rift�.
and
Goast. Fee `
406.00
Elect, Fee
3343
SMI Fee
.6,34 .
Plumbng.Fee
47.00
profp,1Detrel. Fee 450.00
1,►230,37
/^ 4
PD -263,80 7-20-84
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city
A�
TOTAL .'n•
FEE
1.3"In _ 17
=N=
BLDG.DEPT.
o VALUATION 90,595.60
r -I
NO.
OPERATION MTE
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
1 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'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
PSL PAI
i
If
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final