000924 (SFD)PERMIT APPLICATION
City of La Ouinta O! el
Department of Building and Safety �..• �'
This permit 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..
LICENSED 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 ••
and effect.
License Class Lic. Number
Date Contractor;. -
OWNER -BUILDER DECLARATION: I hereby aflirrn'ttjat I am exempt from the Contractors License Law for the
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 structure, prior to its issuance, also requires the applicant for
such permit to file 'a signed statement that he is licensed pursuant to the provisionsof the Contractor's License Law
'
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he isexempt
• . therefrom and the basis for. the.alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty. of -not more than five hundred dollars ($500.):
�O I. as owner of the property,.or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code:. The Contractor's License' .
Law does not apply io an owner of property who builds, or improves thereon, and who does such work himself or.
through his own employees, provided that such improvements are not -intended or offered for sale. If, however, the
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that,, ;
he did not build or improve for the purpose of sale.). ; -
0 I, as -owner of the property, am�exculsivety contracting with licensed contractors to,construct the project (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 `ho contracts for suc .piojects viith;a conlractogs) licensed pursuant to the.
Contractor's License Law.).� //yami
•- 0 1 am exempt under Sec.,'' `�f .r/X' B. 8 P.C. (Attached Certificate)..
• �.
'Date'.
• 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 copy thereof (Sec. 3800. Lab. C.); -
Policy No. Company
0 Certified copy is hereby furnished..
O'Gerlified copy is filed with the City Building InspectionDepartinent or City 'Department.
+.�,:.
Date Applicant
APPLICANT NAME (L. F. MI)
C3Av-V 1RaaralisrAY�wB r,.,,
ADDRESS .-_. -,c
50-102 Avilnidal Vista Ponita
CRY/COMMUNITY/STATE/ZIP`
La Qufnta, CA 92253
JOB SITE ADDRESS/SPACEy
Jam('] /�
CITY/COMMUNITY/STATE/ZIP, , -
� a Cuing. n. CA, 92253
BOK -
-PAG. -
PRC C
Plan Oehck Fee
TWN
RNG'
SE
$
ry'
7RACT 20158
SMr Fee.
LOT
Plv big Fee
MOD '
2
S9_
450.00
' 1,241.03f�_
TRACT NAME - .
a
OWNER NAME (L. F. MI)-
Clark Whim ,og t T
,CONTRACTOR -FIRM NAME
omer
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
PHONE 0 +
564-6448
TOTAL" . '
FEE
LICNC 0
-
ARC/ENG FIRM NAME. ..
atxi(* Sbeehv'
ADDRESS
74-215 icy 111
CITY/COMMUNITY/STATE/ZIP ..
Palm Desert, CA 92260
PHONE •
346-0596
LICNC N
- -
USE OF PERMIT
air --spam condo. ' unit, #
BL
ZON
FSB
SSB
SSB. -
RSB
OFC -
ZONE ORD N .i
LOT SZ '
s
` END
' SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: -This section need not completed if
the permit is for. one hundred ($100).o,less. I certify that in the performance of the work for which this pLawsb6f
issued, I shall not employ any person in any manner so as to become subject to the Workee siConipensation
Date Applicant w �'/ �r
NOTICE TO APPLICANT: ll, after making this Certificate ol•Exemption, you should become subject to the All
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,
01 hereby certitythat no excavation five(5) or more feet in depth into which a persoriis required to descend. will be'*
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or .
'demolition or dismantling thereof,:will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B, •'
6 As owner -builder', I wilt not employ anyone to do work which would require a permit from the. Division of',
Industrial Safety, as holed above, unless such persomfias a permit to do such worWkrnPthat division, y)
0 Divisipn of Industrial Safety Permit No. i 1��� 1/ �•�� � �'+. .
Date Applicant,/ elh K - .•! ,
CONSTRUCTION LENDING AGENCY: I hereby affirm hMhereisaconsiructionlending agency for the performance
of.the•work for which this permit is -issued (Sec. 3097, Civ. C.).
Lender's Name'
! Lender's Address
certify that I have read.this application and state that the above information is correct. I agree to comply with all
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.
Signature of'Applicant or Agent '' Date
"CERTIFICATVF• COMPLIANCE AND AUTHORIZATION -OF ENTRY: I certify I have read this application and state that
`. the information given is correct. I agree to comply. with alltstate laws and county.ordinances relating to buidling
construction/and authorize a -representative of'the City'of La Ouinta Department of Building and Safety to enter
upon the property.for which,(.have applied for thls`per I for the purpose of making inspections.
. �i Aly ,oZ�i � /' � ..- _
Signature of Applicant or Agent L/ Date
Print Applicant/Agent Name
APPL/PRMT �>
9-=20 DATE
-84 S.F.D.'
PP,m t to cronst"i F,,iR c'm f#-. f
rvw,rin ni „ta 1 FA ff- of tnt'trr"'n P A
438 sa. £t of praeve Am par salrrrrr"*A
Y•� ax,
Mach. Fee"
24.00
Plan Oehck Fee
267.80
Qanst. Fee-
412.00
Elect. Fee y,
33:75
SMr Fee.
6.48
Plv big Fee
47.00
Pz�o�, Deve
450.00
' 1,241.03f�_
SEP 2 4, ,
PD - 267:$O 7.20-84
8 ftp
973.23
. _
-
TOTAL" . '
FEE
- /,.
l w 241.03
- �• VALUATION 92,57760
BLDG. DEPT.
Ah
Ah
NO.
OPERATION I WATE INSPECTOR
NO.
OP ATION I 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 O
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 o�
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) 4 A,
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
STREET NAME
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring.
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service-
ervice
32
32 Final