000928 (SFD)PERMIT APPLICATION
City
. Department of
of La Ouinta
Building and Safety •
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..' . •-
e>
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 (81170) o: less. I certify Ihat.in the performance of the work for which this permit is .
(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
issued, I shall not employ any perprip any manner so as to become subject to the Workers' Compensation Laws of
California: �. r% J%/�' %? L
'x.Date Applicant. ��', V/ 011
!,�'r f[. �.t •
Date - Contractor ,
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you become subjecI o the Workers' x.• •_•.,-
OWNER -BUILDER OECLARAf bk:J • I hereby}affirm ihat'•I am exempt from the Contractor's License Law for the ':-
Compensation provisions of the Labor Code, you must forthwith complywith such provisions or this permit shall
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
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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 a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law -
01 hereby certify that no excavation live (5) or more feet in depth into' hichaperson isrequired todescend,will b.e
(Chapter 9 (commencing with section 7000) o6Division 3 of the Business and Professions Code) or thatheisexempt. ,
made in connection 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.byiany 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, TilleB)r
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): -
C.A.C.t I'` `'S=•
V 1., as owner of 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 of
As
�ructure is 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
Safety, asnoted'above, unless such person figs a permit'to do such wdrk from -that division. '
,, - �^,f :
I •
through his that improvements are not intended for IL however, the
of Industrial Safety Permit No. V / / r ("
own employees. provided such or offered sale:
orimprovemntissoldwithinone ofcompletion. the owner -builder will have the burden ofproyingthat
„ oO.Division
f
,Applicant/��/�x�_
.building year.
he did not build or improve for.the purpose of sale.).: r;
•
Date
CONSTRUCTION LENDING AGENCY: I hereby affirm hat there a construction lending agency far the•performance.
..-0. 1. 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 Cade: The Contractor's License Law does not apply,to an owner of property who
builds or, improves thereon, and/who contrails for suctiprojects wiltia contractor(s) licensed pursuant to the
Lender's Name
- Contractor's License Law.)) J), ///PL' % �l
Lender's Address
^. 0 1 am exempt under Sec.' �'�� - r Lr ! B. 8 P.C. (Attached Certilicate).
I certify that I have read this application and state That the above information is correct. l agree to comply with all
Date Owner _ E
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
v
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, ora '
,.
' 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 l have read this application and state that
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
0 Certified copy is filed with'the City Building.lnspectiori Department or City Department. ,
construction, and.authorize a representative of the Citylof La Ouinta Department of Building and Safety to enter
= the�properI fOr have applied for Ris for the inspections..—
Date )front
App
upon whit el permit purpose of making
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Signature `o1 Applicam V or Agent Date
•
Print Applicant/Agent Name
APPLICANT NAME It., F. MI) • . .. •
Clark Da torment
ADDRESS _ -
50-102 Avwi4a Vista Bonita—
CITY/COMMUNITY/STATE/ZIP
La (Xi ntsa. CA, 92253
JOB SITE ADDRESS/SPACE- / - +� " . Wle '
C}l
CITY/COMMUNITY/STATE/ZIP •�J
La Quinnta, EA y 92253
BON
PAG
PRC
C-1
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TWN .'
RNG.
SE
S
•� C
T''G8156
LOT.
t
SMI Fee
MOD
2
SB
47.00
TRACT NAME NOTle . . . • .
OWNER NAME (l. F. MI)
.Iik DGY�..1
CONTRACTOR -FIRM NAME
owner
ADDRESS Ai.7om
CITY/COMMUNITY/STATE/ZIP. ..
Above
PHONE 564-6448
-
LICNC F
R Al
ARC/ENG FIRM NAME ••
PatxIck w . /eetm
ADDRESS -
74-215 Hw 111
CITY/COMMUNITY/STATE/ZIP
•Palm Desert, CA 9226Q f"
PHONE • I
346-0596
I
LICNC P
.
USE OF PERMIT •� �_ �7� . *nom ,Q
�Sil:-' Condo. tJlVl1 '# -
BL
ZON
FSB
'SSB
SSB
RSB
OFC
ZONE ORD
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LOT SZ •
-
END
SIDE-
APPL/PRMTa■;ngti
°x;:20-,84 S.F.D•
permit to =Ist awt 1638 sq. ft. of
=ido plus 150 `sq. ft. of porch and
438 sq. ft. of garage as per approved
plans.
Mach, Fee
24,00'
Plan Check Fee
267.80
Omst, pee'
412.00
Elect. Fee
33,75
SMI Fee
6.48
Plumbing Fee
47.00
Prop. Dev. •F &
450.00
1,241.03
@�
0�4
PD• -267.89 '7-20-94
973.23
'�Fp • 01
li. •w
R Al
* EE -
,F
1241 .03
U �-
": •• VALUATION 92,577.60
BLDG. DEPT.
Ah
Ah
NO.
OPERATION ITATE
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
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)
12B Ceiling (Batts)
12CT 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