000921 (SFD)PERMIT APPLICATION
City of La Duinta
• Department of 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.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division Sof the Business and Professions Code, and my license is in full force
and effect.
. License
Lic. Number
Date Contractor
OWNER-BUILOER DECLARATION: I hereby affirm that I am exempt from the Contractor's 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 the a signed statement that he is licensed pursuant to the provisions of the Contractors License Law
(Chapter 9 (commencing with sect ion 7000) of Division 3 of the Business and Professions Code) or that he is exempt
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 notAntended 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
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
hVid not build or improve for the purpose of sale.),
QO.I; as owner of the property, am exculsively 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 who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). 1
O 1 am exempt under Sec.`A��-B. 8 P.C. (Attached Certificate).
Date Dwner'
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
❑ Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection. Department or City Department.
Date Applicant
APPLICANT NAME (L, F; MI) ^y L
Clark _ . 1., .
V
ADDRESS
50-3.02 Avl?. Qi.St'a mita
CITY/COMMUNITY/STATE/ZIP
la Quinta. CA 92253
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
Ira Quanta M 92.253
BOK
PAG
PRC I C
ft. of parch and
TWN
RING
SE
S
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LOT /,�jj/'
Much.- Flee
ILMOD
SB
263.90
,
TRACT NAME NowMMNoww
OWNER NAME L. F. MI)C1 "Clark /J� T1� 1
L•.
CONTRACTOR -FIRM NAME
X
ADDRESS
Aixw?
CITY/COMMUNITY/STATE/ZIP
PHONE *564-6448
n1,230.3-7
LIDN`
i.
ARC/ENG FIRM NAME Pafa-Z& g
ADDRESS 74-215 Hwy13-1
CITY/COMMUNI�T/Y'�/StTATE2tP
�'� ' CA 92260
PHONE 34696
LICNC 1
USE OF PERMIT Air—spam i1 liuiB Unit #
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END
"SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
ssued.IshalInot employanypersoninanymanner soastobecome subject tothe Workers'Compe sationL:'of
California! '� J
i1 Date �• �O— r Applicant/p rC'
NOTICE TO APPLICANT: If, after. making this Certificate of. Exemption, you should become subject to th' orkers'
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:
0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is 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. Sec 341, Title 8.
C.A.C.)
,f] As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a.permit to do such work from that division.
0 Division of Industrial Safety,Permit No.
Date Applicant `✓//��C �� �tfl
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor ante
of the work for which this permit is issued (Sect 3097, Civ, C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county rdinancesQand statelaws relating to but construction, and hereby authorize representatives
of this county/doe ter cupon the ay65e-m ntj ned 0 operty for inspection purposes.
Signature of Applicant or Agent Date
S CERTIFICATE OF 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 all state laws and county ordinances relating to buidling
construction;,and authorize'a representative of the City ofLaDuinta Department of Building and Safety to enter
upon the propfor ywi�i'ch I`rnave.applied forf�iris permit„for the purpose of making inspections.
j Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPRMT t i -i ■ ■ q ? l
7�'W �—H4 5 P
Permit to crostruct 1588 sq. ft. of
colo plus 258 sq.
ft. of parch and
438 sq.* ft. of garage as per ep�wavw
plans.
Much.- Flee
24.00
w
Plan Check Free
263.90
406.00
. Fee
33.13
Fee
Pim. Dev+el. fee
6.34
47.00
450.00
n1,230.3-7
i.
PD -263.90 7-20-84
_
$ 966.47
T
FEE 1.230
BLDG. DEPT.
VALUATION 90,595.1.60
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO. OPTRATION 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 /j� 6 a
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.
❑
NOADDITION A INF RMATION
�� �/ � • �
ff//
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall �D y � -�
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
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final S�