000930 (SFD)APPLICANT NAME (L. F, MI)
(11;;;1 k
PERMIT APPLICATION
City of La Ouinta
Department
of Building and Safety
This permit becomes void if work not commenced within 160 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
•7
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,
(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 (5,100) o. less. I certify -that in,,t e performance of the work for which.this permit is
ec(iothe wArkerspirip sation L h I
issued. I shall not employ any person in any manner so as to become subj e sa ion awso
and effect.
Cal ornia
License Class Lic. Number
'Date
Xr Applicant
Contractor
N0110ETO.APPLICANT: If, after making this Certificate of Exemption, you should become subject 1� workers
'
OWNER -BUILDER DECLARATION: I hereby affirm that. I am e `xempt-from the Contractor's License Law for the
provisions;of the Labor Code, you must forthwith comply with 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.'
TRACT -
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.Contra.ctor's License Law,
'-0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required t6dekend, will be
(Chapter 9(coMmen�cing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in conneitiorf*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 by any applicant for a permit .
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z Art 2, Sec341. Title 8,
subjects the applicant to a civil penalty of not more'than five hundred dollars (MO.):
C.k.)%
I. as owner of the property, or my employees with wages as their sol ' e compensation, will do.the work, and the.
As owner -builder; -1 will not -employ anyone to do work which would require a permit from the Division.of
• structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
1EI
Industrial Safety; as noted above, unless such person has a permit to do such-worlrfrom that division;
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
'Clark nevelprimmt.
through his own employees, provided that such improvements,are not intended or offered for sale. If. however, the
0 Division of Industrial Safety Permit No.
.�,,.building or improverint is sold within one year of.completion: the owner -builder will have the burden of proving that.
,,he d , id not build or improve for the purpose of sale.)..
Dale -Applicant
lending agency performance
CONSTRUCTION LENDING AGENCY: I hereby affirm 4�;here is a construction'n genc fortheti
e 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 contractPor such/projects with s) licensed pursuant to the
Lender's 1 Name
Contractor's License Law.).
Lender's Address
0 1 am exempt under qpr P.C. (Attached Certificate).
.1 certify that I have read this application and state,that the above information is correct. I agree to comply with all
Date AV. Owndi
city and county ordinances anIt state laws relating to building construction, and hereby authorize representatives
ADDRESS
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm thafl have a certificate of consent to self -insure. or a. -
ORITn ne_,gPrf-, _ 922F0
certificate of Workers' Compensation Insurance , or gicertified copy thereof (Sec. 3800. Lab.,C.).
Signature of Applicant or Agent Date
Policy.No. Company
CERTIFICATE ORCOMPLIANCE,AND AUTHORIZATION OF ENTRY: I.certify I 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
O -Certified copy is filed with the City Building Inspection Department oi City Department.
entativelof the Cilipf La Ouinta.Department of Building and Safety to enter
construction, and atithorize � '4pres�
6roOrty/fior I have for this for the of making inspections.
Date 40icant
upon,ihe whit ap plied p6mit purpose
FSB SSB1;SSB
L/ signature' of Applicant dr Agent Date
APPLICANT NAME (L. F, MI)
(11;;;1 k
'ADDRESS,
50-102 AirpniAA ui:c4-,n pryni*=
CITY/COMMUNITY/STATE/ZIP
TA'Otiintg.- 92253
JOB SITE ADDRESS/SPACE
r17) ? /Z
- 8 (-a
CITY/COMMUNITY/STATE/ZIP
I Jara1jn+_A_ M Q79j;9
SOK
• PAG
PRC
C
cbmt. Fea
TNM,
RNG
SE
S
TRACT -
LOTM
47.00
Pr4w)- TIARX0 Tt"111%
OD
1.241-,03
20158
PD .-267.80 7-20-8 1 4
2
1.SB
TOTAL
FEE
TRACT NAME
OWNER NAME (L. F. MI)
'Clark nevelprimmt.
CONTRACTOR -FIRM NAME
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE .
#LICNC'#
I
564 -6448
I.
ARC/ENG FIRM NAME : .
ADDRESS
U-201.1; Mar 111
CITY/COMMUNITY/STATE/ZIP
ORITn ne_,gPrf-, _ 922F0
PHONE 034 -
LICNC #
6-0596
USE OF PERMIT•
Ai wan�►c C'11i TThit A
OIL_
ZON.
FSB SSB1;SSB
RSB
OFC.
'ZONE ORD 0
h
LOT'SZ
END
SIDE.,'
Print Applicant/Agent Name
APPUPRMT
nnnum
9-7,0-84 DATE 'S.F.D,.*
Pemit to construct 1.638 sa. ft. ff
condo iolus 150 sa.
ft. of Domb and
438 saw ft. of cwmae as mr amroved
Metch- relm
24-00
Plan cber-k Fee
267.80.
cbmt. Fea
412.00
Ele'aft.. rep-
33.75
(W T Fie
6.4A
PlumbindFooff"
47.00
Pr4w)- TIARX0 Tt"111%
4r3n-0n
1.241-,03
rl A
PD .-267.80 7-20-8 1 4
TOTAL
FEE
'1,241.03.
�%, W
r
BLDG. DEPT.
VALUATIONI 92,571.6
Ah
Ah
NO.
OPERATION ITATE
INSPECTOR
NO.
OP TION DATEINSPECTOR
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.
❑
OPON
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 P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32. Final