000933 (SFD)PERMIT APPLICATION
City of La Og
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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.
JOB SITE ADDRESS/SPACE • • '
a -nay nqiioa-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. I certify that 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.
issued. I shall not employ any erso in anymannerso.as90 become subject to the,Workers'.CompensationL'aws`of
California"
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V Date ^ Applicants `�(� `_ �•
License Class Lic. Number
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o
Date' Contractor: ' - - -
NOTICE TO APPLICANT If, after making this Certificate•of Exemption, you should become subjects the Workers' -
OWNER -BUILDER DECLARATION:I •hereby atfiim that I am exempt -from the Contractor's License Law for the
Compensation 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 •
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
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DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit.to file a signed statement that he is licensed pursuant to theprovisions ofthe Contractor's License Law
0'I hereby certifi that no excavation five (5) or moie feet in depth into which a person is required to descend,will be ~
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he isexempt
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 Sectigq, 7031.5 by -any applicant for a -permit
4demolition or dismantling thereof, willbe more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2; Sec341, Title8, '
sub'ects the applicant to a civil -penalty of not more than five hundred'dollars ($500.):
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41 . as owner of the property. or my employees withwages 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 >
As'owner-builder, I will' not employ anyone to do viork which would require'a permit from the Division of
/Industir6l.Safety; as noted above, unless such person has,a permit to do such wofk from that th ision. '
' Law does not apply to an owner of property who builds; or improves thereon, and who does such work himself or '
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". + 7- 7.�.
❑Division of Industrial Satety.Permi( No.
throogh his own employees, provided that such improvements are not intended or offered for sale. If, however, the'•.
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building orimpiovemntissold within one year ofcompletion, the owner-builder,willhave the burden ofproving that •'
he did not build or imp.9ve for the purpose of,sale.).
Date • Applicant/
f '
CONSTRUCTION'CENDING AGENCY: I hereby -affirm there is a construction lending agencyfoi.th' performance '
O I, as owner of the property, am exculsivelycontracting with licensed contractors to construct the project (See.:
, . ' of -the work for whichwthis permit is issued (Sec: 3097, Civ. C.):'
7044. Business and Professions Code: The Contractor's License Law does not apply -to an owner of property who ..•
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builds or improves thereon, and 'who contraUs for sucA projects with•a conlractor(s)' licensed pursuant to the -
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Lender's Name- '
-
Contractor's License Law,)." �(�•-
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�% Lender's Address
❑ 1 am exempt under Sec. ' 'R 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
'Date ' . V Owner L• -(, " ' ,
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ZONE.ORD7. -
'of this county to enter upon the above-mentioned property for inspection purposes:
WORKERS' COMPENSATION DECLARATION: I hereby affirm than have•a certificate of consent to self -insure, or a '
',:, cenificate,of'Workers' Compensation Insurance., or•a'certified copy thereof -(Sec. *3800. Lab: C.).
Signature of Applicant or Agent Date
Policy No. Company
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that ,.
O 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 or City '•?Department
^
construction' and authorize a'representative of. he City'oYLa Ouinta Deparlmer)t,of Building and Safety to enter `
upon the erty Jootr/which 31f6e-a6plied�fo is p emit for the purpose of making inspections.
Date .. -Applicant _..��//
pro
' Signature of Applicant or Agent v Date
Print Applicant/Agent Name f
APPLICANT NAME (L. F. MI) °
- Fart. Ploxrcl rx-I�nT�t• C1n
ADDRESS.
Sn-ilm t-cmimMvilllto-a v%n-ni+.';q
CITY/COMMUNITY/STATE/ZIP
Ta n tin al rA92x53
JOB SITE ADDRESS/SPACE • • '
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CITY/COMMUNITY/STATE/ZIP - - T_-* elit-p v,+ RRa QI%ir,
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TRACT20158
LOT
258,05'
Const, Fee
MOO
3
SB
32,49
TRACT NAME
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OWNER NAME (L• F. MI) , y�,�1.
I..W& Development a
CONTRACTOR -FIRM NAME o'
wrex
ADDRESS
abme ,,{y.�� -
CITY/COMMUNITY/STATE/ZIP • . -
PHONE 1 564-6448 `
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ARC/ENG FIRM NAME Patx.l.& Sh6ehy -• -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
Palm Desert. CA 92260 ;•
PHONE A
346=-0596
LICNC
USE OF PERMIT
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END
SIDE,
APPL/PRMT UnR 3.3
§-A721-84 S.F.D.
Pwuit to c omtnact (1537 sq. ft. of
condo plus 150 Sa.
ft. of Hord, and
438 sqe ft. of gagage as Per approved
vlans ,
Ni h, Fee
240'00. .
Plan C,eck Fbe
258,05'
Const, Fee
397.00
Flact. Fee
32,49
SM Fee
6.13
Plumbing Fee- '=. *
47.00
Prop, Devel, Rue
450,00
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1,214.67 -
PD -258:05. 7-20-84
956.62
da
��.74 y: •:.
TOTAL
.'1,214.67.
;VALUATION 87j265.00
BLDG. DEPT.
Ah
Ah
NO.
OPERATION ATE INSPECTOR
NO. OPE TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab Grade
Q
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
1
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.
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OP'N ADDITIONAL INFORMATION
NO.
Q
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 PiI
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
I i i . STREET NAME