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000927 (SFD)V / PERMIT APPLICATION � City of La Og a • r✓ 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. LICENSED CONTRACTORS- DECLARATION: I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 30 the Business and Professions Code, and my license is in full force - and effect. License Class Date Contractor Lic. Number OWNER -BUILDER 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 file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with section 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 dolhe 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 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 complelion, 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 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 suc •p`rojects with a contractor(s) licensed pursuant to the Contractor's License Law.). / /j f ❑ I am exempt under Sec. !/'� �'.tBP B P.C. (Attached Certificate). Date Owner �y 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. 0 Certified copy is filed with the City Building Inspection Department or City Department. Applicant APPLICANT NAME (L, F. Mn //��,,,,�� !._..FR�J k l-yy 6.. Corn. ADDRESS . //��111/��n 77 !M-402 /1.1VP-. V7lcl+ rR11l.L " CITY/COMMUNITY/STATE/ZIP La flair .a. CA 92253 JOB SITE ADDRESS/SPACE Cath Iaicsztle CITY/COMMUNITY/STATE/ZIP Ta rxvintA. CA. 92253 BOK PAG PRC C TWN PING SE S TRACT LOT Plumbing Fee 47.00 MOD Set = 1.23n v PD 263.90 7-20-84 966.47 ety Ol ta Q014ft ® 1 TOTAL FEE 1,230.37 TRACT NAME p� ' lNsY1e OWNER NAME (L. F. MI) /i7 =k SavelprolimM CONTRACTOR -FIRM NAME •' ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE • LICNC 564-6AAQ ARC/ENG FIRM NAME r' Patz'a ck ShedW ADDRESS 74-215 Hwy in CITY/COMMUNITY/STATE/71P Palm Desert, CA 92260 PHONE A 346-0596 LICNC USE OF PERMIT — TT''� A'].�rCbncb BL ZON FSB • SSB SSB RSBOFC ZONE ORD • LOT SZ - LEND 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 perm(tis issued, I shall notyemploy any person In any manner.so as to become subject to the Workers' Compensation Laws 0t! California. / Date - a z�• Applicant.,�f %+ NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the:Workers' 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 I 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, Sec341, Title B, " C.A.C.) 0 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 has4a permit to do such work from that'division. 0 Division of Industrial Safety Permit No. •• Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 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 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 CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the information given is correct. Iagree to comply with all state 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 p operty for which I have applied to this perm flfor the purpose of making inspections.• s�� x , 1�z1el Signature of Applicant or Agent F Date Print Applicant/Agent Name APPUPRMT�ry t t r n q? DATE 9-20-84 S.F.D. Per mt to ommtrnct 1588 sq. ft. of onnido Alts 258 sct. ft. of porsh and 438 ft. of garage as per approved meth. Fee 24.00 Plan Check Fee 263.90 Qolist. Fee 406.00 Elect. Fee 33.13 SMI Fee 6.34 Plumbing Fee 47.00 Prop. Devel. Fee 450.00 8 V F= ® 1.23n v PD 263.90 7-20-84 966.47 ety Ol ta Q014ft ® 1 TOTAL FEE 1,230.37 BLDG. DEPT. VALUATION 90,595.60 Ah Ah NO. OPERATION ATE INSPECTOR NO. OP TION 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 1 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) 126 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 29B Bonding 30 Fixtures 31 Service, 32 Final