000935 (SFD)7
PERMIT APPLICATION r
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ADDRESS `
Sn-- _02 �1sr miLda V3,� Bonita
CITY/COMMUNITY/STATE/ZIP
Tra C3� i nta . M 92253
JOB SITE ADDRESS/SPACE
_
R-nR4 C.a1_]_e Norte
CITY/COMMUNITY/STATE/ZIP -
T onin a _ CA. 92253
BOK PAG PRC •C TWN - RING - SES-> S
TRACT LOT MOD SB
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TRACT NAME
OWNER NAME (I., F. MI) '• '
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I; 7!•Alf"1K Tf�xt•:�1�t
CONTRACTOR -FIRM NAME ...
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ADDRESS '
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�S'1r'15717
CITY/COMMUNITY/STATE/ZIP
PHONE a - LICNC 0
4A--AAAR
ARC/ENG FIRM NAME -
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Patrick �
ADDRESS
CITY/COMMUNITY/STATE/ZIP �•L '
Palm Desert. CA 92260
PHONE LICNC A 1.-
346-0596
USE OF PERMIT ..
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City
• Department of
of La Cull ? �'
Building and Safety
•
.•
1
_ r 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. • '
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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 .
of Professions license is in full force
the.permit is for one hundred ($100) o. less. I certifylhat'in the performance of the work for -which this permit is
issued, I employ any in any manner so as tolecome subject to the:Workers'Compensation L'a`ftof
o (commencing with Section 7000) of Division 3 the Business and Code, and my
and effect.
shall not pel
Californias
" License Class Lic. Number
V Date ' r c�( Applicant�x
Date '' Contractor
NOTICE TO APPLICANT: If, atter. making this,Certifil of -Exemption, you should become subject to the Workers'=
OWNER -BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractor's License Law -for -the'
Compensation provisions of the Labor Col must forthwith comply with such provisions or this permit shall' '•-
fie 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.applicanttor
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.
O I•hereby-certify that no excavajion five (5) or more 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 is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding,.falsework. ol
'therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit '••
'demolition or dismantling th'eieof,'will be more than thirty-six (36) feet'high. (Chap 3.2, Grp 2. Art 2, Sec341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars: ($500.): - -
' 'C.A'.C.)' - •' '' ' `''+'•Sr"•. '
O 1. as owner of the property, or my employees with -wages as their sole compensation, will do the work, and the
O'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
industrial Safety, as noted' above, unless'such person has a permit to d such worlrtrom that division.
' 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
-' • - -. •/' �' �.
O.Division of Industrial Safety Permit No.
�� �` x"y��✓�
buildingorimprovemntissold withinoneyear ofcompletion. the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.) . s
- .;'. Date - " Applicant��� C
T
, ` CONSTRUCTION LENDING AGENCY: I hereby aftirmdhat there is a construction lending agency for the performance "
• O'l, 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 Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon;'and who contracts for such projecis witWa contractor(s) licensed pursuant to the
' . .
J Lender's Name
'Contractor's License Law.). ��
/v'
Lender's Address -
/ �j,�[/
s �8t8 P.C. (Attached Certificate).
C. I am exempt under Se` -_, ��
_ I certify that l have read this application and state that the'above informationis correct. I agree to comply with all
Date {�" Owner ^�
cit and count ordinances and state laws relating to building construction; and hereby authorize representatives,
Y Y 9 9 Y D
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I haven certificate of consent to self -insure, or a
of this county to enter upon the above-mentioned property for inspection purposes.
' certificate of Workers' Compensation Insurance .:or a certified copy thereof (Sec.'3800. LabaC.). , .I •
Signature of Applicant or Agent Date
•- Policy No. _ . Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cettify I have read Misapplication and slate that
-s O Certified -copy is hereby furnished. ,v '
the information given is col agree to comply with all laws and county ordinances relating to buidling .
- O Certified'copy is filed With the City Building Inspection'Department or City Departments'
.Date Applicant-��i
construction, and aurtliorize a'repirresentative of the CityAf La Ouinta Department of Building and Safety to enter `
upon Chef pcaperty for which U 've app led for his permit for the purpose of making inspections.
_
-Sig- natur o Applicant or Agent Date
>
Print Applicant/Agent Name
APPLICANT NAME F,
APP RMT
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. •' DATE ,
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1;214.6/ ..
PD -25805 7-20-84
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956,62
a.
TOTAL'
FEE 214-67
Lr :: VALUATION
BLDG. DEPT.
Ah
r1
NO.
OPERATION I IrATE INSPECTOR
NO. OPITATION 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 7
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. ❑
NPON ADDITIONAL INFORMATION
L I tk I
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 62p?®,
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb Q
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final