000942 (SFD)PERMIT APPLICATION
Ouinta
City of La
Department of Building and Safety
This permit becomes void if work not commencedwithin180 days from date of issuance, OR. it work has been suspended or abandoned for a period of 180 days.
4w
CITY/COMMUNITY/STATE/ZIP
r
LICENSED CONTRACTORS DECLARATION:1 hereby -affirm that I am licensed under provisions of Chapter 9
CERTIFICATE OF EXEMPTION FROM W'ORKERS'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
I (commencing.with Section -7000) ol-Division,3 of the Business and Professions Code,and my license is in full force
and effect.
issued, I shall -not employ any. person !pny manner so as to Qcome subi Ito the workers ,Compensation LaQol,,�
CaIi or
License Lic. Number
111
V Dy/_Applicants`
I -Class-
PRC I -C I
-nate ContractorNOTICE
TO APPLICANT: If, after,making this Certificariof Exemption, you should become subject 16the Workers'.
OW4FI-BUILDER DECLARATION: I hereby affirm that I aiwexempt from the Contractor's License Law for ft, -
4- Compensation provisions. of the Labor Code, you must forthwith comply, with such provisions or this permit shall,
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to,
be deemed revoked.
• construct. alter, improve. demolish. or repair any structure, prior to*its issuance. also requires the applicant for,
`DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:..
% - suckpermit N.file a signed statement that he is licensed pursuant to the provisions ofthe Contra.ctor:s License Law,
'01 heieby certify that no excavation five (5) or more fiiet in deoth into which'a person is required to descend, will be -
JChapter 9 (commencing with section 7000) of Division Sof the Business and Professions Code ofthat heisexempt
) a .
madia in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
1.1herefrom,a ' nd,the. basis.for the allegedexemption.- Any violation of:Section 7031.5 by -any applicant fora.permit
.'demolition or dismantling thereof: will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z Art 2, Sec 341: Title 8.
• subjects the applicant to a civil penalty of not more than five -hundred dollars ($500.):
c.A.c.)
0 1. as owner of.-the.property: or my employees with wages as their sole compensation, will do.the work, and the
0 As owner -builder, I will not employ anyonit-to do wor0which 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,permil to do such wor0rom that division.
• Law does not apply to an owner of property who builds, or improves thereon,�atrid who does such work himself or
through his own employees..provided that such improvements are not intended or offered for sale. If however. the,
- .. . . . . I r -.1
0 Division of..Industrial Safety,Fprmit,No. f 4
building or improverrint is sold within one.year of completion, theowner-builder will havethe burden of provingthat
Date Applica, I Ale 4Z &,/"/V: VI/ -
he .did .not build or improve for the purpose of, sale.).}-, . .
, , ,
CONSTRUCTION LENDING AGENCY: I hereby affix that tKere is:a construction lending age ncy for thep®rfIrmance
.14 1, as owner of the property, am ex i ng with licens
contracting
culsively contra ed.contractors to construct the project (Sec..
of the work for which this permit is issued (Sec. 3097. Civ. C.). .
17044. Business and.Prof * e ' ssions Code: The Con1factor's License Law does not apply to -an owner of,property-who
ho con/t;rIs for such projects wit a contractors) licensed pursuant. the -
builds or improves thereon, and/who
I - . . . . . . * I . ... . 1 7 1
Lender's Name
Contractor's License'Law)� �j
0 1 am exempt under4ec- 6��_avlg�e 9P.C. (Attached Certificate).
Lender's Address
I cerlity,that I have read this application and state that the above information is correct. I agree to comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize.representatives
d
of this county to enter upon the abovementioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
USE OF PERMIT (all
AiL-spam Condo
certificate of Workers. Compensation Insurance -. or a certified copy,thereof (Sec. 3800. Lab. C:).
.7
Signature of Applicant or Agent Date
PolicyNo.- Company .. . . . I . . . -
. / -.'CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and'state that
.0rtified copy is hereby furnished . . : . . . . .
Ce I shed.
--the information given is correct: I agree to comply with all statejlaws and county ordinances relating to buidling
❑ Certitied copy is iled with the City Building Inspection Department or City Department:
.;construction, and authorize a representative of thexity of La.Ouinta Department of Building and Safety to enter
46A Aef property fdr which Ave. applied for ifii's permit46ythe purpose of.making inspections.
Date Applicant
N/ /V
§irnature ofApplicant or Agent Date
APPLICANT NAME (L. F. MI)
DATE
9_20-84 _SOFODO
ADDRESS
condo plus 263 sq.
CITY/COMMUNITY/STATE/ZIP
Ta 0mLT*A_ rA 9 2.7 S I
JOB SITE ADDRESS/SPACE
7A-asi caue
CITY/COMMUNITY/STATE/ZIP
TA n,fiin+,A_ M Q7 9 rM
BOK
PAG I
PRC I -C I
TWN
FING
I E7
Elect, Fee
TRACT01�8_
2
Smi-Fee
1.0�6
I . :1
M10 D
Ise
TRACT NAME
NOM
OWNER NAME (L, F. MI)
CONTRACTOR -FIRM NAME J
pD 228.80 7-20-84
ADDRESS
abrffe
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC #
TOTAL
FEE -
5646448
I
'
ARC/ENG FIRM NAME
Patrick C>%PP_hV
ADDRESS
74-215 Wy 111
CITY/COMMUNITY/STATE/ZIP .1 . I I..
La Oftnta, CA 92253
PHONE
LICNC
k6-0596 I
d
USE OF PERMIT (all
AiL-spam Condo
BL
ZON
FSB
SSB
"Sse
RSB
OFC
ZONE ORD 0
;1
LOT -SZ
END'-,
Print Applicant/Agent Name
APPUPRMT
Hn-nq.4Z
DATE
9_20-84 _SOFODO
Pen-ait to c6nstract 1705 sq. ft. of
condo plus 263 sq.
ft. of porch and
438 sq. ft. of garage as per approved
Plans,
mech. Fee
24.00
Plan Check Fee
275,60.
424.06
Elect, Fee
34'.59
Smi-Fee
Plumbing Fee
47,00,
Prop, Devek. Fee
450.00
1,261.95
pD 228.80 7-20-84
1,033.15
r.U..
TOTAL
FEE -
1..261.95
• BLDG. DEPT.
VALUATION I 96,779.80
Ah
Ah
NO.
OPERATION WATE
INSPECTOR
NO.
OP ATION 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
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.
❑
OP'NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 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 /