000919 (SFD)PERMIT APPLICATION i i '
• City of
Department of Building
La Og a
and Safety / UU
CITY/COMMUNITY/STATE/ZIP'
La Qainta; CA 92253
JOB SITE ADDRESS/SPACE
0700-08,9 I9 Ca11e 14orte
'This permit becomes void if work not commenced within 180 days fromdatemf
issuance. OR, if .work has been suspended or abandoned for a period of 180 days.
• • • t
, • . CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE: This section need not be completed it
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 performance of the work for which this permit is,
(commencing with Section 7000) of Division 36f the Business and Professions Code, and my license is in full force
and effect.
issued, I shall'not employ any person in anymannerso sto became subject totheWorkerss''Com/p/e/gsat/isonnLL)�aws of
Ca lilorniaZ�'���,'_%
SE
- l./--
• License Class Lic. Number
%i Date Appliiant./'
Date _ •. -'k - •+' '- .1 Contractor
NOTICE'TO APPLICANT: If, af'ter making this Certificate of Exemption, you should become subject to the Workers' .
y% -hereby
. •
OWNER -BUILDER DECLARATION:'I affirm 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
- v
be deemed revoked. •
foil owing. 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
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
.` such permit totileasignep statement that he is licensed pursuant.to the provisions of the Contractor's License Law
p Ilierebycertifythatnoexcavationfive(5jormorefeetindepthintowhichapersonisrequiredtodescend,willbe •• -
(Chapter 9(commencing with section 7000) of Division_3 of the Business and Professions Code)orthat heis exempt:
'made in connection with work authorized by this permit and that no building structure: scaffolding, falsework; or
therefrom'and the basis forthe 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) teet high. (Chap 3.2, Grp 2, Art 2: Sec341, Titlell,
subjects the, applicant to a civil penalty of not more than five hundred -dollars ($500.):
' C.A C) A— • T.,
` 1, as owner of the,property, or my employees.with wages as their sole compensation, will do the work, and the;4,
As owner builder, I will not employ xanyone to do work which wduld require a permit from the Division of
y'structure isnot intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License ...
Industrial Safety; as noted above, unless such person has1a permit to do such'woik from III a division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
improvements intended for If, however,
0 Division. of Industrial Safety Permit No. e j 1 .� •,� ����
through his own employees, provided that such are not or offered sale. the
Z 61 �/I e, f�✓� ' ��
building orimprovemntissold within one year ofcompletion, theowner-builder will havetheburdenofproving .that
he did not build or improve for the purpose of sale.).
-(Sec:.
DateApplicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
' I; as owner of the property, am exculsively contracting with licensed contractors to construct the project
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 appy to an owner of property who -'
builds or improves thereon: and whoijcontract •for'such/projects w'(h a contractors) licensed pursuant to the' Lender's.Name
Contractor's License Law.). �/ Lender's Address
❑ 1 am exempt under Sec.' � ! l' f '.'B. B. 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 Ownery `
a city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above=nientioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
ZONE ORD •
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800.'Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company
}/ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have Pead this application and.state that
11,, O Certified copy isherebyfurnished.. '
the information given is correct. I agree to comply with all state laws and county ordinances relatingao buidling
O Certified copy is filed with the City'Building Inspection Department or City Department..
"�^.• *•�:
construction, and authorize a representative of the City of a'Ouinta Department of Building and Safey,to enter
upon the I have applied. for this permit for the of making inspections.
0ate Applicant'J✓-
proPert�ycfor�which purpose -
w
v Signature of Applicant or Agent Date
Print Applicant/Agent Name
'APPLICANT NAME (L. F. MI) '
'0
amik ORP'.
ADDRESS
50-102 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP'
La Qainta; CA 92253
JOB SITE ADDRESS/SPACE
0700-08,9 I9 Ca11e 14orte
CITY/COMMUNITY/STATE/ZIP CA92253
BOK
PAG
PRC
C '
,TWN
24.00
RNG '•
SE
S
TRACT-
20158
LOT'
SMI Fee *,r
•.
MOD
1
SB
,
TRACT NAME
OWNER NAME (L. F, Mq-
Clark Develppwnt Wrp,
CONTRACTOR•FIRM_ NAME _ - •-
mer
ADDRESS ..
, 7-20-84
PD -882o,35
CITY/COMMUNITY/STATE/ZIP
above
PHONE 1 •-
564-6448
-�
LICNCI
R'
-ARC/ENG FIRM NAME Patft&k heehy
ADDRESS
74-215 BW 111
CITY/COMMUNITY/STATE/ZIP
Palm Desert, CA .92260•
PHONE •
346-0596
LICNC a
IJtS;�G,�<P�M uniuni unit #
BL
ZON
FSB
SS8
SSB
RSB
•OFC '.
ZONE ORD •
iLOT SZ -
-
END _ `
SIDE',
APPL/PRMT �
.1
DATE
9•18`84 Q_ r lJ
Penhit to construct 1705 sq. ft.-
t.of
ofcondo plus 263 scl. ft. of porch
and - 438 sq. ft.
of garages as Per
approved plans.
Mach. Fee
24.00
W Plan C vxk Flee
275.60
Const. Fee 424:00 r
MRct. Fie
34.59
SMI Fee *,r
6.76
Plumbing F1F�eT
47.00
.Prop. Develop.
Flee 450.00
IE C E 0 V E 0
11261.95
S t P 2 4 1984
, 7-20-84
PD -882o,35
X275.60
-�
TOTAL;':-
FEE '
1', 261.95
BLDG. DEPT.
VALUATION 96,779.80 '
r-1
Ah
NO.
OPERATION IIATE INSPECTOR
NO. OPtrtATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frma
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart.
3
Steel
O
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
/ i
39 Appl. Clearance
7
Framing 42
D .�
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire'rVall
42 Commercial Hood
10
Fireplace P.L.
❑
43 Final
10A
fireplace T.O.
❑
OP'NO. ADDITIONAL INFORMATION
F Q+
�� 3 2 p Q
((( 1
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lat.-i
12 Internal Latt
12A Drywall
13 Finish Grade
INSULATION Thick
Value�U
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (elovwn)
14 Final
PLUMBING APPROVALS
15 Ground Plum
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
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final