000941 (SATT)PERMIT APPLICATION
( City of La Ouinta
• Department of Building and Safety . �.
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. '
' •. . �•' .,
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
thepermit is for one hundred ($100) o, less. I certify that in,lhe performance of the work for which this•permil.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 person i .any mannerso as to become subject lothe Wo k'ersAApCompensation Lawsof
California ����
License Class Lic. Number
Date Applicant �/ � YV �••'�
of, Workers
Date' Contractor - V
NOTICE.TO APPLICANT.: If, atter making this Certificate Exemption, you should become subject to I #e
OWNER- BUILDER DECLARATION I hereby affirm that I am exxe6 mpt Iron tffe Contractor's License Law for the
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 anystructure, prior to its issuance, also requires the applicant -tor
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
' such permit to,file a signed statement that he is licensed pursuant to the provisions ofthe Contractor's License Law
..:i7lherebycertifythatnoexcavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe-
(CAapter 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, lalsework, or --
therefrom and the basis for, the alleged exemption: Any„v,iolation of Section 7031.5 by, any applicant for a permit _
demolition or dismantling thereof, will be more than thirty-six (96) feet high. (Chap 3.2, Grp 2, Art 2, SecNlJitle 8.
subjects the applicant to a civil penalty of not moreUhanfive hundred dollars ($500):
_ C.A.C.) ,
❑ I, as ownerot the property, or my employees with wages as,their sole compensation, will do the work, andihe
16 As owner -builder, I will not employ anyone to do'work which would require a permit from the -Division of Y
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 do such. work"from that division: f
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
w- �� tj �Z / `
through his own employees, -provided that such: improvements are not intended or offered for sale. If, however, the °
.. 0 Division of. lndust/ial Safety Permit No.. 1. _
Col
building or improverrint is sold within one year of completion. the owner -builder will have the burden of proving that ,-
he did.not build or improve for the purpose of sale.). '
DateApplicant` •-
���� ,
here is a constron lenthe tling agency for performance
``CONSTRUCTION LENDING AGENCY: I hereby affirm th t tucti
I, 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.).
" ;44. 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. suptprojects with a,contracior(s) licensed pursuant to the
_
Lender's Name •
Contractor's License Law.). ,/ �'I ,_
j Lender's Address
{j/
01am exempt under Sec. °''! •�;� ',' ( GLrL � 8�8 P;C. (Attached.Certiticate):•
v`—°
... I certify that I have read this application and state that the above information is correct. I agree to comply with all
c-•� ' •
Date Owner
'city and county ordinances and slate laws relating to building construction, and hereby authorize representatives
of this county to enter'upon the above-mentioned property for inspection purposes. '
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self:insure, ora •.
• certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800: Lab: C.).
Signature of Applicant or Agent Date
_ Policy.No. Company.
• _ -
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplication'and statethal . -
' 0 Certified copy is hereby furnished.: , :: a , '
the information given is correct: I agree to comply with all state laws and county ordinances relating to buidling
' 0 Certified copy is filed with the Citj Building Insliection.Department or Cit ” %Department.•
•.
construction, and authoRze a'representative of.the City of La,Qinta Department of Building and'Safety to -enter .
upon the erty for which I h viapplied•for I ermit.for'the purpose of making inspections.
Date, Applicant.
pro
/. '
- -
Signature o`I Applicant or Agent. Date
OFC
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI) '' •' - .• '
r T?�x�a nrx�nl- (terra
ADDRESS '• " 4
C
51(,3—T n� Acro _ flit a#�a ill, �'
CITY/COMMUNITY/STATE/ZIP
T ()1tTl14A M
JOB SITE ADDRESS/SPACE - -
aa-rt�� k�i�l� i'wTnly� • �'
CITY/COMMUNITY/STATE/ZIP -
La Ouinta.. M 9299;'1M
BOK '
PAG
PRC
C
TWIN,
RNG
SEL .
S
T2til.i.RACX 58
45 LOT
Plu birm Fee
47.00
X o
se
07
TRACT NAME *�•y�� +�;
lY1A,R
OWNER NAME (L. F. MI)' -
Clark Develommmt
CONTRACTOR -FIRM NAME
o�.�M .. -
w Y.i
ADDRESS -
U
l .261.95
CITY/COMMUNITY/STATE/ZZIIPq,� �
ate= •.
PHONE A'
- LICNC 1
5ka4-64-AR
ARC/ENG FIRM NAME ^j
•�_.
ADDRESS
74-215 i"7- ll_7.
CITY/COMMUNITY/STATE/ZIP .. .. ..
lintA_ CM
PHONE A
LICNC
USE OF PERMIT
Ai vv ---q r t'7P_ rVWW76,
BL
ZON
FSB SSB
SSB '•
RSB
OFC
• ZONE ORD 6 ^,' ,
1 • LOT SZ
END
'SIDE.
�P
LY
APPPRMT
L/
DATE
9-20-84 S.F.D
Plar .t to construct 1705 sQ; ft. of
cando olus 263 scz.
ft. of mrc h and
438 sa• ft. of comae as oer an raved
• D.i.C%i is w
.
mech. Pe
24.60
PlanC� Fee
275.60
cwstwA19e
424.60 .
Meet., F
34.59
SMo[C
.7G
Plu birm Fee
47.00
necrn1__
450.00
1..26x„95
Pn A75..60 7-20-84
07
i
TOTAL '
FEE
U
l .261.95
VALUATION 96A779i80
BLDG. DEPT.
Ah
Ah
NO.
OPERATION I ATE
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'N
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)
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
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final