000920 (SFD)PERMIT APPLICATION
City of La Quinta
• Department of Building and Safety
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
rl 09 - 0 U C&Ue -Lb to
This permit becomes void if work not commenced within 180 days from date of issuance. ORJf work has been suspinded. or abandoned for a period of 180 days: -i
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CERTIFICATE OF EXEMPTION FROM WORKERS',COMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that'l -am licensed under provisions of Chapter 9
with Section 7000) of Division 3 of the Business and Professions Code, and my license is intfull force
the permit is for one hundred ($100) a, less. I certify that in the performance of the work for which this permit is
subject to the Worke
issued,I shall employ any person in any manner so as to become rs'Compensation Laws of
.(commencing
and effect. * �v . -
License Class Lic. Number
ornia-4-11 — .", �w
Zie' Applicant'- / -
XZr I,"
Date Contractor,-'-.-
NOTICE TO APPLICANT: -if, after making this Certificaterof Exemption' -you should become subject to the Workers'
OWNE . R:BUI . LDER . DECLARATION: I hierety affirm"that I am','exe-mpt 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
following reason (Sec. 7031.5. Business and Pr - ofessions Code: Any city -.or county which requires a permit to
be dee . med revoked.
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the -applicant for
DIVISION ORINDUSTRIAL SAFETY PERMIT CERTIFICATION:
such.permit to file a signed statement that he is licensed pursuant to the provisions of,the Contractor's License Law
1 0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend 'w ' illtie
(Chapter 9 (commencing with,section 7000) of Division 3 at 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.' falsewark.or
therefrom and the.basis-for the 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) feet high. (Chap 3.2, Grp Z Art 2, Sec341, Titleli,-
subjects the applicant to a.civil penalty at not rrrii�e`ihan five hu'ndred d6liars ($500.):
'C.A.C.)
0 I. as owner ol.the property, or my employees with wages as their,sole compensation, -will do the work, and.the:..
:1 As owner -builder, I Will not employ 'anyone to do work Which would require -a permit from the Division of.
Andustrial
.structure is.notdritended 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
Safety, as noted above, unless such person has,a permit to do such work•I Ah I di
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through'his own employees; provided that such improvements are not intended or offered for sale. If, however, the.
.
6 Division of)n'4pst' , � . 7
rial Safety Permit No.
Z 6/K /7—
,building or improvewt is sold within one year of completion. theowner-builder will havethe burden of proving that -
he"did not build or improve for the purpose of sale.).
O'L as owner at the property, am exculsively contracting with licensed contractors toconstruct the project (Sec.,
Date. AppIican't--/t"/,/�`//- -
CONSTRUCTION LENDING AGENCY: I hereby affirm that is a' construction lend 0 ing agency f rthe*performance
X 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
V I . "
builds or improves thereon; and who conlracts for such projects with a contractor(s) licensed pursuant to the
Lender's Name
Law:). a
Coniractor L, I
Lender's Address
ON',
0. 1 am exempt under Sec_ B. & P.C. (Attached Certificate).
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V
I certify that I have read this application and state that the above information is correct.) agree to comply with all -
'Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
•
of this county to enter upon the above:menlioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION:- thereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance:; or a certified copy thereof (Sec. 3800Aab. C.). -
sig . nature of Applicant or Agent Date
Policy No. Company
a
R OF ENTRY I certify I have read this application and state that
X CERTIFICATE OPCOMPLIANCE AND AUTHORIZATION
-0 Certified copy is hereby furnished. :1.
information given is correct. I agree to comply with all state laws and county ordinances relating to buldling
0 Certified, copy is filed with the City Building Ins . pection'O . eliartment orjbty.:, Department.
Date Applicant
construction, and authorize a repre;entative of the City of La Puinta Department of Building and Safety to enter
up6n the 6roperty forfwhich-I ha4i app-i6d for—this 'permit for the purpose of making inspections.
7 -MV,// ,
"Signature of Applicant or Agent Date
APPLICANT NAME (L. F, MI) .. ., . .1 .
Clark Dmmloamnt Corp.
ADDRESS
50-102 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
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CITY/COMMUNITY/STATE/ZIP
La Quinta. CA 92253
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TRACT
20158
LOT
MOD MOD
I'SB.,
TRACT NAME
OWNER NAME (L. F. MI)
Clark neve3�'Qatm.
CONTRACTOR -FIRM NAME
ADDRESS
ablme
CITY/COMMUNITY/STATE /ZIP
PHONE 564-6.448
LICNC 0
ARC/ENG FIRM NAME
Patrick Sheehy
ADDRESS. 744215 My .Ul
CITY/COMMUNITY/STATE/ZIP
. v PhIn Desert, CA 92260,,-.
PHONE 346--0596
LICNc
USE OF PERMITAix-space Unit
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END
SIDE --4
Print Applicant/Agent Name
APPUPRMT11 n. 9 DATE -84 n n R 7. ra s: Z, 0,
Penna t to amstrmh 1705 - sa. ft^
of condo pilus 263 sq. ft'.' of
porch and 438 sq. ft. of 'garage
as per approved -plan.,
Mach. Flee 24.00
Plan Check Fee 275.60
Qmist:* Fee y424.00
Elect -0 Fee' 34.59
SMT. Fee -6076
pluribim IFIM 47.0
Level. Fee 450.00
751
1,261.95
SEP 2
PD.--L?5.60* 7-20-84
986 15Q5
TOTAFEE L• > 261.95
VALUATION 96,779,80
BLDG. DEPT.
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Ak
NO.
OPERATION I 75ATE
INSPECTOR
NO. OPMATION 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 00jvltq /p
,
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
Lf
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall. 7
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb a U14
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 P1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final