000940 (SFD)PERMIT APPLICATION
0 City of La Og a • p/ �(�
Department of Building and Safety p
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.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed. under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and.my license is in full force
and effect.
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
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 applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than.five hundred dollars ($500.):
O I. as ownerof the property or my employees with wages as their sole compensation, will do the work, and the
structure is not intended 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
through his own employees, provided that such improvements are not intended or offered for sale. Ifvhowever, the -
building or improvemnt 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.).
V I, as owner of the properly am exculsively contracting with licensed contractors to construct the project (Sec.
°Y-044. Business and Professions=Cod The Contractor's License Law does not apply to an owner of property -who
builds or improves thereoli:=and who contracts for such pppJJJojects with a co tract�(s) licensed pursuant to the
Contractor's License Law.)._ f��� J �' j
O 1 am exempt under Sec. 9/� �r �� B. 83P.C, (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). ,
Policy No. Company
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City
Date Applicant
Department.
APPLICANT NAME (L: F. MI)
Clark�1�,r.' 1 /'.�
i.,lark Deva om l-Jt1.� .
ADDRESS
crIndo talus 263 sa.
CITY/COMMUNITY/STATE/ZIP •- '-
Ia Ce:inta, CA 92253
JOB SITE ADDRESWSPACE ,
8-0179 Cale Norte
CITY/COMMUNITY/STATE/ZIP
T,adata M 92253
BOK
PAG
PRC C
275-60
TWN
RNG
SE.
S
TRACT
6.76
LOT
47.00
MOD
SB
,
Cp
2011.518
44
ri ' cs�4
986. ,3.5
TFEE 1.261.x95
TRACT NAME
OWNER NAME (L. F. MI)
Q'_7.ark ttip4m xs It
CONTRACTOR -FIRM NAME
f�A11'1F•?
ADDRESS
Abow
CITY/COMMUNITY/STATE/ZIP -
PHONE M
LICNCR
ARC/ENG FIRM NAME
PPtr4 t�k Axa
ADDRESS
74-215 mn, iii e
CITY/COMMUNITY/STATE/ZIP
La CA 92253
PHONE 0
LICNC 11
USE OF PERMIT ,
Air-s3iaoe Godo
BL
ZONFSB
SSB
- SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' 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
ssued,IshalLnofemploy any personl any manner so as to becomesub'ecttotheWorkers'CompensaionLawsof
California/ `��
Date C��� g �/ Applicant
NOTICE TO APPLICANT: It, all making this Certit ate of Exemption, you should become subject to the Workers'
Compensation provisions, of the Labor Code, you must forthwith comply with such provisions or this'permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend: will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2,;Grp 2 Art 2. Sec 341, Title 8,
C.A.C.)
y, "As owner -builder, I will not employ anyone to do work which would require a permit from the Division o1
'Industrial Safety, as noted above, unless such person has,,a permit to o such coo k "from that division. , t
O Division of Industrial Safety Permit No. r" r�
41
Date Applicant / /�✓/� ��at. , .
CONSTRUCTION LENDING AGENCY: I hereby affirm•t�there is a construction lending agency for the pirformance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
y Lender's Name_
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
-of this county to enter upon the above=mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
T. the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling;
construction, and a0orize a'representati've of thirCity of La Ouinta Department of Building and Safety to enter
upon the p o eectty/fo/r�which Lhaveapplyied'for`this permit for the purpose of making inspections.
��1
Signature o(Applicant Jr Agent Date
Print Applicant/Agent Name
APPL/PRMT n n 4 A
M �Ar
DATE
9-2n-84 S.F9D.
Pmt to +f ist nvt 1705 sa. ft. of
crIndo talus 263 sa.
ft„ of =xch axe,
43; sa. ft. of aamacne as ner arimmved
�s7_ariis.
P
275-60
cci st. -ree
424.00
Elegy. Fee
34.59
Ma Fee
6.76
Plurbincz
47.00
,.�Fee �
Pron. Devfel. Fee
450.00
1,261.95
PD - 275.60 7-20-84
ri ' cs�4
986. ,3.5
TFEE 1.261.x95
k i do
BLDG. DEPT.
VALUATION 96.779.80
Ah
AWL
NO.
OPERATION HTE
INSPECTOR
NO.
OP . TION 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)
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
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