000939 (SFD)2
APPLICANT NAME (L; F, MI)
7
• _ PERMIT APPLICATION
City of La Ouinta C
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.
a CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if %
` LICENSED CONTRACTORS DECLARATION:' 6 hereby affirm that I am licensed under provisions of Chapter' 9' _ .
the permit is for one hundred'($100) o. less'. I certify that in the performance'of the work for which this permit is
(commencing with Section 7000) of Division of the Business and Professions Code, and my license is in full force '
and effect. .
issued, I shalbnot employ any person in -any marine ysoasto become subject to the worke'rs'CompensationLaws of
California// '�� ,,�•��1�`
` License Class. Lic. Number
"-
'�4/
Date ej i/ Applicant ��� /� i
' Date Contractor
^'Compensation
OWNER=BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractor's License Law for the
NOTICE TO APPLICANT: If, after making this, Certificate of Exemption, you should become subject to the Workers'
provisions of the Labor Code, you&mmust.forthwith comply with such provisions or this permit shall
'
,.efollowing 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:-
suchpermittofileasignedstatementthatheislicensedpursuantto the provisions of the Contra ctor'sLicense Law
p I hiriby certify that rib ekivation five (5) or mote feet in depth into which a person is required to descend, w ill be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business.and Professions Code) or that he is exempt. "..
made in connection with v/ork'authorized by this permit; and that no building structure, scaffolding; falsework, 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_thamthirty-six'(36) feet high. (Chap 3.2, Grp 2, Art 2; Sec341, Title8,'
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): -
C.A.C.)
0 -Las owner of the property, or my employees with wages as theirsole compensation, will,do the work„and the'xf]
is intended offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
As owner -builder, I will not employ anyone to do work -WIiich would 'require a permit from the Division of
'noted -above, permit
structure not or .•
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or • -
”
'
Industrial Safety, as unless such person has a to do such work'fiomdhat division.
:r - r p
O Division -of Industrial Safety Permit No. ^wj7 ^rss - ' / "/^�'
through his own employees. provided that such improvements are not.intended or offered.for sale. If, however, the
�/ ✓
building orimprovemni.issoldwithinone year ofcompletion. the owner -builder will have the burden of proving that .
he did not build or improvefor• the purpose of sale.).`'vim•
Date. Applicant
`
CONSTRUCTION LENDING AGENCY: I hereby affirm thit�here is a construction lending agencyfor the performance
,•.'&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. Q.'
7044, Business and Professions'Code: The Contractor's:L'icense Law does not apply to an owner of property
-t i
' builds or improves thereon, and who contracts forss , projects with a contiactor(s).licensed pursuant'to the
'
Lender's Name
,[ .
Contractor's License Law.): ' �/ ////
�/
�1 Lender's Address
O I am exempt+under-Sec % Fr B. 8 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 y,
Date ' Owner" C'" '' '
city and county ordinances and state laws relating to building construction, and hereby authorize' representatives
of this couniy to enter upon the above-mentioned property for inspection purposes.*
WORKERS' COMPENSATION DECLARATION: I hereby affirm that] have a'certificate'of consent to self -insure, or a.
-
'-certificate'of Workers' Compensation Insurance: or a certified copy thereof (Sec. 3800. Cab. C.).
.�
Signature of Applicant or Agent Date
Policy No. Company,
•CERTIFICATEOF
ti
COMPLIANCE AND AUTHORIZATION OF ENTRY:, I certify I have lead thlsapplicationand statetfiat
O Certified copy is hereby furnished..
the information given is correct.'I gree to comply with all state'laws and county ordinances relating to buid]ing
O'Certified copy is filed with the City Building Inspection Department or City' Department.'
construction, and ouch iize a representative of theCityJ of....I ,tints Department of Building and Safety to enter
upon the property or4�which Vtia4e9appheddor this pernlit;for the purpose of making inspections' .. .
Date Applicant.
-
:.. .
t/ `Signature of Applicant or Agent - J / - Date
"
Print Applicant/Agent Name
2
APPLICANT NAME (L; F, MI)
Clark peyeaomient cbrb_
-ADDRESS
50-3,02 .Aver., vista nanita
CITY/COMMUNITY/STATE/ZIP
La Quinta., CA 92253
JOB SITE ADDRESS/SPACE - -
78-077 Calle Norte
CITY/COMMUNITY/STATE/ZIP -
La Oualnta. CA 92253
BOK,
PAG
PRC
C
dont, Fee
TWN -•
RNG
SE '
• S
TRACT
LOT
47.00
Prop, Detre]. Fee K
MOD
SB ..
-
1158 -
43
1
TRACT NAME
None
OWNER NAME -(L, F. MI) •-
Clark rievml,cwirp-xit a
CONTRACTOR -FIRM NAME
S�-
F.fF#rAl�r
ADDRESS - .. ...
akx�>e •
CITY/COMMUNITY/STATE/ZIP ' .. • .
PHONE I - '
LICNC 1
564-644R
ARC/ENG FIRM NAME ' ' ' . ' •
ADDRESS
CITY/COMMUNITY/STATE/ZIP ..
P,- lint; m ai wn
PHONE I •
LICNC • -
USE OF PERMIT -
"
'Bl
ZON
FSB
SSB
SSB
RSB
OFC
i
f
•,
-:' ZONE ORD
LOT SZ'
END
.SIDE
c
' APPVPRMT fl n � 11 3q
' ' 9 -Cry DATE '
-84 S.r;D. .
Penni t to crost cwt 1705 sq. ft. of
ernwin n1tim .?WA C"_
ft• of rW"ft-,', ="A
AIR acTr f#- of rr�Tv-�rx+ r►o�r rr�r�r�>n�r�
... Ulans .
Mach. Fee
24.00'
Plan (mak Fee- I
275.60
dont, Fee
424.00 V
Elect, Fee F
84.59
SMI Fee
6.76
Plurbin-
47.00
Prop, Detre]. Fee K
450.00. '
1,261.95•
PD -275.60 7-20-84
r,Qa
986 35
TOTAL
FEE
1.261.95-'-
i ;• �, VALUATION �!W l=lT,hvOy y
BLDG. DEPT.
NO.
OPERATION I Im I E
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.
❑
NON
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 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