001042 (SFD)PERMIT APPLICATION
• City of Vg a
Department of BL;IGining 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.
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 lull force•
and effect..
License Class Lic�Number
Date - Contractor. A-_ ,�
• OWNER -BUILDER DECLARATION: I hereby affirm that dam exempt ,from the Contractor's.Lticense •aW or e
following reason (Sec. 7031.5, Business and Professions Code: Any city or'county which requires a,permt 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 h e.is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing wilti 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,S�by any Applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500,): - .
O I. as owner of the property, or my employees with wages as their sole compensation, wilfdo 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: If, however; 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 trhe purpose of sale.).
0 I, as owner of the property, am exculsively°contracting with licensed contractors to construct the project (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 contracts for.such projects.with.a contractor(s) licensed pursuant to. the
Contractor's License Law.).
0 1 am exempt under Sec. B. & P.C..(Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I 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
0 Cerlified copy is hereby furnished.
O'Certified copy is filed with the City Building'lnspection Department.or City. • Department.
Date Applicant
APPLICANT NAME (L, F. MI)�w{���_^'^w -
M. B. Johns l l
ADDRESS . .
400 N. Tustin Ave. Mite 231
CITY/COMMUNITY/STATE/ZIP
Santa Ana, CA 92705
JOB SITE ADDRESS/SPACE - -
x/?-//nQ Sexes
CITY/COMMUNITY/STATE/ZIP
La Qui nta. CA 92253
BOK
617
PAG. PRG_ _
059 ICta._
C
-
TWN'
RNG
SE `.
S
TRACT
1.3540-3
LOTMOD
47
6
SB
TRACT NAME
TAma De Ia Paz
OWNER NAME (L. F. MI) __,�i
MQUICa `
CONTRACTOR -FIRM NAME L
amllmnt
ADDRESS
ahme
CITY/COMMUNITY/STATE/ZIP
above
PHONE 0
LICNC 1
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC A
USE OF PERMIT..
BL
ZON
FSB
Sse
SSB
RSB
OFC
- ZONE ORD.
LOT,SZ
END -
-SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: -This section need not be completed if
the:permil is for one hundred (5100) o, less. l certify that•in the performance of the work for which this permit is
issued, I shall.not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant _
NOTICE TO APPLICANT: If, after making this Certificate 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:
0 I hereby certify that no excavation five (5) or more feet in depth into which Aperson 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, Sec341,TitleBr
C.A.C.)
0 As owner -builder; I will not employ anyone to do work which would require a permit from the. Division of
Industrial- Safety; as -noted above: unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDINd AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, -Civ. C.).
Lendef'iName
Lender's Address
;a l.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
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'fepresenPt�e of theAty otTa!Ouinta Department of Building and Safety to enter
upo the property for which 1! ave applied for this per t tor. the purpose of making inspections.
Signature of Applicant"or Agent Date
Print Applicant/Agent Name i a%
APPUPRMT DATE `
0"M42 11-19-84 S.F.D.
Pemit tD add an additional 26 sq. ft.
Refer back to original pennit #0558.
Previouusbedroom does not
o, onfom
as bddrom per UM and '..
Redress reuiranents. At no time
can this man be used as a bedxxm.
r )
p•.
RECEAV '
NOV 2 9 1984
A
' BUILDING DF_P RT .
- ":TOTAL '.
FEE
—(�—
BLDG.DEPT.
VALUATION —0—
r.•
Ah Ah
NO.
OPERATION ATE
INSPECTOR
NO.
O 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.
❑
NPON
ADDITIONAL •INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick "Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
X16 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/I
STREET NAME
26 Power Pole
27 Conduit'
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final