001041 (SFD)PERMIT APPLICATION
City of La Ouinta
• Department of Building.tand Safety
This.permit becomes void if work not commenced within 180 daysfrom date of issuance, OR, it work has been.suspended or,abandoned for a period•of 180 days:. '
LICENSED CONTRACTORS DECLARATION: I hereby affirm' that l 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 '- rc^N tuber
.Date ' Contractor _� a
OWNER -BUILDER DECLARATtON:.l heretiy affirm that am exempt liom th Contractor's icense L w•foPre
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permyt 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 pursuanl4o the provisions of the Contractor's Lice)& Law
(Chapter 91com mencing with section 7000),of Division 3 of the Businessand Professions Code) orthat 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 owner of•the property, or my employees with wages.as their sole compensation, will do the work, and the
structure isnot 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: add 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 the 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. 8 P.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 _
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building In spection,Department or City. Department.
Date Applicant
-
APPLICANT NAME (C, F,_M.B. Johnson
ADDRESS - 400 N. Ztistin Ave. ' SUite 231 .
CITY/COMMUNITY/STATE/ZIP
Santa Ana, (M 92705
� .f� - -
JOB SITE AOORESS/SPACE0-496
7./ -496, Seroma
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA 92253 '.
617
P0591,O
can this roan be used as a bedroom.
TWN
RNG
SE
S'
TRACT
13540-3
RECEIVED.
LOT
43
1
MOD
1 6
SB
'
TRACT NAME T
_ Lagona De la Paz
OWNER NAME IL, F. MnAW' Z. -
licaft
CONTRACTOR -FIRM NAME •- •.
awlimnt
ADDRESS
abwe
CITY/COMMUNITY/STATE/ZIP M ,
1
PHONE •
LICNC tr
'
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE II -
-
LICNC 0
USE OF PERMIT '
&F.D.
BL
ZON
FSB
SSB
SSB.
RSB
OFC
' ZONE ORD 0
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
issued. I shall nottemploy any person i n any manner so as to become subject to the Workers' Compensation Laws of '
California.
Date Applicant
NOTICE TO APPLICANT: It, 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 of this permit shall
be deemed revoked.,
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '
O' I hereby certify that rio 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,;willbe more than thirty-six-(36)feet high. (Chap 3.2. Grp 2, Art 2, Sec341, Title8,
0 As'owner-builder, I will nol'employanyone.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
o.•Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm thatther"e'is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).' r
Lender's Name
Lender's Address
'I certify that l have read this application and state that the aboveinformation 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 lor.inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENJAJ: I certify I have read this application and state that
the7infoimatiotn given is correct. I agree to comply with all state'Ows and county ordinances relating'Io buidling
car`struction, and authorize a Yep r8lsentatirve of the Cilf of L%a Ouinta Department of Building and Safety to enter
upo t e_p[operTy for which I have appliedVor this pe mi or t"e purpose of making inspections. .
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT DATE - -
of 0 U-9-84 S.F.B.
Peemit to ad,,d an 26 sq.
,�.aa&Uti+oyal
ft. Refer back o orRanalpennit
#0546.
Previous bedrom does not confom
as bedroaon per UEV BgBess and
regress requirenents. . At no time
can this roan be used as a bedroom.
w. I
RECEIVED.
9 1924
BUILDING pFP RT10FNT
-TOTAL
FEE
—(�—
VALUATION
BLDG. DEPT.
A Ah
NO.
OPERATION ATE
INSPECTOR
NO.
O ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ft& & 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 PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final