001048 (SFD)PERMIT APPLICATION
City f. La Og a
pa
Dertment of wildinng and Safety
P 01
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 LiiceNuumber rf
Date • ContractorJ:::✓ - A l` f -
OWNER -BUILDER DECLARATION: I hereby affirm that I m exempt from the -Contractor's License Law for toe
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a pe mi 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'sLicense 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 owner of 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 Processions 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 orimprovemntissold withinpneyear ofcompletion, the owner -builder will have the burden of proving that.
he did not build or improve for the purpose of sale.). ;
O 1, 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.).
O I am -exempt under Sec. B. 8 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 certified copy thereof (Sec. 3800. LaW4C.).
Policy No. Company
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department:
Date Applicant
APPLICANT NAME(l,. F, MI� -
M.
-ADDRESS 400' N. Tustin Av6. Stine 231
CITY/COMMUNITY/STATE/ZIP
Santa Amo Chi 92705
JOB SITE AOORESS/SPACE , /lge /1
L/_.•G:•t•1(Ahi
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
617
PAG
059
PRCA? C
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.RNG
SE I.S.
CITG�F UINTFNT
TRACT
13640-a
LOT
41
r TOTAL
r FEE
MOD
6
SB
TRACT NAME
Lagum De La Paz
OWNER NAME ILpli,�.Gi.O ft
CONTRACTOR -FIRM NAME
aplianant
ADDRESS ,
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE 0
LICNC •
ARC/ENG FIRM NAME ..
ADDRESS
CITY/COMMUNITY/STAIE/ZIP '
PHONE N
USE OF PERMIT y1
SwF .D.
BL
ZON
FSB
S.S8
SSB ;
RSB
OFC
• ZONE ORD N. •• c
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 not employ any person in any manner so as to become subject to the Workers' Compensation Laws of;.-
California.
f;: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:
O I hereby certify that no excavation five (5) or more feefiri 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 mole tfian.thirty-six (36) feet high. (Chap 3.2, Grp Z Art 2. Sec 341, Title 8.
C.A.C.)..
O 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.
O Division of Industrial Safety Permit No.
Date • 'Applicant
CONSTRUCTION LENDING 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', Q.
•, 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
the information given is correct. I agree to complypith all slate laws and county.ordinances.relating to buidling
constructin, and authorize a ieprese alive -of t�e Ciiy�6f fa Ouinta,Department of Building and Safety to enter
upon the p. perrty�for hich I have applied�r this p` "rm or -thy purpose of making inspections.
ff_
Signature of Applicant or Agent / Date
Print Applicant/Agent Name
APPVPRMTDoi n48 1qO=yE�H4 S•F•D•
Femit to add aWiitfonal 26 sq. ft. defer
back to original ponit #0536. Previous
Abtom does not confom as bedr,•oom as per
VA.' bgmw & MAless requests •
At no time can this room be used as a
beldrom•
V 2 1984
CITG�F UINTFNT
r TOTAL
r FEE
BLDG. DEPT.
VALUATION —0
Ah
Ask
NO.
OPERATION ATE
INSPECTOR
NO.
OPWATION 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.
❑
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)
128 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 P1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance.
29 Wiring
29A Grounding Wire
296 Bonding
30 Fixtures
31 Service
32 Final