001384 (SFD)PERMIT APPLICATION
• City of La Dg a
Department of Building and Safety • '
This permit becomes void it work not commenced within 180 days from date of issuance, OR, it work has been suspended or abandoned for a pe'iod 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 isin full force
and effect.
License Class Lic. Number
' 'Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the'C � ctor s License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any citydoec�un y which requires a permit to
construct, alter; improve• demolish, or repair any structure, prior%to itsissuance, 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 bast's 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.): <
0 1, as owner of the properly, 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, 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,r
building or i mprovemnt 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 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.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I herebyaffirm 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. Q.
Policy No. Company
0 Certified copy is hereby furnished. . .n .
0 Certified copy is filed with the City Buildihq.lnspection Department or City Department.
Date Applicant
♦.,,I S
APPLICANT NAME (L, F, V1% C= -
ADDRESS P.O. E= 173 '
CITY/COMMUNITY/STATE/ZIPF� CA92053
JOB SITE ADDRESS/SPACEJ5m ,1�zy Driva
CITY/COMMUNITY/STATE/ZIP
In Cr. �p • 0,22533
��i'1 66TNN
BOK
PAG
PRC
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Eli Fez 5.46
Pilabirm FC -2 85.00
PING
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TRI cli 0�
LOT
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TRACT NAME '
Emazin PMG
OWNER NAME (L. F. MI)
C x..xi T �atagzr� E=P.
CONTRACTOR -FIRM NAME
JZ Qciatsucum
ADDRESS
OSLJV"V�.'
CITY/COMMUNITY/STATE/ZI
PHONE a I
I LICNC .
,
ARC/ENG FIRM NAME r,Yi c za D� . _== •
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ADDRESS 240 S. �`� Dr. W,12CITY/COMMUNITY/STATE/ZI,P_.
- (A 92292 '
Yc11�S� .�2TL� r
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PHONE N 323-7877
LICNC N
USE OF PERMIT
Sin7lo rMily iT 1g ir�q
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FSB
SSB
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RSB
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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) or less. I certify that in the performance of the work for which this permit is
issued, [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:'
0.1 hereby certify that no excavatiori 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, Sec341, Title8,
C.A.C.)
0 A5 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 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. C:). '
Lender's Name
Lender's Address
I certify that I have read )his.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 a Date
CERTIFICATE OF COMPLIANCE AND AUTH9RIZATIONOF EN TRY: I certify I have read this application and state that
the information given is correct. I agree'to,comply4th all state laws and county ordinances relating to buidling
construction, and authorizeze a'representarliyYthe City of La Ouinta Department of Building and Safety to enter,
upon t`the er�'y for Which_I:hav( a11- �� ed�PPor. this permit for the purpose of making inspections.
�r Signature of Appliian or Agent Date
I( �
Print App%AgenfName
APPUPRMT 5,20-85 Q • .D•
P=At to oomtruct 1247 sq. ft. of
1ivira a=- a d 433 sq. ft. of tgan-ga, rao p r
�zd p1mo.
K=h'. Ftp 37.00
PIM (� YIc—.3 307.951
Oanotruo2ian rtn_ 357.00
Fieri. r3to 60.18
Eli Fez 5.46
Pilabirm FC -2 85.00
862.60
106.15 DEP. PAID
756.,S&
6` •°`� '
yy��..�,�f
vAth Qammit'y 8-w-a1cR"nnfic C=p=tr--�.
TOTAL
8 2.60
A 1 1 1 2 5 22 7J
VALUATION r1�.00
BLDG. DEPT.
a
Ah
NO.
OPERATION DATE
INSPECTOR
NO.
ERATION 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
Ggout 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
P/L PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
r29A Grounding Wire
296 Bonding
30 Fixtures
131 Service
32 Final