001144 (BLCK)Z
PERMIT APPLICATION
City of La Quinta
Department.of Building and Safety
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., This permit becomes void if work not commenced within 180 days from dale of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
ADDRESS P.6. Box 123
CITY/COMMUNITY/STATE/La Quinta, CA 92253
JOB SITE ADDRESS/SPACE. 4-385 Avenida Diaz
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I 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 3 of the Business and Professions Code; and my license is in full force ..
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
and effect. 7 % / . /
California.
License Class Lic. Nu/tuber I /
Date Applicant
' Date - Contractor;'/-/ rr, !� '
NOTICE TO APPLICANT: If, after making this.Certificate of Exemption, you should become subject to the Workers'
ti Y /
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
following 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:
such permit to file a signed statement that he is licensed pursuant to theprovisions of the Contractor's License Law
01 hereby certify that no excavation five (5) or mbre feet in depth into which a person is required to descend, will 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 work 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
f demolition or dismantling thereof; will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penally of not more than five hundred dollars ($500.): -
C.A.C.) '- - % In. I ' -
❑ I, as owner o1 the property, or my employees with wages asAheir sole compensation, will do the work, and the
O As owner -builder, I will not employ anyone to do work whicWwould require a permit from the Division of
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has_a permit to do such work from that division.
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,
❑ Division of Industrial Safety Permit No.
building or improvemnl is sold within oneyear of completion, theowner-builder will have the burden of proving that
Date Applicant-
; he did not build or improve for the purpose of sale.).
-(Sec.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project
of the work for which this permit is issued (Sec. 3097, Civ. C.). .
7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the.
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Sec. B. it P.C. (Attached Certificate).
I cenify that I have read this application and state that the above information is correct. I agree to comply with all
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora '
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).- e
Policy No. Company
O Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City Department.
- Date Applicant
APPLICANT NAME (L. F. Michael Head
ADDRESS P.6. Box 123
CITY/COMMUNITY/STATE/La Quinta, CA 92253
JOB SITE ADDRESS/SPACE. 4-385 Avenida Diaz
CITY/COMMUNITY/STATE/ZIP
ITU/COMMUNITY/STATE/ylPa Quinta, CA 92253
La
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Const. Fee 38.50
MOD
SB
TRACT NAME None
OWNER NAME (L. F. MI) Applicant -
CONTRACTOR -FIRM NAME
Applicant `
ADDRESS ..
above
CITY/COMMUNITY/STATE/ZIP _
above
PHONE .
564-407'51
LICNC
1
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE I
.LICNC I
USE OF PERMIT
Cedar Fence
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD I- '.
LOT SZ.
-
END
SIDE .
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 f + Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF,ENTRY: I certify I have read Misapplication and state that
the information gived'is correct: I agree to comply with all state laws and county ordinances relating to buidling
construction,'and authorize a'representative of the City of La Quinta Department of Building and Safety to enter
upon th6r6pert for. which 1 -have applied for this permit for the purpose of making inspections.
Sig'nature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPRMT 14 / n l 1 A4 127`48/84J
BLDG.
Permit to install a 50' long 6' higl
dogoeared Cedar fence and
100' long
6' high Slump stone block wall as
per approved plans. -
Plan Check 25.02
Const. Fee 38.50
SMI Fee .50
DEC
TOTAL ' •
FEE
6 4 . 0 2
BLDG. DEPT. VALUATION 2,825.00
NO.
OPERATION DATE -INSPECTOR
NO. OPERATION DA i'¢ 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
P/L P/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29. Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service "
32 Final